Our system is delivering better health for Americans, and more years of life with their loved ones. Delivering more of those results, delivering better health, is the goal. That is what guides our work at HHS: not just improving health insurance or healthcare delivery, which is so often the focus in Washington, but improving health.
As Prepared for Delivery
Thank you for that introduction, Gary [Reedy], and thank you to everyone for inviting me to address you here today.
It is always a pleasure to address a group of highly engaged, well informed patient advocates. Patients have played a powerful, important role in shaping what is great about American healthcare.
Even as cancer steals the lives and quality of life of far too many Americans every year, we also have much to be proud of in how our system tackles this terrible disease.
Survival rates for common cancers are consistently higher than they are in our peer nations.
Our system is delivering better health for Americans, and more years of life with their loved ones. Delivering more of those results, delivering better health, is the goal.
That is what guides our work at HHS: not just improving health insurance or healthcare delivery, which is so often the focus in Washington, but improving health.
Better health and longer lives is the fundamental goal of the vision President Trump has for our healthcare system. He understands the vital importance that health holds for every American—but especially for Americans who have known serious illnesses like cancer.
I know the pain that cancer can inflict on our families and lives: I lost my stepmother two years ago to the disease. We need a system that is capable of better treating these diseases and, ultimately, providing a path to cures.
The President has laid out a particular vision for healthcare: a system with affordable, personalized care, a system that puts you in control, provides peace of mind, and treats you like a human being, not a number.
Such a system will provide you with the affordability you need, the options and control you want, and the quality you deserve.
But today, not all Americans get those things from our system, and clear weaknesses exist.
Too many Americans still are burdened by high healthcare costs—especially when they are struck with a serious illness like cancer. Too many Americans don’t receive the high quality, high value care they deserve, often because our system pays for procedures rather than outcomes.
Too many Americans suffer or die from preventable or addressable health challenges, including forms of cancer.
So how do we go about fixing these problems?
The President’s first priority is to protect what works, and fix what’s broken. That means protecting what has helped our system produce such high quality outcomes for cancer patients—while addressing where our system falls short.
That is the strategy that guides our work across the three cross-cutting platforms HHS has for improving health and healthcare: reforming the financing of care, deriving better value from the care delivered, and addressing impactable health challenges.
Today, I want to touch on how we’re working across each of these platforms to improve the health of Americans who are suffering from or at risk from cancer.
Let’s start with financing. The President recognizes that many Americans are happy with how they finance their care. 180 million Americans finance their care through employer-provided insurance, and 60 million Americans do so through Medicare or Medicare Advantage.
These Americans are overwhelmingly happy with their coverage, and the President will always defend these two pillars of our healthcare system.
Any plan that proposes to undermine or eliminate them is a direct threat to the financing system that has helped so many Americans have a real sense of protection and security in healthcare.
Compare the size of those two sources of care financing, covering 240 million people, with the program that consumes most attention on healthcare financing in Washington: the Affordable Care Act exchanges, which cover just under 10 million Americans.
The President has been very clear: We will always protect Americans with preexisting conditions—a guarantee we will maintain at the federal level.
This guarantee can be especially important to cancer patients and cancer survivors, and the President’s commitment to this promise is fundamental and unquestionable.
Moreover, we believe Americans deserve protection from high healthcare costs. No American should ever lose their house because of healthcare expenses—expenses necessary in some cases to helping their loved ones fight off cancer.
Because we believe Americans need this protection, we’ve opened up new, affordable options within the Affordable Care Act.
When Congress is willing to work with us, we will determine ways to replace the Affordable Care Act with a more sustainable arrangement that still provides financial protection and a federal guarantee for Americans with preexisting conditions.
Delivering financial protection in a fiscally sustainable way gets a lot easier if we look not just at insurance, as the Obamacare debate has often myopically focused, but also value in care delivery—the second area I want to discuss.
There are three areas here I want to highlight: improving the delivery of cancer care through paying for outcomes, lowering prescription drug prices, and accelerating approval and coverage of new drugs.
I have made it a top priority for HHS to move from paying for procedures and sickness to paying for health and outcomes, and this shift, we believe, can make a significant difference in the experiences of cancer patients.
Earlier this year, the Center for Medicare and Medicaid Innovation unveiled a new mandatory bundled payment model for cancer care, which will enroll up to 40 percent of traditional Medicare patients receiving radiation therapy.
