Click here to view video of Murphy’s remarks. 

WASHINGTON – U.S. Senator Chris Murphy (D-Conn.), a member of the U.S. Senate Health, Education, Labor, and Pensions Committee, voted against the confirmation of Secretary Alex Azar of the U.S. Department of Health and Human Services. During a speech on the floor of the U.S. Senate earlier Wednesday, Murphy expressed concern that Azar will defend Trump administration efforts to sabotage and undermine the Affordable Care Act. 

“Connecticut is a state that has efficiently, ably, and responsibly implemented the Affordable Care Act. We have hundreds of thousands of people in our state who now have insurance because of the expansion of Medicaid and the successful offering of plans to the uninsured through Connecticut's exchange,” said Murphy. “And so it was perplexing to those of us on the health committee that Mr. Azar seemed to defend the administration's decisions to sabotage and undermine the Affordable Care Act, and even went so far as to try to spin those changes as strengthening the law. And so I am going to vote no. I encourage my colleagues who care about the effect of the administration on the Affordable Care Act to vote no.

Murphy continued, “Remember, this is a remarkable success story. Twenty million people have insurance. People know the strength of the Affordable Care Act. That's why they pressed Congress not to repeal it. Even despite the undermining campaign, just as many people signed up this year than last year, which is frankly, extraordinary. And I would hope that those people here who believe in the Affordable Care Act, as the American people do, will oppose this nomination at the same time. I hope that there are ways, significant ways, if he is nominated and confirmed that we can work together with Secretary Azar.”

Last month, Murphy joined HELP Committee Ranking Member Patty Murray (D-Wash.), and the Democratic members of the Committee in sending a letter to then-nominee Alex Azar on the troubling reports that the Trump administration is once again putting ideology before science by restricting the Centers for Disease Control and Prevention and other agencies within HHS from using certain words or phrases in preparing documents for the fiscal year 2019 budget. 

The full text of Murphy’s floor remarks is below: 

Mr. President, I come to the floor today to express my opposition to the nomination of Alex Azar to be the next Secretary of the Department of Health and Human Services. But let me admit to the chamber that this, for me, was certainly not as easy a call as was the first vote on the nomination for this position when Congressman Price was up for the job.  

I want to talk about the reasons for my vote in opposition. But I first want to begin by giving the nominee some credit for I think a very important series of exchanges that he had before the committee. 

One of the biggest potential disasters that would have been visited upon this country by four years of Secretary Price would have been the reversal of eight years of transformation in the way that we pay for healthcare through Medicare primarily. In 2011, Medicare made almost no payments to providers through what we would call alternative payment models. I know this sounds a little weedy, but this is really the way that we drive down health care costs in this country. And that's something Republicans and Democrats should be focused on together. 

Alternative payment models generally refer to a switch in the way we pay for health care, moving away from reimbursing providers based on how much medicine they practice to a reimbursement system that rewards providers for the outcomes that they achieve. In fact, rewarding hospitals and doctors and clinicians when they keep their patients out of the doctor's office or out of the emergency room or out of the hospital, which is the exact opposite of what the existing system does, which rewards hospital systems and doctors the more their patients show up in the emergency room, in the doctor's office, and in the hospital. 

Tom price was, in the House of Representatives, the leader of the opposition to what we call value-based payment. He was the chief defender of fee-for-service payment. And while the Obama administration had made remarkable progress – they had set a goal of moving 30% of all Medicare payments over to outcome-based payments which they achieved by the end of 2016 – Secretary Price was in the process of moving all of that backwards. 

So the reason that I say that my vote here against Mr. Azar was not a slam-dunk and is not a slam-dunk is because I give him credit for his testimony on this question of alternative payments. He said in answer to a question posed by Senator Whitehouse that, 

“one of the greatest legacies of Secretary Burwell's tenure was launching so many of the alternative payment models that we have out there. And I would like to keep driving that forward for all of us who care so deeply about reducing costs in our health care system, integration and coordination, and just thinking of ways to deliver better for our patients and beneficiaries. There are so many opportunities for bipartisanship here because we share so much of the same goals on this.”

I want to applaud Mr. Azar for his seriousness about working with Democrats and Republicans to try to shift our payment system over to something that makes more sense. And his openness about how important the Obama-era reforms were, and his decision, if he gets this job, to reverse some of the sabotage to those alternative payment models that Secretary Price began.

Unfortunately, my enthusiasm for Mr. Azar's statements on alternative payments through Medicare are outweighed by his inability to convince the HELP Committee or the Finance Committee that he is going to be a responsible steward of the Affordable Care Act (ACA). This is where much of my worry comes in part because Connecticut is a state that has efficiently, ably, and responsibly implemented the Affordable Care Act. We have hundreds of thousands of people in our state who now have insurance because of the expansion of Medicaid and the successful offering of plans to the uninsured through Connecticut's exchange. 

And so it was perplexing to those of us on the health committee that Mr. Azar seemed to defend the administration's decisions to sabotage and undermine the Affordable Care Act, and even went so far as to try to spin those changes as strengthening the law, which simply does not pass the straight face test. I get it. It's very hard for a nominee to serve in the cabinet to be critical in his confirmation hearings of the Commander in Chief, the person who chose him for the job. But this is obvious for everybody to see what is happening. 

By canceling the payments to insurance companies that helped compensate them for the most expensive patients, by eliminating all the funding for marketing and advertising of the exchanges, by shortening the enrollment period in half, by constantly going on social media and telling all perspective enrollees in Obamacare that the ACA is dead – even though it's not dead, even though as we find out just as many people signed up this year despite the campaign to undermine it, has signed up last year. We all know that that is an obvious campaign of sabotage – that President Trump is trying to kill the Affordable Care Act administratively because he can't convince the American public to press Congress to do away with it. The Affordable Care Act has the support of the American public today, and that is the reason why Congress could not repeal it.  

It was very troubling to me that Mr. Azar didn't acknowledge this campaign of sabotage, which leads me to believe that he is going to fulfill instructions from the administration, from the White House, to continue it. He went so far in questioning with me to suggest that shortening the enrollment period actually would help consumers with something that the insurance companies were asking for. That's not true. The insurance companies were not asking for that in Connecticut. That does not help consumers, certainly when you are also withdrawing all of the money from marketing and advertising, which would have been used to tell people that the enrollment period was being shortened. 

So at the same time that I am going to vote no on this nomination because I am deeply worried that as Secretary, Mr. Azar is going to continue this campaign of ACA sabotage, I do look forward to working with him if he will allow it – those of us who vote against his nomination – in a bipartisan way on payment reform because as much time as we spend talking about coverage in the Senate, frankly, the more important long-term reform is changing how we pay for health care. Because if we fundamentally change the way we pay for health care and start rewarding good outcomes rather than just rewarding more medicine being practiced, then we will save enough money to insure everybody in this country through a means that both Republicans and Democrats can support.  

And so I am going to vote no. I encourage my colleagues who care about the effect of the administration on the Affordable Care Act to vote no. Remember, this is a remarkable success story. Twenty million people have insurance. People know the strength of the Affordable Care Act. That's why they pressed Congress not to repeal it. Even despite the undermining campaign, just as many people signed up this year than last year, which is frankly, extraordinary. And I would hope that those people here who believe in the Affordable Care Act, as the American people do, will oppose this nomination at the same time. I hope that there are ways, significant ways, if he is nominated and confirmed that we can work together with Secretary Azar.  

I yield the floor. 

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