2020 State of the Department Address

As Prepared for Delivery

Good afternoon, everyone, and thank you for joining us here in person or tuning in today. I hope everyone enjoyed that new video.

I'm glad to have members of our HHS family watching via livestream not only from across America, but also from around the world.

That's especially the case because our department's global work has been in the news quite recently, as all of you are well aware.

Since December, when the novel coronavirus outbreak in China began to threaten to spread to American soil, there have been men and women at CDC, NIH, and elsewhere hard at work to respond to the outbreak and protect Americans.

The commitment to keeping Americans safe runs straight to the top.

I have been speaking with the President regularly on the issue, and through the coronavirus task force, we've been working closely with other departments and the National Security Council.

There are still many unanswered questions about the virus, which your colleagues are working hard to resolve.

But everyone here should be proud to be part of a department, and a healthcare system, that is capable of mounting the rapid and science-driven response we've seen.

Within just weeks of the outbreak's beginning, CDC scientists were able to develop a test that is now being distributed to state and local health departments so they can confirm cases of the virus here in the United States. NIH, ASPR, FDA, and others are hard at work on possible therapeutics and vaccines.

There is much work ahead of us, but for now, I want to give a round of applause to all the members of our HHS team, and our partners across other federal departments and at the state and local level. Let's thank them for their hard work so far.

Today is a chance for us to celebrate the results that you, as public servants, have delivered over the past year—and to talk briefly about what we can accomplish together this year and over the next five years.

The accomplishments I'm going to run through today can't be comprehensive—we'd be here all day if I tried to go through every major achievement of the department over the past year.

We have a little more room to be comprehensive in the annual report that the department published today, so I encourage you to check out that report and learn more about the amazing work your colleagues have done over the past year.

Like last year, the annual report is organized into our five strategic goals as a department, which are important guides for our long-term planning.

I've also talked about our work as falling under three key themes: facilitating patient-centered markets in healthcare, protecting life and lives, and promoting independence.

All of our policy work—from each and every payment rule out of CMS; to the work that the CDC does around the world; to the partnerships ACF builds with state and local governments—all of it falls within one of those three themes.

I'll start with what it looks like to use markets to put patients at the center and deliver more affordable healthcare and better health for every American.

President Trump has an exciting vision for healthcare, which we've articulated and worked toward this past year: 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.

Undergirding this vision is a promise from the President: He'll protect what works in our system and make it better.

Some steps we took to deliver on that vision over the past year are going to be truly dramatic improvements to the patient experience.

We finalized a requirement that hospitals have to disclose to patients, in an easily accessible way, the prices that they want to charge.

We proposed to require that insurers provide their pricing information, too, so patients know what they'll owe for a procedure before they have to get the procedure—and long before they get the bill in the mail.

We put out our draft rule on interoperability, which will require that patients finally be given access to their own healthcare data at no cost to them.

Fixing these problems will be a fundamental shift toward putting the patient at the center of our healthcare system.

Every little step counts, and we've already seen many changes have an effect on the provider and patient experience. I'll give you one example from CMS's Patients over Paperwork initiative, which is projected to save 42 million hours of providers' time through 2021.

Last year, we heard from an organ transplant surgeon at Johns Hopkins in Baltimore that he liked to set up his patients with their medicines, in an organized pillbox, and talk them through the medications, before they were discharged from the hospital following a transplant.

But, due to a Medicare policy, he couldn't set them up with their immunosuppressant medications.

Those had to be shipped to the patient's home address or home pharmacy. So we looked into this, and made a change so that the patient can receive his or her meds before heading home from the hospital.

Here's what one of the surgeon's patients said about the change: “I don't know how I could have handled going to a pharmacy and filling all of these medications that I need to take this evening after all I've been through. Thank you so much for making sure I have my medications—this is one less thing to worry about.”

That is the kind of result you can produce through hard work to put the patient at the center.

