Press Briefing by Press Secretary Sarah Sanders and HHS Secretary Alex Azar
James S. Brady Press Briefing Room
2:58 P.M. EDT
MS. SANDERS: Good afternoon. The President just finished rolling out new actions and proposals to drive down prescription drug prices for all Americans. The current situation is unacceptable, and fixing high drug prices is a top priority for the President.
The blueprint will seek to encourage innovation, while also promoting better competition and reform. The Department of Health and Human Services will take a range of immediate actions to implement the President's plan.
I'd like to welcome Secretary Alex Azar to the podium to speak about this and take a few questions on this topic. And as always, I'll be back up to take questions on other news of the day.
SECRETARY AZAR: Thank you, Sarah. Good afternoon, everyone. Well, as the President said earlier, we need a system for prescription drug prices that puts American patients first, and one that takes care of America's patients and doesn't take advantage of them.
What I wanted to do was try to just put a frame together for the actions that you'll see in the blueprint and what the President and I talked about today so you just have a sense where we're going here.
There are four major problems that we face. The first is high list prices for drugs. The second is government rules that get in the way of plans getting good deals for our senior citizens in our Medicare program. The third is foreign countries freeriding off of American innovation. And the fourth is high out-of-pocket costs, especially for our seniors.
So as you heard from the President today, this administration has already made a lot of progress in this regard. So in the first year and a half in office, the FDA has approved more generic drugs than ever before in history, saving $8.8 billion in the first year. We also changed Medicare's reimbursement rules to bring down the out-of-pocket spending for senior citizens, saving them $320 million out of pocket on the drugs that they buy each year.
That work, and the work that we're laying out now in the President's blueprint, it's focused on four strategies to help fix this very complex problem that we face. First, increase competition. Second, increased and better negotiation. Third, incentives to actually lower list prices. And fourth, lowering out-of-pocket costs.
So first, it's crucial that we have more competition in the prescription drug markets. That means we need a vital and vibrant generic drug industry and generic drug market. We need to foster and nurture a new, competitive biosimilar generic drug market. Those are the generics, essentially, for those really complex, expensive biologic medicines. We need to foster and nurture that.
We also have to get after pharma companies who engage in anticompetitive practices and try to block the entry of generics or biosimilar products to market by, for instance, blocking access to their products so they can't do the studies they need to do in order to get approval of an affordable generic or biosimilar market. So we're going to go after all of these kinds of abuses.
Second, we've got to bring more private sector negotiation and better tools to our Medicare program so we get the best deals. The Part D Drug Discount Program for senior citizens is now 15 years old. I was there when we created it and helped to launch it. And when we did it, it was -- it's still a great program, but it had the best tools, it was the best at negotiating great deals for our senior citizens, and really was able to drive tight formularies that were very efficient. And that's what's helped keep the cost of that Part D drug plan down below forecast and constantly low premiums throughout its time.
But over 15 years, as so often happens with government programs, it got frozen in place. And the private sector kept adapting and learning, especially after the economic crisis in 2007, how to control drug spend even better. Okay? Part D stayed more static. We need now to bring the same tools that are available to the private sector to those Part D drug plans so they can negotiate better. We need to unleash them so they can drive great deals for our seniors.
We also have another part of our program, a major part, which is called Part B. These are the drugs the physician administers. I mentioned those in the Rose Garden. These right now are paid, basically, on a list price plus a markup. They send us a bill; we write a check. There's no negotiation involved in that at all.
And the President has proposed in his budget, and we are reemphasizing, we've got to figure out ways to move those drugs, especially the high-cost ones, into the private Part D drug plan negotiations so that we can get a deal and start getting bargains on that for our seniors and for taxpayers. We need to look at other mechanisms -- and you'll see that in the blueprint, some other ones -- that also help us negotiate better deals there for those plans.
Third, and this is a very complex area right now, we have to bring incentives to lower list drug prices. Okay? Right now, every incentive in the system is to increase and have high list drug prices. Because everybody in the system, except the patient and the taxpayer, is wetting their beak along the way. They're getting a percent of that list price. List price goes up, list price higher, everybody makes more money along the way. So it's just -- the math just works that way. We need to try to flip the incentives backwards so that financially it makes less sense to increase prices.
