bloodies the other from time to time. the other is a leakage of the power which leads to rupture. different days suggest different things about these two scenarios. my own view is if the west acting responsibly, and we define the use for the armies, and we spend billions and hundreds of billions by creating the perhaps no-fly zone and knocking out his arms ammunition dumps and military equipment, then that could be a stimulus to the weakening of the regime. i think there are options here. and there is responsibility now in europe and elsewhere to hasten the end of this brutal mission. >> do you feel an instinct it's the end? >> yeah, i'm starting to believe

this is the end for colonel gadhafi. for me, it's not like the end, it's when. he's the most important question. because it's not now, a couple of weeks ago i was certain he was going to last for a long time. we need to start to think about months, you know, at least. talking about days or weeks or something. i think it's unrealistic. because he managed successfully and deliberately to come from a peaceful regime to be a war situation. he was very successful in this tactics. and i'd like to emphasize here, he is successfully as well, immediately switched from the mood of the leader as like a king or president, whatever you are going to label him, to be a warfare leader. and it's were dangerous. the mood now, he's operating. >> he's very comfortable in that roll. >> he's very comfortable. he was ready for this. we should focus as well. because it's war, you know, we can't talk about just the people protesting outside in the streets.

just if you see or if you followed the protest, you know? since it starts in february until today, every day you will see the scene being militarized, increasing of the militarization of the situation, and people liberating his own cities. everybody starts to have the own guns. there's a lot of guns out there. this situation, i believe, it will help colonel gadhafi's force to remain for, i think, a long time. and then from there he will hope to start to negotiate with the west. not with his own people to secure something. >> does that mean you actually, you know, compared to a couple of days ago, his position is stronger than it was. colonel gadhafi's own position? >> i'm not prepared to say that. i would also like to take some of the emphasis away from the west. united nations is an awful lot

more than the west. and the west doesn't always act. and above all it does not have the kind of unity of view on a huge and inaccurate generalization. arabs should not be invisible in the way he suggests as seen from my side of the fence. i can see how you would appreciate that differently from your side. >> i do warn against west intervention. it seems like interventions in iraq and somalia and afghanistan. i don't think it bodes well. i don't think an intervention in libya will help. i this will it end up escalating the situation. the libyans were probably as hard core as the afghanis and iraqi of resisting the presence of americans there. having said that, i don't think the way back is the way forward in libya.

certainly, gadhafi is on his way out. whether they are going to give him a safe passage to join his friend remains to be scene. i think he insists on staying and fighting it out. the army is breaking away from him. that's the good news. the tribes are breaking away from him. that's even better news. his diplomats are breaking away from him. that's the third good news. >> that's the easiest. for those outside libya, that's the easiest break to make. >> actually, even, internally, the minister has left and so on and so force. he has a legitimacy, tribal army, and civilian leaders of some sort. and they've all -- or are they leaving him slowly but surely. what is left with him are the militias, the militias, he and his sons have armed. but i don't think they have a future in libya. >> thank you very much. if you could raise your hands if

you have a question. could we get the microphones to the back of the room there? just while the mike comes, please say who you are. this is live on the frontline web site and filmed by c-span. and if you are tweeting about it, then it has frontline clout. so your name. >> mr. christian, i work with plan international a humanitarian agency. what's your take on the humanitarian fallout? >> could you hold the microphone closer? >> yeah, what's the humanitarian fallout of the violence, if there's a fallout if sanctions are put in place? please remember in iraq, in december 50,000 children died during the sanction period while it was put in place. your take on both. followed from the violence, as for the sanctions. >> thank you. >> who'd like to start up? what is your fear of what the humanitarian impact would be for the sanks -- sanctions or indeed

just ongoing violence? >> honestly, i don't think it's anyone like to advocate for like sanctions affecting the people. no, i don't think. now all of the debate, it's about like no-fly zone. it's still the issue itself that's highly debatable because it's not just you are going to ask gadhafi kindly, would you mind don't fly your make, you know? it's not like this. you need to launch attacks. the situation is highly debatable. i would like to add something. what's they reach gadhafi is false, it's something like 15 or 20% are domestic. the air force capacity. because since the problems start, one the major european countries, they would draw all of their technical stuff. one the major like airplanes.