And it's just the beginning of building a more patient-centered system—including our sweeping efforts, through HRSA and CMS, to increase the number of lifesaving organ transplants.

I'd be remiss if I didn't note that, next year, when we've finalized our proposed changes to the Stark Law and the Anti-Kickback statute, that doctor may be able to make that pillbox a smart pillbox, and provide a home health aide to go home with the patient, talking them through their medicines as needed.

Providing these convenient, tailored benefits to promote health is also what we're trying to do with new flexibilities in Medicare Advantage, which now allows plans to provide more supplemental benefits, such as home-delivered meals, transportation, and home modifications.

You may or may not be aware of that change, but if you watch a lot of cable news—which none of us should do, unless it's to see Dr. Fauci talk about coronavirus—you may have seen frequent commercials talking about how Medicare beneficiaries can call a 1-800 number to inquire about whether they're eligible for these new benefits.

I should note, these ads aren't just on cable news—they also drive me a bit crazy when I just want to get back to binge-watching the latest Bravo show.

One particular ad looks a bit like something out of the 1990s, with red, white, and blue graphics, and, to complete the picture, there's an NFL star from the 1960s involved.

On its surface, this doesn't look or sound like the future of healthcare—but it represents important work done here at the department, placing patients at the center and providing them with a tailored set of benefits that will keep them healthy and keep their costs affordable.

We've delivered significant results on affordability over the past year: Average Medicare Advantage premiums are now the lowest in 13 years, while Part D premiums are the lowest in seven years. We saw 1,200 MA plan options added from 2018 to 2019. These are real savings for our seniors—let's thank everyone at CMS who worked hard to make that happen.

And, according to the National Health Expenditure data, in 2018, retail prescription drug prices dropped for the first time in over four decades.

What's driving that historic trend? In part, it's the amazing success we have seen at FDA for several years now: Fiscal Year 2019 saw a third straight year of record generic drug approvals, a historically high number of novel drug approvals, and a record number of biosimilars approved.

FDA also laid out the first-ever pathway for the safe importation of prescription drugs to lower drug costs, which we look forward to implementing this year. Let's offer a special thank you to the men and women of the FDA for the results they've delivered over the past several years.

As all of you know, HHS is also proud to deliver patient-centered care directly, through the Indian Health Service.

I've been immensely proud to see IHS's commitment over the past year to establishing a new culture of quality, including through the formal establishment of the first-ever IHS Office of Quality. Any major hospital system has a quality office like that, and the patients we serve in Indian Country deserve the same.

We've seen some results already, from the award of a new contract for an adverse events reporting and tracking system to steps forward on CMS certification.

As of the end of 2019, 96 percent of all IHS hospitals and 97 percent of all eligible ambulatory care facilities have CMS certification. This work has been supported by the significant boosts in funding for IHS that the leadership of this department helped secure over the past year.

Tribal healthcare is a key piece of our initiative to end the HIV epidemic in America, which is a part of the second theme I want to touch on: protecting life and lives.

President Trump announced our HIV initiative just around this time last year, in his 2019 State of the Union.

Since then, Congress fully funded the President's budget request for the initiative; we've secured a donation of prevention medication for 200,000 uninsured Americans; we've made planning grants to the 57 jurisdictions that account for half of the new infections in America; and we've already started implementation in four jurisdictions.

That is an incredible set of results in one year, so I'd like to applaud everyone, across the department, who has played a role in launching that initiative with such speed.

The initiative will also build on the successful programs we already run for HIV, such as HRSA's Ryan White HIV/AIDS Program, which hit another record this past year, reaching an amazing 87 percent viral suppression.

HRSA has also played a role in the success we've begun to see in combating our country's crisis of opioid addiction and overdose.

At long last, in 2018, we began to see results on the most important number of all. For the first time in more than two decades, the number of drug overdose deaths declined by 4 percent, helping American life expectancy rise for the first time in four years.