So one of the things we're going to do -- I talked about this in the Rose Garden -- is that we are having the FDA look at how we can require in direct-to-consumer TV ads that you have to disclose the list price of your drug. We believe it's an important part of fair balance that if you're telling a patient, activating a patient to have a discussion with their doctor about a drug, telling them all the good things that drug can do for them, it's material and relevant to know if it's a $50,000-drug or a $100-drug, because often that patient is going to have to bear a lot of that cost.
In addition, we have, in Medicaid and Medicare, some key incentives that we can turn around on list prices. As part of Obamacare, one of the deals with the pharma industry was capping the statutory rebates on drugs in the Medicaid program at 100 percent. We're going to work with Congress to look at overturning that cap on rebates. That, again, will make the math work so that when you increase your list price, it's going to cost you more money if you're a pharma executive thinking about raising prices.
We're also proposing -- we want to think about some really creative ideas in our programs of reversing those incentives. So, right now, in our drug discount program, if you have a drug that fits into one of these protected classes, it's almost impossible for the drug plan to negotiate and get any kind of discount from you. Well, everybody gets that. What if instead we say, you only get to be in that protected class if you haven't raised your list price in the previous 18 months? What if we say, you can be exempt from these specialty tiers where the patient has to pay a lot out of pocket, but only if you haven't increased your list price in the previous months? So a lot of tools like that.
The other big area we have to look at is the entire system of rebates that we have with pharmacy benefit managers. We are calling into question, today, the entire structure of using rebates as the method of negotiating discounts in the pharmacy channel. Because, right now, every incentive is for the drug company to have a very high list price and to negotiate rebates down, often in a very non-transparent way. What if instead we said, no rebates; flat price; fixed price in the contracts; take away this whole, what's called the gross-to-net spread that removes that and makes people indifferent to what the list price is in that system and takes away the incentives where even the pharmacy benefit manager makes money from higher list prices.
We also have a real issue that we've got to look at, which is the role of compensation for pharmacy benefit managers. They're taking it now from both sides. They're getting compensated by their customers -- the insurance companies -- but they're also getting compensated by the drug companies they're supposed to be negotiating against. They're getting rebates and keeping some of the rebates. They're getting administrative fees. Should we move to a fiduciary model where the pharmacy benefit manager works for the insurance company or the individual, and only is compensated by the insurance company or individual? Forbid remuneration from the pharmaceutical company so that it's all completely on one side there, complete alignment of interest.
And then, finally, how do we lower out-of-pocket drug costs? Well, as the President talked about, we're going to get rid of these gag rules. Right now, some pharmacy benefit managers are telling pharmacists, "You're not allowed to tell the patient that if they paid cash for this generic drug, it would be cheaper for you than if you run it through your insurance." We think that's unconscionable. And in Part D, we're going to work to block that.
We also think it's a right that when you're sitting there with your doctor, you ought to be able to know what your out of pocket is for a drug you're going to be prescribed under your precise drug plan, and you ought to have that information, and you ought to have information on what competing drugs are that your doctor is not prescribing, and what you would pay out of pocket for that. And that ought to be across the Part B Plan and the Part D Plan.
Let me give you an example. If you're in with a doctor -- this doctor has an infusion clinic as part of their office. So they write you a drug that might be an infused drug. You might have a $300 copay for that. Well, wouldn't you like to know that if the doctor instead wrote you a self-injectable drug, you'd have a $20 copay? And you could at least have an informed discussion. So we think that kind of informed consumer on out of pocket will also help drive real savings in the system.
So these are just some of the measures. There are over 50 actions that we have in the blueprint. And this, again, not one and done. We are learning, we are open, we're hearing. We want this to be an active, ongoing process. This doesn't get solved tomorrow. It's going to take years of restructuring the system. But these are big, they are bold steps. This is the most comprehensive attack on prescription drug affordability in history, by any President. And I'm just grateful President Trump is standing behind us and encouraging us to do these kind of bold measures.
So with that said, let me open it up to questions.