and they have started -- they are still struggling with others like even the russians make. they have a lot of problems in terms of technical stuff. it's the idea of no-fly zone, maybe it will clear, and help the libyans, but i know it's like a conflict like this start everybody to be like national -- international conflict. maybe it will send like just a clear signal to colonel gadhafi to make -- for him to behave. but just regarding the humanitarian issue, i think it was planned a couple of weeks ago, there's a huge lack of food supply, especially in the eastern part of the country and western cities as well. i believe it was planned, you know? to create a war situation obvious a civil war situation. and now a lot of countries, include qatar, and they are

involved in food. the libyans, we've never been in this situation. usually, we used to see it in the news. now libya themselves starts to be a recipient of aid and medicine. it's painful. myself, i can't feel it. i think this is the situation. st libyans are in need for the national aid, unfortunately to say that. >> richard, are you in favor of the no-fly zone? >> under certain conditions, first it has to have legitimacy. you could get legitimacy from a united nations security council resolution, or if that was not going to pass, you could as in other humanitarian interventions, obtain legitimacy through regional consultation, and through the receipt or there wouldn't be anything formal of a sense or a request that the libyans under pressure inside

libya want intervention. >> but it cannot be a british-american effort? that would be wrong? >> it would make much more sense if it was a spanish-italian effort. they are in the front line of this issue. it's their world supplies, for example, that's at the greatest risk. it's their immigration problem rather more than the uk. maybe the u.s. and uk would play a part. i think people who advocate armed humanitarian intervention need to think quite widely about the kind of coalition that would be put together. >> yes, you had a question in the back. >> i'm maria, i'm a postgraduate student at the african studies. i've been very much following what's been happening in the past month, being from the middle east myself as well, and of course, it's very interesting. and my question is on something that i've been thinking about is the definition of how al-jazeera

is defining the professionalism, so to say. the western ethics of journalism, and i put western between two quotations. i wanted to know your upon about how al-jazeera is kind of playing with the idea of distance, the emotional distance. it's not like any other channel. when you watch specific, you can use egypt and libya and tunisia, and i you feel like you are part of the news. al-jazeera has redefined the concept of coverage in the last events. and the other question is what do you think about the exclusion of the al-jazeera to the exclusion that gadhafi gave to abc, and nbc, i think. >> abc, bbc. thank you. my bosses maybe watching this.

>> i'm not going to take too long just because the subject matter is libya. i don't want to think i'm promoting al-jazeera and promoting or defending it. we did pride ourselves for a long time of being a voice of the south, and the voice of the people. we have an hour program that people phone in and speak endlessly in the morning and so forth. has it been an emotional moment? of course. imagine this was the french television after the second world war, or the british television after the second world war. this is probably the biggest moment in recent history in this region. imagine someone like gadhafi for 40 some years. the generation of libyans have lived under him. for young journalist, and young people in the arab world were for a young channel like

al-jazeera, having it all, or living and being in the midst of all of this, of course, it's something. but did they keep a certain distance? yes, i think they did. in a sense, until today, leaders of the world would become al-jazeera. before it all started, as many of you might know, we were banned in kuwait, we were banned in morocco, we had a big fallout in egypt, and now we are banned in libya. this is, of course, a certificate of good behavior. when urbanned from dictators, you must be doing the right thing. >> the final bit was about the exclusion of al-jazeera. i mean that was -- none of us know the inner workings of colonel gadhafi's mind. the fact that al-jazeera was already banned precluded that. >> we should have had one libyan official comment on al-jazeera