We're winning because our strategy is working. The number of Americans receiving medication assisted treatment has increased by 41 percent from 2016 until now. Since January 2017, the estimated total amount of opioids prescribed in America declined by 32 percent.

These are real victories—but we're not going to let up in our focus on substance abuse and mental health.

We know there are concerning trends, such as a rising number of deaths from methamphetamine overdoses.

This past year, we've already taken action to respond, securing flexibility for states to use SAMHSA's State Opioid Response program to deal with addiction to stimulants like meth, too.

We're also continuing to ensure that Americans have access to appropriate pain treatment. Toward that end, today, our Agency for Healthcare Research and Quality released a new evidence-based tool to help primary care providers better manage patients who need long-term opioid therapy.

I should note, not every division gets to announce something in the State of the Department address—but 2019 was AHRQ's 20th anniversary, so, happy birthday, AHRQ!

We've been vigilant against addiction on all fronts. In 2019, NIH, FDA, and CDC data showed that the number of American youth using e-cigarettes rose dramatically again. We laid out a path for action, effective this week, that prioritizes enforcement against the products most popular with kids.

This is just part of the Trump Administration's overall commitment to protecting a new generation from nicotine addiction and to continuing reductions in smoking rates. You saw that commitment reinforced recently with the release of the first report the Surgeon General has issued in almost 30 years that focuses specifically on how to quit smoking, and the benefits it delivers at any age.

Another vital way to protect the health of our kids is ensuring that parents are working with their doctors to get kids their recommended vaccinations.

Sadly, this past year saw our country's largest measles outbreak since 1992, threatening our country's measles elimination status. CDC led an aggressive response, in cooperation with state and local health departments. We took this troubling development as an opportunity to go on offense, launching an unprecedented media campaign of HHS leaders promoting the importance of vaccination.

Our work to protect life and lives goes beyond healthcare, too. In 2019, FDA took major new strides to keep America's food supply safe. As part of implementing the Food Safety Modernization Act, the agency began the first-ever routine inspections of large farms for produce safety, working under cooperative agreements with state partners to conduct more than a thousand large farm inspections.

We've protected Americans in times of emergency, too.

Last year, ASPR led the federal government's public health and medical response to seven hurricanes, two earthquakes, and the California wildfires. More than 2,120 federal disaster responders were deployed by ASPR to help lead the response, along with 214 tons of medical equipment and supplies.

That included more than 1,400 officers from the U S. Public Health Service Commissioned Corps, who deployed for nearly 32 disaster events, planned events, and community health missions.

I'm proud to say that the Commissioned Corps is increasingly ready to respond to 21st century health challenges, and is in fantastic shape today.

That is literally the case—the Commissioned Corps is now the second most physically fit service as measured by body mass index. They're second only to the Marines!

I'd like to personally thank all HHS personnel who contributed to this emergency work over the past year.

Our work to protect life and lives extends well beyond our shores, and I had a chance to see that in person this past year. Combating the ongoing Ebola outbreak in the eastern Democratic Republic of the Congo has been one of the Trump Administration's top global health priorities since the outbreak began in 2018.

This past fall, I underscored that commitment when we traveled to the DRC, Uganda, and Rwanda with our head of global affairs, Garrett Grigsby; Director Redfield of the CDC, Dr. Fauci of NIH, Admiral Ziemer of USAID, and officials from the National Security Council.

I cannot overstate what a challenging situation we face in the Congo.

We have a large-scale outbreak of Ebola in a warzone—one of the most remote and least developed places on earth. One key reason that the outbreak hasn't spun out of control is that we have tools today that we did not have during the 2014 West Africa outbreak, and a key reason we have those tools is the dedication of men and women across HHS—at NIH, FDA, CDC, the Commissioned Corps, BARDA, and elsewhere.

It was incredibly moving to see firsthand how these tools have helped. We had one young boy proudly show us the certificate he would bring back to his family, declaring him Ebola-free, after he received one of the drugs that's part of the clinical trial NIH is running, right in the hot zone. Many of the healthcare workers we'd met had received what was then the investigational vaccine to protect themselves from infection. As of December, that vaccine is now an FDA-approved product.