Q: Mr. Secretary, there's a tremendous number of moving parts in this blueprint, many of which will require legislative action. How much of this works without the rest? Do you have to do it all, or can you do just a part of it? And how much can be done through executive action versus legislative?
SECRETARY AZAR: That's a great question. Most of this, we believe, can be done by executive action. Now, we are more than happy to work with Congress on a bipartisan basis. So many of these solutions ought to be attracting bipartisan support. We all acknowledge these are problems we have to deal with. But we believe most of these actions are steps that we can take using our regulatory authorities, especially with the power in the Medicare program.
They are -- a few of them are interdependent. And so it's not as if any one is requiring a preceding act there. We think we can attack many of these steps. It is complex, though. It is very -- because the system is rocket science. It's unbelievably complex. And it is a very sophisticated approach hitting at so many of the financial and business levers behind the system. Instead of throwing just, sort of, political speak at this as it would have been easy to do, it's a very business mindset focus on how do you actually change the underlying financial levers here to genuinely solve the problems. That's what the President wants. He wants it to actually solve the problem and lead to results.
Q: Thank you. How soon will consumers actually see lower drug prices?
SECRETARY AZAR: Yep. So already they're seeing drug prices from that historic level of generic drug approval last year. That's an almost $9 billion a year from all those generics on the market. The cuts that we made on how we reimburse on Medicare drugs, $320 million a year from that already.
As we make more of these -- we are certainly moving forward with any of these changes to make sure that they're going to see it in the pocketbook right away. You know, it's going to take time. Some of this will take regulatory action. We'll have to go through the administrative process. But I can tell you, as soon as I walked out of the Rose Garden, you know what the first question the President and the Chief of Staff had, was?
Q: How soon can --
SECRETARY AZAR: When's the -- I want the executive framework. We're going to have a meeting next week on the timelines and getting it all done. So there's --
Q: Is it a matter of weeks or is it months that consumers could actually see that benefit?
SECRETARY AZAR: It's going to be months for the kind of actions that we need to take here. Again, this is -- it took decades to erect this very complex, interwoven system. We're talking about entrenched market players, complex financial arrangements that would have to be redesigned. So I don't want to overpromise that somehow on Monday there's a radical change. But there's a deep commitment that this is fundamental structural change that we're talking about to our system.
Q: Mr. Secretary, thank you very much, sir. India is making a lot of drugs by your company. There are many other companies. How India is going to be affected for this action today? And also, at the same time, next month is Yoga International Day announced by the United Nations and Prime Minister of India. How yoga can help? Maybe you don't need any drugs if you have yoga. (Laughter.)
SECRETARY AZAR: Well, I'll stick with the first one, which is generic drugs. Generic drugs, competition in our system is absolutely vital. That's why the deep commitment of the administration to remove any anticompetitive barriers to generic competition.
Q: Mr. Secretary, you talked about calling into question the entire rebate structure.
SECRETARY AZAR: Yes.
Q: Specifically, what steps are you doing now? And when might consumers see changes on that?
SECRETARY AZAR: Yes, so as part of the blueprint, we're releasing a request for information that's the initiation of seeking input. This is the possible restructuring of a major sector of the economy. One doesn't do that lightly. It's beginning a national dialogue with the public, with stakeholders, with Congress, on, if we were to do this, if we were to outlaw rebates, say, in the Part D Drug Discount Program and instead require that the products be discounted at a fixed price.
So for instance, just to explain how this works now. Let's say you have a $1,000 drug. You go to the pharmacy benefit manager and say, "Hey, if you cover my drug, I'll give you a 30 percent rebate on that after the fact if any of your patients use this." Okay? So a $300 rebate on that. What this would say is, instead of that, you would have to negotiate, and the contract would say you get reimbursed $700 this year. And then maybe $702 next year, for some inflation. So it's fixed and indifferent, then, to list price.
So this game -- what goes on now is, frankly, a bit of a game, which is the drug company negotiates this 30 percent rebate. And then the next day, increases price 30 percent. And it's this game of chase that goes on. Instead, fixed price, make everything indifferent to this list price and all the fees not be based on a percent of this artificial list price, which for so many people is like the rack rate on the back of your hotel room door. Almost nobody pays it. But too many people now in the healthcare system are paying it, and they're suffering from that.