and say we will let you come in only if we start behaving. when asked what they mean by behaving, when they start being good journalist. so you are not giving us certificate of good behavior. they said no, all of the media outlets are good, expect al-jazeera is bad. until you behave, you can't get in. i think they have blamed the disturbances in yemen and israel on al-jazeera. >> thanks. lady over here. then the gentleman there. thank you. >> i'm zoey from the university. when i talk about the west, i'm meaning britain and the states. it seems from an arab perspective, and perspective of many in the west that the west relations in the middle east have been defined by self-interest mostly over the past decade. i'm wondering what you think the sort of policy that britain and

the states could adopt towards libyan that might redeem this kind of behavior or morally rectify the situation in the middle east. >> you are looking for a single, coherent approach for the region? >> yes. on the part of britain or the states, not necessarily unified. >> david? >> well, i profoundly agree with your question. i mean the relationship between the united states and european's big powers in the middle east has generally been a movement between on the one hand a movement of red carpets to the middle eastern leaders and on the other hand when things go wrong, the cardboard box. there's been the shift in coherence on middle east policy. on one hand seeking to pursue political advantage when it suits, and on the other hand, in

another point in time, not necessarily a consistent point in time, suddenly saying this is the crucial task. i think the wars in the iraq and afghanistan, of course, have backfired. the war on terror has caused, you know, great damage. not just, of course, to the countries. but the heart of those wars, but to the west of the eyes of the young arab populations. one the things to me that's different in 1989 and the extraordinary arab uprising now was in 1989, the peaceful movements had a common purpose and common goal. which was to embrace the west. they wanted western democracies. they wanted higher standards. they wanted markets. the image of the west now in the extraordinary arab spring as it is being called is much more tainted. it's been tainted exactly for the reasons that you've said. >> do you want similar things to what was wanted in eastern europe? perhaps it's not -- perhaps not overall articulated as clearly

and not as organized. >> the point that i'm -- the only point i'm trying, yes, absolutely, i agree with you. however, because the war on terror had such negative consequences for the reception of the west, i think it's made the political demands that are emerging from young people and other groups a more mixed and their direction is not always entirely clear. whereas, gadhafi's incredible and remarkable movements to bring down the regime is one thing. to turn those on democracies is another. which is another important question. what can the west do now? the one thing the west can do is to respect the determination of their peoples, listen to their voice, engage more in dialogue, and if and when they intervene and wish to support the arab movements, they build up the infrastructure of the autonomy of the movements, and

determination rather than in other words bottom up politics rather than deals in the old style to suit interest of the level of autocratic states. >> bridget, obviously, you know what's it's like to be part in the region. would you accept that mistakes have been made? it hadn't been made a coherent approach or consistent. >> if mistakes have been made, they have been supposed by the democratic system of the united kingdom. the point that i'd like to start, yes, states act in accordance of their self-interest. that's international policy 101. you wouldn't expect egypt, or brazil, or the united kingdom to behave differently. second, british people have a right to jobs. british people have a right to the attempt to influence on human rights in their democratic value. british people have a right to security. so when you frame as a foreign

policy person, the objective is for your foreign policy, you frame it in accordance with that which the british people want and express through the parliamentary representatives and in turn through the selection of their governments. this is always been the case. it was in the case when we were working with the soviet union to sell things to the soviet union. to export our culture to the soviet union, to discuss the future of the region through the conference and security and cooperation in europe. engagement differs from region to region and country to country. but those principals are eternal. now the next point to emphasize is that if you are trying to achieve certain objectives like security and like jobs, you can't expect to be able to insult and demean and oppose the government you are working with in other matters. and inevitably, when the foreign

country wants to work with us, we at the uk set the term. the same is true for international relations when you want to achieve your objectives with another country. so what you try to do is maintain a balance so that you advance on a broad front. now the instruments that we chose to assist in the extension of civil and political and human rights to arab people while at the same time trying to pursue a national interest of the british people was one, the action programs under the european neighborhood policy study very carefully the conditionality on the extension of the trade privileges and the european union in those agreements, the dialogue on agreements and human rights. and secondly, bilateral program of the a civil society. >> let's make it specific to libya. at the time that you were the british ambassador in tripoli, which is the same time that tony