The model will make one prospective, bundled payment for the radiation services a patient receives, rather than many different discreet payments.
This model would eliminate any incentive for providers to choose a more expensive setting, like a hospital, over a less expensive and sometimes more convenient setting, like an outpatient clinic.
The model will also provide a new opportunity for assessing the added value of innovative treatments like proton beam therapy, and, importantly, is projected to result in lower cost-sharing burdens for the patients enrolled.
One driver of high cost sharing for American patients has been the staggeringly high price of prescription drugs. All the new cures in the world aren’t worth anything if patients cannot afford them, which is why President Trump has made lowering drug prices such a high priority.
A particular problem for cancer patients is the cost of physician-administered drugs, which are covered by Medicare Part B. Part B does not negotiate—it essentially pays whatever price manufacturers decide to set.
Last year, the President unveiled the boldest approach to fixing this system that any administration has ever put forth: a payment model to tie the prices Medicare pays for these drugs to the prices paid in other countries.
The model is projected to save $17.2 billion for patients and for Medicare over its first five years—bringing down costs for American patients, who can owe up to one-third of a Part B drug’s price in cost-sharing, while still spreading the burden of supporting innovation to our wealthy peer nations.
I want to be very clear with you about the aims of this model, and all of our drug pricing efforts: The ultimate goal of these efforts is expanding access to the drugs Americans need, and the better health that can deliver.
One emerging challenge in drug pricing is a new generation of extremely high cost drugs, sometimes costing a million dollars or more, which includes some cancer treatments like gene therapies.
These drugs can carry a staggering sticker price, but also can deliver significant cost savings by preventing years of more expensive maintenance treatments.
Unfortunately, a variety of CMS rules and regulations can make it difficult for payors and manufacturers to come up with innovative payment arrangements that reflect the value some of these drugs can bring.
We’ve already permitted two states to start subscription models for high-cost Hepatitis C drugs, and we’re committed to providing the flexibility needed for payors to finance these expensive drugs as more come onto the market.
We’re also bringing drug prices down through more efficient approvals of generic drugs—approving record numbers of generic drugs in both FY 2017 and 2018, some of which can be important elements of cancer care.
Last year, we also approved 59 new drugs at FDA, an all-time record—with 17 of them to treat different kinds of cancer. FDA is committed to make its approval process as efficient as possible, recognizing that every delay could be time lost to patients who are in need of new treatments.
Alongside those efforts, CMS is working to ensure that new FDA-approved treatments can be reimbursed as soon as possible—and receive the appropriate payment incentives to support innovation.
That is why, this year, we increased the add-on payment for new technologies provided in Medicare, which will help support the development of new CAR-T treatments for cancer.
Ultimately, the goal of lower drug prices and better, newer drugs is better health, and the final part of our vision I want to discuss is some impactable health challenges that relate to cancer.
Cancer is especially tragic when it strikes our society’s most vulnerable members, with so much life ahead of them: our children.
That’s one reason why we’re treating pediatric cancer as one of these impactable health areas, but we’ve also selected it as a priority because the children suffering from cancer in this country could benefit significantly from a focused effort by HHS and the National Cancer Institute.
Earlier this year, the President proposed $500 million in new funding for childhood cancer research at NCI over the coming decade, with a special emphasis on improving data. We were pleased to see the House appropriations committee already decide to allocate $50 million for this initiative for 2020, and we look forward to seeing the Senate follow suit. While NCI needs new resources to deliver on the full promise of better data around pediatric cancer, they’re already getting started, by launching the Childhood Cancer Data Initiative earlier this year.
This effort seeks to make it easier for researchers to learn from each of the approximately 16,000 children and adolescents diagnosed with cancer in the United States each year.
We especially need researchers to collaborate because cancers in children and adolescents are relatively uncommon, representing less than 1 percent of all new cases of cancer diagnosed in the U.S. each year.
Because the number of children with cancer is small and patients are treated at disparate institutions, the data collected is segmented. In order to answer complex biological questions about childhood cancer, we need more information sharing and greater collaboration.
The data initiative will be the first of its kind in terms of the quality, size, and scope of data accessibility, making it an immensely valuable asset for young patients with cancer, their families, clinicians, and researchers.
Ultimately, we want to support data repositories that can provide a wide range of comprehensive information on patients, including imaging, pathology, side effects, and patient- and caregiver-reported outcomes.