Q: But any timeline for this? How long this might take?
SECRETARY AZAR: So this is out today. And we're going to seek comment and we want to learn, and then we're going to move forward on that if it makes sense. And we need to learn how to restructure things. I believe that even one pharmacy benefit manager just yesterday talked about this precise issue of restructuring their contracts to get out of this rebate spread conundrum that the world is in.
So I believe it's doable, and I think it will have tremendous systemic impact.
Q: Mr. Secretary, there are a couple of notorious examples in the last couple of years of drug companies buying drugs that have been on the market for years and suddenly raising their prices extraordinarily. Is there anything in this blueprint that addresses that?
SECRETARY AZAR: There is.
Q: For example, the EpiPen situation a couple of years ago.
SECRETARY AZAR: Yep. There is. So one of the elements on increasing the power of negotiation that we're doing in this plan is if a sole source generic drug, which is what these instances that have gotten so much attention in the past several years -- this is when you have one generic drug out there -- and if there is any increase in price by a sole source generic, we are going to allow the drug plan to reopen their drug formulary immediately and take action against that drug. Whereas right now, they have to wait for the end of the year and the new plan cycle. They can immediately go after the drug, come up with alternative drugs, or create preferential treatment for other drugs over that one right away if there's any increase of price of a sole source generic.
Q: Yes. So you're talking about the increases in drug prices, while in areas like Maryland and Virginia, insurers are talking about double-digit health insurance premium increases. There's a Maryland regulator that said something like, the ACA is in a death spiral, kind of echoing past words of the President. What are you doing to deal with that? Does HHS just accept these premium predictions as reality? What are you doing to reduce those costs?
SECRETARY AZAR: So some of these premium submissions right now, it is the very beginning of a process that happens with state regulators around those insurance designs. These price increases were happening under President Obama. They continue because of the structural infirmities in how Obamacare was designed. This is why the President has been so adamant about producing alternative, affordable options for patients. Because for so many -- the 28 million forgotten men and women in this country have been forced out of the individual market, and are sitting there without insurance, even though with the promise they would have accessible, affordable, competitive insurance that they could keep.
You know, 6.7 million Americans paid $3.1 billion in the Obamacare taxes for the privilege of not buying insurance they couldn't afford and didn't want. And 80 percent of them make $50,000 or less. So we're trying to bring short-term plans as an option for people. We're trying to bring association health plans out of the Labor Department as options for people. The President is just -- we want to keep looking for more options to get people out of some of the traps that the Obamacare system has created of these high-cost and uncompetitive plans for people.
Q: Mr. Secretary, I have a question about another issue at HHS, actually. The Justice Department has indicated the Department is set to change an Obamacare rule that would bar medical practitioners from denying medical treatment to transgender people, including gender reassignment surgery. Will HHS repeal that rule?
SECRETARY AZAR: I'm not familiar with that particular issue. So I'm going to talk about drug prices. I'm not familiar with that. I'll look into that when I get back over to the Department. Thank you.
Q: Mr. Secretary, thank you. So you talked about Medicare Part B negotiating better prices. That is the same thing that the President referred to when he said that other countries' socialized medicine systems are ripping us off. Why is that okay for Medicare, but not for other countries?
SECRETARY AZAR: So the difference is having entities negotiate in a competitive environment. So what happens in some of these socialist countries -- I dealt with them in the past. What they do is they say, "You don't come into this country unless you pay this low price. And here's a low, below-market, noncompetitive price. You either pay it or you don't come into this country." And they don't really care if the people of their country don't get access to that drug, and people aren't informed even that they don't have access to that medicine in these rationed systems.
And so that's completely different from what we're doing where we're harnessing the power of the private negotiating market to negotiate deals. So for instance, the way Part D works -- the system that we want to try to emulate and use tools from in that Part B -- is one drug plan might say, "I'm not going to cover this drug because I didn't get a good enough deal." And then another plan might cover that drug because they think they got a good enough deal. But the key is the senior citizen is in the driver seat. They get to say, "All right, then I'm going to choose -- I need that drug, I'm going to buy this plan and I'll pay the premium for that plan because I want insurance there." You know, if you're in a socialized country, it's one-size-fits-all. You can't exit, except getting on an airplane to America where you can get access to that medicine.