blair's government was carrying out. did you have doubts that we are making all of the advances in the relationship with libya, but this is still an absolute regime, it is still a police state, there's not going to be an election here or anything close to an election? >> yes, indeed. as did my colleague and ambassador in moscow as he watched the deterioration of public life in moscow. clearly there are degrees to these things. i'm not trying to say all international villains. the consensus in our country about the advancements of people's interest and national interest you have to accept that you can't pick and choose your partners and you can't force them to change so they fit into our mold. >> you wanted to say something on that? then back to you sir, and the question over there. >> i just came back from washington this morning. and i -- throughout our discussions about libya, i always -- i tried to distinguish

between washington and the rest of america. i think there's rules between london and the rest of the uk. i mean by london, the politics and the special interest, and the lobbying and so on and so forth. the arms lobbies and oil lob business. no, i think it's a cop out, mr. ambassador, we were for national interest and that's it. that's not how democracy functions. democracy has values and positions. they don't want to deal with someone that's oppressing his people and killing his people for the last 40 years. >> the point that you were making is the british people didn't rise up in the streets. >> the british people didn't know how tony blair was sitting in a tent making deals in the dark with colonel gadhafi about what's next. the contracts to be given to the uk, just like america and other cynics, french and so forth. i don't mean the french as the

french people, i mean paris. as a human being and citizen, what is the government? why does the bbc exist and other media outlet? to put you folks in power your view with the principals and values. sometimes you don't. most of the times you don't. it's a cop out. you need some serious soul searching on the question for libya. this was a regime. you did business with them. knowing what they were doing. i think we need to do this. [applause] [applause] >> i think you know what's going on now with libya and i think in egypt and tunisia and the rest of the middle east. myself and, i believe everybody that i spoke with, they believe it's undermining the arabs themselves as countries or as ethnic group or whatever you are

going to classify them to talk about their destiny within the context, okay, the opinion of the uk or washington. or even the west. i think this approach, it's a completely wrong. and i believe all of the arabs, including myself, we don't like to discuss the issues from this approach or perspective. i am starts to believe i cannot claim the uk or any other european country about why i don't have a democratic system in my country like libya or any other arab country. it's because i believe they can't create it themselves. but if you start yourself, and here's what's going on now, the people when they are fed up and they go out on the streets, i'm always good it's 100% transparent referendum. this is what the people want. not al qaeda, not a political group. this is the people of the middle east, one country after another they are protesting outside the

streets. and they start to ask for democracy, a political system, so what's the role here for the west? because they start to see what's going on there. what the people they want. here's what the libyans, they want. i think, yes. many western countries, they can help what the libyans they want. so they can help them, they can support them to justify, or really to make us believe, yeah, this country, or these societies, they stand for the democratic values they believe in. this is, i think, the most important thing. but practically to be honest with you, i know exactly how these things works, you know. i think maybe because myself i'm not academic. i'm very practical person, you know. i spent like 25 years of my life very practical. [laughter] >> academics can be practical too. >> no, i am very practical. >> okay. [laughter] >> so, you know, everyone -- no one can just go appear in front

of people and start to talk about very sensitive issues. i would like to make it clear like this. what's going on now in the middle east, i think, creates one heck of a vacuum. excuse me my language. in many western capitols. why? because they start to see other leaders, they have no profile for them. other likes, i will say groups, not political parties, they aren the ground and reclaiming the states which they used to do business with. we don't need to fool ourselves. there's no country on earth that can just accept this and okay we'd like to help you to establish your democratic system and we will support you in terms of human rights or whatever. it doesn't work like this. believe me, it doesn't work like this. first of all, it's always what's for me on the table? if there's any other foreign country, why should i help you? why should i take the risk? especially in this time. this is what i'm trying to say.