That isn't the only international humanitarian crisis that HHS had to handle this year. I also had the chance to see officers of the U.S. Public Health Service Commissioned Corps at work on the USNS Comfort, the American hospital ship that was deployed this past year to respond to the humanitarian crisis in Latin America, which was caused by the failed Maduro regime in Venezuela.

The Commissioned Corps also played a key role in responding to the humanitarian crisis we saw at our own southern border, which resulted in an unprecedented number of unaccompanied alien children entering ACF care—nearly 70,000 in FY 2019.

ACF's Office of Refugee Resettlement worked to maintain consistent, high-quality care and safely unify children with sponsors, while we secured emergency funding from Congress and found other flexibilities to help care for these children.

ACF was able to expand our capacity to care for this record number of children while laying a foundation for a more flexible, sustainable system to handle such influxes in the future.

Much of this work at ACF relies on our faith-based and community partners, and we took significant steps this past year to remove unfair burdens that had been imposed on faith-based partners.

That's part of a much broader effort to protect life and conscience in our programs. This past year, we finalized new Title X regulations to ensure we're following the law that Congress passed.

Meanwhile, our Office for Civil Rights has been relentless on so many levels. We are enforcing, like never before, the rights of people of faith and conscience who do not wish to perform, cover, or refer for abortions.

We are protecting the rights of Americans with HIV to get equal access to care, and took historic actions to guarantee that Americans with disabilities are not excluded from organ transplant lists based on bias or stereotypes.

The third theme I mentioned is the work we've been doing to help Americans reach independence.

This past year, to help break down barriers to finding work and economic independence, ACF started a public-private partnership across six New England states, which engaged parents, state legislatures, philanthropists, and the Federal Reserve Banks of Boston and Atlanta.

The partnership's work resulted in the introduction of 17 different new policies or pieces of state legislation, as well as the National Conference of State Legislatures' adoption of a national resolution to address benefit cliffs and work disincentives.

We've also looked at how to promote independence for Americans with serious mental illness and Americans with disabilities.

In 2019, we approved the first-ever demonstrations for states to use the Medicaid program to cover inpatient treatment for serious mental illness. That was the first time we've taken steps to address serious mental illness in this way in the nearly half-century history of the Medicaid program.

Thanks to the roaring economy we have under President Trump, the number of Americans with disabilities who are working has been rising steadily.

But there's more we can do. That's why, this past year, the Administration for Community Living issued a challenge to businesses to develop programs that better include workers with disabilities—particularly people with intellectual and developmental disabilities.

Promoting independence also means helping American kids in our foster care system find a forever home—and preventing kids from having to enter the foster system in the first place.

ACF's latest data show that the number of children entering foster care decreased at the end of FY 2018, for the first time since 2011. The number of adoptions with child welfare agency involvement increased to over 63,000 in FY 2018, the largest number of adoptions reported since we started collecting data in 1995.

Each child exiting foster care for a permanent home, each child who never has to enter foster care, is a tribute to the work of ACF, our state, local, and community partners, and most of all, to the families who welcome them.

We were honored to have some of these families join us here in the Great Hall, alongside Vice President Pence, to celebrate National Adoption Month in November. That included a family from Minnesota, the Arntsons, who adopted their son Isaiah as a teenager—and, together, they've now become leading advocates for adoption, and adoption of teenagers in particular, throughout the country.

Finally, I want to recognize the work that so many members of our HHS family have done this past year to make HHS as healthy an organization as we can be.

That means a department that's a responsible steward of our resources, that's well-managed, and that's the best possible place to work.

In 2019, we continued delivering results on regulatory reform, reducing the burden of our regulations in present-value terms by $11.4 billion, leading all cabinet departments for the second year in a row.