Q: Mr. Secretary, thank you. When people hear about this plan, read about this plan over the upcoming days, they're presumably going to learn about yourself, as well. And they might say, "Wait a minute. Somebody who was a pharma executive is now going to be the one in charge of lowering drug prices. How is that going to work?" Your pitch to Americans that they can trust you to oversee this effort would be what?
SECRETARY AZAR: I'd say trust us by our actions and by the deeds in the blueprint. Over 50 action plans that are hard hitting. It's the hardest-hitting plan ever proposed by a President across the entire spectrum of every player in this industry to drive down drug prices and make drugs more affordable. And this is -- I know this from having been on the other side running a drug company and these issues -- which is, I actually looked at if you could lower drug prices. It didn't work for any one company.
This is how perverse the system is. You put yourself at a disadvantage in the system by having a lower list-price drug than others -- again, because every player system makes more money as a percent off of that list price. This is precisely why I'm so excited to be here in government, with knowledge that I've got and this team has about how we can change the rules of the road and actually change the system so that we can reverse those incentives to make that work, make those choices work, bring down drug prices, and make things more affordable.
Q: Are you suggesting that when you were running a big pharmaceutical, that one of the reasons why you couldn't lower the price was because you were at a disadvantage? And do you regret --
SECRETARY AZAR: The math doesn't work.
Q: -- that it's gotten to this point, as somebody who was in that position?
SECRETARY AZAR: The system doesn't make that work. My job now, with the President's commission, is to make that work so that the incentives work to actually bring prices down, charge less on the list price. That's exactly what we're about, is to fix that, because no one company on their own can change that dynamic. The entire system actually is built for increased prices and high prices. This plan reverses those dynamics.
Q: The President said in the Rose Garden that you guys were going to try to stop pharmaceutical companies from using patents to extend their monopolies. I'm wondering if you'd walk through exactly what patent process you plan to change, if it's going to extend beyond what we saw in the budget proposal a few months ago, and whether we should expect to see, sort of, increased enforcement on pay-for-delay deals.
SECRETARY AZAR: So I'll give you one or two examples of the kinds of abuses we're talking about. You know, to be able to bring a generic drug to market, or a biosimilar to market, you actually have to prove that your version, your copy of it, is bioequivalent to the innovator medicine. Well, you have to have access to that medicine to be able to run the tests and studies.
Well, what some companies are doing is locking down access to those medicines, hiding behind what are called the REMS programs, these safety programs of FDA. And even when FDA says, "No, no, no, you can share that for clinical trial testing, no problem," they're also creating limited distribution agreements with distributors to not allow these generic companies access to them. And that's one of the things we're going to be going after to make sure that these kind of anticompetitive behaviors that don't allow the affordable medicines to get to market, that we blow those away.
Well, thank you all very much. A very complex system, of course. A multi-factor, multi-stakeholder approach. It is the President -- it's the most comprehensive approach ever. Look forward in the days and weeks ahead to keep engaged with you, to help walk you all through the different elements of it as you get a chance to digest it. Thank you.
MS. SANDERS: Thank you, Mr. Secretary. A couple more notes.
On behalf of the President and the First Lady, I'd like to wish a very happy birthday to America's oldest living veteran of World War II, Richard Overton. Richard, who lives in Austin, Texas, is turning 112 years old today. He served in the Pacific Theater from 1942 to 1945 as part of the all-black Engineer Aviation Battalion. Happy birthday, Richard, and thank you for your service.
Speaking of birthdays, and those with a lot of candles on their cake, I'd also like to wish General John Kelly a happy birthday.
And finally, looking ahead to Sunday, Happy Mother's Day. And as a note of free advice, don't forget to call your moms. You might even buy flowers if you feel inclined.
And with that, I will take your questions.