i think it's a very critical moment, but i still believe it's a very good opportunity. >> but it's an opportunity for the libyans. >> and the libyans, and libya it's very sensitive area. you know why? i'm going to explain the situation maybe later on if there's other questions. but just the area there, it's part of europe. because this is the southern part of the mediterranean. >> thank you, noman. i'm good to take the question. out to you. >> is there any possibility that the toppling of saddam and creation of democratic iraq has actually positively contributed to these series of revolutions in perhaps even libya? >> who'd like to start? >> that was a good question, by the way. >> i wonder how many people are viewing intervention in iraq differently. >> i actually think what's happening today happened despite, not thanks to.

meaning, we were passing sort of around november of last year, i think the darkest moment in our region. most of it part of the domino affect from the war in iraq. i've never seen the region so divided, so burdened with tension with some bitter violence. i remember that i listed nine cases for al-jazeera in preparing what i call the hot winter coming up in the memo. but the use of the arab world surprised us, being far more mature than all of the rest. what they have done, they have raised two issues. one is: democracy is possible out tanks and airplanes and invasions and death of 1 million iraqis in one form or the other. democracy is possible because democracy is the business of the people, by the people, and for the people. not on the back of a tank. i think that was the message

that we don't want to go iraq's way. there was an alternative. how it's happening, it's a work in process. in egypt, tunisia, and morocco and so forth, it's a start with comparison on what has happened and what is happening in iraq and iran. i think the arabs have proven that george bush was wrong. you could create a situation peacefully almost where freedom, the arabs by the way don't like to call it a democracy in the liberal sense today. they call it justice. freedom and justice is possible today without more tanks. >> david, then to you. >> yeah, i think a few historical examples of successful creates of democracies from above. look at the examples that we have, after the second world war, the reconstruction of germany and japan. these were total wars on the conditions of total defeat.

in the age of post em -- imperial empires, they do not bow down. the most extraordinary and bizarre statement ever made in contemporary was rumsfeld shock and awe. we had shock people and from that they will bow down and consent. what makes the new arab revolutions difference -- different is these were from below. with the international or national conditions. here you had the extraordinary pressure on local economies and arab economies, rising commodity prices, rising food prices, which impacted directly on the dire and stance of living. at the same time, you have a hugely young population wired together more than before with

rising expectations. an educational system that works and turned out educated people and educated people driving buses. nothing wrong with driving buses, but finding the roles and occupations lower than the expectations that they have. this produces the blow. that seems to be historicically creates greater conditions for the democracy than anything that the britain or america were trying to do in iraq. >> does the end result and the process to get there? >> i think if you go to iraq and in the process kills tens of thousands of people and displace hundreds of thousands more, and turn the authortarian regime into a failed state, you cannot claim much achievement for yourself and you should be judged by those promises. >> richard? >> i agree completely with

manwar, and david. i would only add that i think one useful way of looking at what's happening in the arab countries is to look at the social contract. this helps one to explain why some countries are rather slower to catch on to what's happening than others. in saudi arabia, the social contract is still much stronger. it's got religion, it's got deference, it has a popular king, and cemented together with a lot of cash. where you see the countries that have burst into flame most quickly, it's where the social contract is weakest. jordan, it's stronger. the big mystery is syria. if anyone can speak to us about syria, that would be helpful. >> just talking on the subject of cash. because it has been to be very in sync to see how much. is there a point where however

much money you spend, and clearly saudi arabia has a lot of money to spend in this department, it will not be enough? >> absolutely. this is not about money anywhere. it's about grievance. and some of the grievances are about money. the tunisia revolution, i believe, was fundamental revolution. it was discussed and that gives me the opportunity to say that i think one the remarkable things is how little ideology there are in the revolution, and how much raw emotion. that's where the international satellite television broadcasting element comes in, led by al-jazeera, a lot of others because people in the region channel hop. it's about bringing into your living room, the family discussion and the sense of shame you get if you are suffering under the same condition and haven't done anything about it. so that's so much more important in galvanizing people than the