Expanded data sharing among researchers reflects a sentiment that parents and kids suffering from cancer have long held. I’m sure many of you in this room can attest to the selflessness of patients who’ve been enrolled in clinical trials.
Yes, they hoped that the trials will work at getting rid of their disease, but they are also motivated by the fact that their participation, even though the odds were against them, could benefit others in their battle against cancer.
It is this kind of dedication, compassion, and generosity that will lead to new cures. I want to mention one particularly exciting clinical trial for pediatric cancer we’ve launched, called the Pediatric Molecular Analysis for Therapy Choice, or Pediatric MATCH.
Launched in 2017, Pediatric MATCH is one of the first large pediatric clinical trials to test drugs systematically that target specific genetic changes in cancers, rather than particular types of cancer.
We’ve already seen promising results. Because there are fewer genetic changes in pediatric cancers than adult cancers, there had been concerns that we would have a low “match” rate for these cancers, meaning relatively few cases where we can identify a mutation that’s targetable by an available drug.
In fact, more than a quarter of patients tested have targetable changes—more than twice as many as we expected.
This built on the larger MATCH trial for adult cancers, which grew out of the Precision Medicine Initiative.
Both the PMI and the Cancer Moonshot remain extremely important, overarching efforts for NCI and for all of HHS.
The same kind of focus NCI is going to bring to pediatric cancer has already yielded some success in an another particular health challenge we’re focused on: rural health.
As we’ve ventured into the world of precision medicine, academic medical centers are playing a more and more important role in cancer care—potentially leaving patients in rural areas behind.
Today, there are fewer cancer diagnoses in rural areas than in urban areas, but the overall death rate from cancer is actually higher in rural areas.
But new technology offers ways to improve access to top quality doctors and diffuse knowledge and best practices across the country.
There is no reason why we shouldn’t be able to extend the benefits of, say, incredible cancer doctors at Johns Hopkins to improve care where I’m from, two hours away in rural Maryland.
We believe that with modern technology, a patient’s survival rate should not depend on his or her ZIP code.
Improving rural cancer care has been a focus for NCI under both Director Sharpless and now Acting Director Lowy.
One step in this direction is ensuring cancer patients living in rural areas have access to the latest clinical trials, which is one of the goals of the NCI Community Oncology Research Program, or NCORP.
NCORP just made a new set of awards this summer that will support expansion of trials to community oncology practices in 44 states.
Incredibly, NCORP is now supporting clinical trial work at more than 1,000 affiliates across the country—everywhere from Hawaii to Montana.
I want to mention one final emphasis we’ve put on providing the best possible care for cancer patients: the right-to-try law signed by President Trump in 2018.
The President’s right to-try law is now opening up even more opportunities for patients diagnosed with a broad range of life-threatening diseases or conditions, including cancer, who have exhausted all other approved treatment options and cannot participate in clinical trials.
The kind of healthcare system President Trump envisions for Americans supports every American patient with the personalized care they deserve.
That means giving patients every opportunity possible in their fight against life-threatening diseases, and that’s why the President delivered Americans the right to try.
The final public health priority I’ll mention is the potential to reduce drastically some forms of cancer through increased uptake of the HPV vaccine.
According to CDC research released earlier this year, among the approximately 35,000 cases of cancer each year probably caused by HPV, 92 percent could be prevented if Americans received the recommended HPV vaccines.
Equipping parents and healthcare providers with information about the importance of this vaccine and the potential it holds for protecting our health is an ongoing priority for HHS.
Today, I’ve laid out the President’s comprehensive vision for improving American health: how we can protect what works and fix what’s broken in our financing, our delivery of care, and our work on public health challenges.
What I want to leave you with is a reminder of the importance of the role of patients and patient advocacy in delivering on that vision.
You provide a vital voice in the policy discussion. But further, through your experiences as patients and the active role many of you take in your care, you are advancing healthcare and improving health for all Americans.
We’re not going to deliver the next generation of cancer treatments without patients eager to enroll in clinical trials.
We’re not going to improve care delivery without actively engaged patients, who are eager to work with their providers and ask the right questions.
We can’t do any of it without you, and we’re doing it for you. So thank you for your commitment to improving American cancer care, and improving American health.
Together, I believe we have bright years ahead of us in delivering better health for all Americans—especially Americans who are so bravely battling cancer.
Thank you so much for having me here today.