Q: Sarah, on the Kim Jong-un summit, we're told that the summit will be a day long, possibly extending to a second day. What is the best-case scenario for what can be accomplished in a single day? What does the President think can be done in a single day with Kim Jong-un?
MS. SANDERS: I'm certainly not going to get ahead of those conversations. As you stated, we plan for a full day of meetings on the 12th with some time reserved to carry over if necessary. Certainly the best outcome would be an agreement for complete and total denuclearization. But this is the beginning part of these conversations. I'm not going to get ahead of what we expect for that day, but certainly that would be, I think, the best outcome. And we've been pretty upfront about that.
Q: Do they think that can actually happen in a day? Or is this --
MS. SANDERS: Again, I'm not going to get ahead of this conversation and the process. But there have been several conversations that have taken place leading up to both -- Secretary Pompeo has had now two meetings that have been part of this process. So it's not just one day that is -- you have to look at the broader picture. But certainly we have that time set aside at this point.
Q: I wanted to ask about the auto meeting earlier today. I know attendees of these sort of spitball sessions can often leave with the impression that the President agrees with their position. So I wanted to see if you could clarify both if the President or administration has agreed to open negotiations with California on a national CAFE standard, rather than, sort of, the dual system that could exist. And --
MS. SANDERS: We haven't finalized what that looks like, but today was a part of that conversation, part of the discussion on how best to move forward. We're going to continue these conversations. As we have a specific announcement on that front, we'll let you know.
Q: If I could come back to North Korea. The President says that he believes that it's Kim's intention to denuclearize. But when you listened to Kim Yong-chol, who's in charge in North Korea of North-South relations, he said, listen, the reason why we're doing all this is because our nuclear program is complete; the reason why we're shutting down our test site is because we don't need it anymore -- our nuclear program is complete. I mean, it's kind of akin to somebody who builds a house and then enters a negotiation to tear it down. What gives you confidence that Kim actually wants to take apart something that he just built?
MS. SANDERS: Look, the President is going into this with eyes wide open, as he said many times, and we'll see what happens. But this is certainly a process that has moved in the right direction. We've seen some signs of goodwill from North Korea just this week, with the three Americans brought back home; also the stopping of the ballistic missiles tests; them stopping with their research and development on their nuclear program. And we're going to continue to push for complete and total denuclearization. We're also going to continue maximum pressure until we see that happen.
Q: But again, stopping the ballistic missile testing, stopping all this testing, according to Kim Yong-chol is because they don't need it anymore; they're done. It's kind of like, you can put the saws and the hammers away because the house is done.
MS. SANDERS: Again, the President has been very clear that we're going into this; certainly, we would like to see something happen. But as he has said many times, we'll see what happens. And we hope not just for North Korea, but for the entire world, that they do the right thing and that this goes forward in the way that I think everyone would like to see.
Q: Thanks, Sarah. This week, the CEOs of AT&T and Novartis both said that they thought it was a mistake for their companies to work with the President's lawyer. Does the President think it was a mistake for his lawyer to work with them?
MS. SANDERS: I think that this further proves that the President is not going to be influenced by special interests. This is actually the definition of draining the swamp, something the President talked about repeatedly during the campaign. And for anything beyond that, I would direct you to the President's outside counsel.
Q: Explain one way this is the definition of draining the swamp. I mean, this is companies paying for information (inaudible).
MS. SANDERS: I think it's pretty clear that the Department of Justice opposed the merger, and so certainly the President has not been influenced by any -- or his administration influenced by any outside special interests.
Q: Sarah, thank you. You said in this room the other day that it is unlikely there's going to be an infrastructure bill this year. That was supposed to be the signature legislative item of 2018 for Republicans and this administration. Can you lay out for us what exactly is this White House's legislative agenda for this year?
MS. SANDERS: Certainly we'd love to see something done on immigration. It's something the President has been talking about for a long time. We've laid out the principles and the priorities that we'd like to see as part of an immigration package. There's still some movement on that front, and we would still like to see something happen. We'd love for Congress to actually show up, do their jobs; Democrats to stop opposing good legislation and actually fix our broken immigration system.
Q: So is it fair to say, from that answer, that immigration is now the signature priority item this year?