Our Office of Inspector General continued to excel at safeguarding taxpayer dollars, returning some $5.9 billion in taxpayer funds and barring 2,640 bad actors from billing HHS programs.

That included the largest healthcare fraud prosecution in history, taking down a scheme where doctors were being bribed to admit patients into a care facility, to the tune of $1.3 billion in billings.

We've continued to improve how we serve our customers through the Medicare appeals process. The Departmental Appeals Board has been modernizing its technology so that it can now upload CMS claim files directly to its processing system, and the Office of Medicare Hearings and Appeals cut the appeals backlog by around 30 percent in FY 2019, surpassing the 19 percent target that had been set by court order.

You don't need to be a lawyer, or an administrative law judge, to know that it's always very good to beat a target that's been set by federal court order.

The Office of the Chief Information Officer has also been using the latest technology to produce cost savings and keep our IT infrastructure safe.

Using data collected and analyzed through the Department's artificial intelligence platform, and using principles from the ReImagine HHS Buy Smarter initiative, OCIO and the Program Support Center evaluated software spending across all of HHS's 29 agencies and offices to leverage the Departments collective buying power.

Last Friday, the department finalized a deal that will save in excess of $33 million over 5 years, for the same or greater functionality and IT capabilities. Continuing to use this data- and AI-driven approach, we believe we can conservatively generate an additional $250 million in savings over the next 5 years.

We've also continued to look at how the department can be structured to best accomplish our mission. As part of ReImagine HHS, this past year saw the development of the first-ever deep rethinking of how we organize our regional offices. The goal here is both to reduce the overhead costs we have in running the regional offices, while also bringing new authority to the regional staff, including our regional directors, to make them the most effective departmental representatives they can be.

Lastly, we know that our organization is healthy because that's what the data tells us. As the Deputy Secretary mentioned, according to the Federal Employee Viewpoint Survey, HHS was again the best Cabinet agency at which to work in 2019, a distinction we've now held for three years.

I want to thank everyone who helps contribute to employee engagement across HHS, including through promotion of the FEVS.

These data are highly valuable, and we take feedback extremely seriously. I want to encourage everyone to pay close attention to the survey and what your leadership has to say about it when the 2020 survey comes out this May.

I want to close by emphasizing just how important the work of this department is, and I have a data point for that, too: how often the President of the United States calls my cell phone to talk about the latest healthcare or public health topic.

He has been closely engaged on issues like responding to the coronavirus outbreak, and he cares deeply about the work we do to improve Americans' health and well-being.

For those of you who tuned in for the State of the Union on Tuesday night, you'll have noticed just how much of it was spent on healthcare, public health, and promoting independence—about a fifth of the speech, in fact.

So, the President is grateful for all your hard work and the results you've produced. But I also want to remind everyone that there is a great deal of work still to do, and I have the utmost confidence we can do it.

The CDC numbers I mentioned earlier, which show decreasing rates of death from drug overdose and rising life expectancy, also show a number of troubling trends that we need to confront: rising rates of suicide, high rates of maternal mortality, and stubborn health disparities between rural and metropolitan America.

In the year to come, and the five years I hope I have ahead, we have our work cut out for us.

That means the looming issues I just mentioned, and it means continuing to respond to and prevent infectious diseases; ending the HIV epidemic; tackling serious mental illness and addiction; working with Congress to achieve lasting reforms on drug pricing; restoring a focus to promoting work and family in our human services programs; delivering even more results on transparency and consumer empowerment; continuing the drive to pay for value rather than procedures; and advancing research in critical areas the President mentioned on Tuesday, like pediatric cancer and Alzheimer's.

In other words, we have lots to do—but the entire HHS family should be very proud of what we've accomplished so far.

Thank you for the dedication you have shown to the HHS mission over the past year, congratulations on all you have to show for it, and I can't wait to get to work with all of you on our important goals this year.

Thank you again for joining us here today.

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To view the HHS 2019 Annual Report, click here.