MS. SANDERS: It's been a constant priority for the President and something we'd certainly still like to see.
Q: Sarah, thank you. Two questions. We've heard a lot
about White House aide Kelly Sadler and her comments about Senator McCain, reportedly saying in a meeting that the President shouldn't worry about the Senator's opposition to the nomination of Gina Haspel because he is "dying anyway." Meghan McCain, his daughter, wondered aloud today why Kelly Sadler still has a job here at the White House. Does she still have a job?
MS. SANDERS: I'm not going to comment on an internal staff meeting.
Q: And then, secondly --
MS. SANDERS: Sorry, you had two questions.
Q: -- President Trump said today that he still has faith in EPA Administrator Scott Pruitt. Do you know if he was aware, when he said that, about these new Freedom of Information Act documents that showed, last year, Administrator Pruitt had dinner, in Rome, with a Catholic cardinal who was under investigation for child sex abuse?
MS. SANDERS: I'm not aware of that. I haven't spoken with the President about Administrator Pruitt today.
Q: Sarah, following up on that question about Kelly Sadler's comment, does the White House not think that you need to condemn these remarks, or comment, or issue an apology?
MS. SANDERS: Again, I'm not going to validate a leak, one or the other, out of an internal staff meeting.
Q: Are you saying that she didn't say this?
MS. SANDERS: Again, I'm not going to validate a leak out of an internal staff meeting, one way or the other.
Q: Does the President regret what he said during the campaign about John McCain, when he said he wasn't a war hero; he prefers people that weren't captured?
MS. SANDERS: I believe the President has spoken about that. I haven't talked with him specifically about that.
Q: If you won't comment on the specific comment, what does the White House believe about Senator McCain? And is there a tone set from the top here where it is allowed for an aide to say he's "dying anyway"?
MS. SANDERS: Certainly there is not a tone set here. We have a respect for all Americans, and that is what we try to put forward in everything we do, both in word and in action, focusing on doing things that help every American in this country every single day. And I think if you look at the policies we've put forth, you'll see that reflected.
Q: Why not just apologize to Senator McCain, though? Wouldn't that be easier for the White House just to apologize?
MS. SANDERS: Again, I'm not going to get into a back-and-forth, because people want to create issues --
Q: But why are you digging your heels over this?
MS. SANDERS: -- of leaked staff meetings.
Q: Does the President have confidence in Secretary Nielsen?
MS. SANDERS: As we've said many times before, if the President no longer has confidence in a Cabinet member, he'll let you know.
Q: Sarah, in that regard, what more does the President think Nielsen could do now under the law that she hasn't done already? Does he really think -- really want her to close the U.S.-Mexico border?
MS. SANDERS: The President wants us to do a number of things. He wants us to work with Congress, as we've laid out time and time again and as we've called on them to do. If Democrats in Congress would stop playing political games, we'd love to secure the border. We'd love to close the loopholes in the system. We would love to get a fix on DACA. There are a number of things that we've laid out, and we'd like to see all of those things get done.
Q: Does he support the Republicans pushing to get a vote on the floor of the House to get this issue going?
MS. SANDERS: If it addressed all of those problems, certainly we would support things that actually fix the broken immigration system that we have.
Q: The Secretary of Homeland Security made a statement last night in which she said that the President was rightfully frustrated by congressional inaction. Why was that frustration -- reportedly -- expressed at the Secretary herself? She doesn't serve in Congress and she can only act under what's enacted in law by the Congress. So why did the President direct his frustration specifically at her at the Cabinet meeting?
MS. SANDERS: Again, I'm not going to get into a back-and-forth with you guys on an internal meeting. However, I can tell you that both the President and the Secretary share the frustration that Congress is simply not showing up to work and getting their job done.
Democrats have got to stop playing games. They've got to stop doing this just because it's a midterm year. They still have to do their job, and we would like to see them fix our immigration system.
Not only is the administration frustrated, but Americans are too. Eighty percent of Americans would like to see this problem fixed. They want something to be done. They are begging Congress to do it, and certainly, I think, not only does the President have a right to be frustrated, he has a right to be angry. And he is. And he's going to express that. He's done it both publicly, and he's going to continue to do that until we can actually fix this problem.
Q: On NAFTA, is the White House on track to meet Speaker Ryan's deadline next Thursday?
MS. SANDERS: I'm sorry, can you speak up?
Q: Is the White House on track to meet Speaker Ryan's deadline next Thursday on NAFTA?
MS. SANDERS: We're continuing in these conversations and we've made progress, and hopefully we'll get there.
Q: If it doesn't reach it by Thursday, is the President really willing to revisit this after the elections in Mexico and the midterms?
MS. SANDERS: We'll let you know.
Q: Sarah, just a quick follow-up on one of my colleagues. To be clear, does Kelly Sadler still work at this White House?
MS. SANDERS: Yes, she does.
Q: She does? Okay. And to follow up on that, more broadly, does the President set the tone? Does he bear responsibility for the tone within this White House?
MS. SANDERS: The President, as I mentioned just a moment ago, supports all Americans. If you look at what he's doing every single day, he's showing up to work, he's working hard to make this country better, whether it's through building our economy, creating jobs, defeating ISIS, fixing our judiciary system, helping with the legal immigration problems that we have. The President is addressing a number of issues. That is what our focus is. That is what we are doing here every day. And that is what the President has, I think, laid out very clearly what is interests are.
Q: Understood. But my question is a little different. Does he bear responsibility for the tone set here at the White House, and all of the staffers who work here, frankly?
MS. SANDERS: Certainly does. And I think he has done a good job of laying out what the priorities of the administration are and that what they are doing is helping impact Americans all across the country.
Q: And just very quickly --
MS. SANDERS: Sorry, Kristen, I'm going to keep moving. We've been here a while.
Q: Very quickly -- so many of us have spoken --
MS. SANDERS: Kristen, I'm going to keep going. Saagar, go ahead.
Q: -- to people who've said they've heard these comments. Do you say that they're lying?
MS. SANDERS: Sorry, go ahead.
Q: Sarah, General Kelly came out and endorsed, in an NPR interview, a pathway to citizenship for temporary protected status recipients who have been in the United States for quite some time. Does the President share General Kelly's view on that?
MS. SANDERS: I haven't seen that specific comment from the interview. I certainly know that both the President and General Kelly want to fix the system. I'd have to look at that specific comment in the interview.
Q: But to follow up on that, did General Kelly oppose the administration's push to end TPS and actually give a deadline to some people who have been here for over 20 years to leave the country? Is he specifically against that?
MS. SANDERS: Again, I would have to look at the comment before I could weigh in.
Q: Thank you, Sarah. South Korea has a huge stake in whatever Trump and Kim agree upon. Will President Moon or another representative of South Korea be at the talks?
MS. SANDERS: I don't believe that there are plans for them to be part of that specific day, but certainly have been a partner in this entire process. And, as you know, President Moon will be here on the 22nd to continue those conversations, and we continue to be in lockstep with the South Koreans.
Q: Thank you, Sarah. On Wednesday, the President tweeted, "The fake news is working overtime." And he said, "91% of the Network News about me is negative (Fake)." Do you have the view that all negative stories about the President are fake?
MS. SANDERS: No.
Q: Why would he say that, then?
MS. SANDERS: I'll take one last question.
Ayesha. Ayesha, right here.
Q: Thank you. Just to follow up on these payments that Michael Cohen received from AT&T and Novartis. You said that this is a sign that the President won't be influenced. But just to be -- but just to clarify, does the President think it's appropriate for his personal attorney to be collecting payments from private companies, presumably saying that -- or presumably promising to influence policy or to give them strategy on government policy?
MS. SANDERS: I think the bigger point is that the President isn't going to be influenced by outside special interests; he's going to do what he finds to be in the best interest of Americans across the country.
Thanks so much, guys. Hope you have a great weekend and Happy Mother's Day.
Donald J. Trump, Press Briefing by Press Secretary Sarah Sanders and HHS Secretary Alex Azar Online by Gerhard Peters and John T. Woolley, The American Presidency Project https://www.presidency.ucsb.edu/node/335872