twitter aspect or the social networking aspect which is about communication. once something has gotten going. >> thank you. i'm sorry. you've been waiting far long time. >> craig with international. we've seen the middle east that the change has been driven by young people. why do you think the young people in the west and across the world can do to support the positive change that we're seeing and hopefully move international relations to a more positive future? >> okay. can young people in the west, noman, do you think, support the positive changes that we're seeing what the use of the arab world are starting to voice? >> from a very practical, very practical -- >> yeah. >> that's why it is -- i think -- the way i understand it, it's like we have two levels here. like international governmental help which is more effective, way more effective. and none government held.

so we talk about in the west, i think it would be part of this like a government efforts to help what's going on in the middle east. now like the work of the ngos or social movements, or whatever. but practically, as well, i can't see it honestly. you know, now they can deliver unless they can help to either to push for like certain policies to be taken by their own governments. with every possible like means and tools available for them. including like going outside protesting outside in the streets without causing any damage. but it's -- the only thing. but practically, i think it's still in the middle east the work of the government rather than government politics. or the groups or ngos or whatever. >> by the way, just for your information, i think -- they will be helping in a very, very interesting way. >> the tunisians and egyptians

weren't able to break the fire wall imposed by the government, but by the help of the young serbs, young bulgarians, i think also a bench of french-americans, a lot of what was going on in the social network, sometimes when they created the tweeting, a lot of young people were actually involved over the last several weeks already. not only in solidarity and the universities and other places, but actually in, you know, if bloggers -- if bloggers and -- if bloggers and the new insurgents seconded the use around the world and have joined the arabs in social. >> thank you. the gentleman there has a question. then there's some questions at the front, thank you. this lady here. i'll come to you after that. thank you. >> they told me a month ago that a young man called muhammad

committed suicide in tunisia, and this set off the events which is causing this discussion and the world in it's way looking at the whole events of the middle east. what role do you think the press has in this whole event? and what -- what -- how will it actually develop into reporting events beyond the middle east? >> so you mean the press coverage initially from tunisia, how that essentially -- >> yeah, the effect of the whole thing, which only happened what, a month ago? >> a little more. december. yeah, thank you. i'm going to allow you to speak about the power of the arab media of al-jazeera again. >> no, no, i won't mention it even once again. actually, it can be conceived that way. when muhammad azizi set himself

on fire, the image of him and in the hospital went on the web. that came part of the social network. when they got interest, the social, especially arab, media got interested. what started as social networks rooting for social justice became massive demonstrations, spreading through entire cities. it turned into an uprising. it had to be covered by the rest of the world. that became a national uprising. then it became a revolution that will start spreading to egypt and yemen. then no one else could avoid. what started as social networks rooting for social justice because the arabs were invisible in social media. they were working on various media outlets on what's going on in the world, it caught fire,

the world, not the person, putting conditions in the west notably, but also elsewhere under the spotlight. they had to do things, and they started saying things that weren't eloquent. eventually, they did catch up because of the press. because the media did catch up. yes, the bbc, yes, when the cnn folks as they call them in america got beaten up in cairo, believe me it was not longer cultural calculation. >> equally if you look at libya, we are not able to tell the same kinds of stories that do exist. because no one has that kind of access and that kind of ability to operate. david? >> well, i agree with what you have said. but i would just say this is not just the story of the west, it's also the story of the east. two articles in the arab 199 -- 1989 and sent it to a variety of newspapers. they accepted it.

the next day they turned it down on the ground is that chinese policy of what was happening then in egypt was a matter for egypt alone and not an issue for wider concern and consideration. i think right across asia, many of the same points apply. it's not just the west of all ages has in the sense not seen the development and the changing dynamics of the arab world. it has seen in in terms of awe cattic -- autocratic regimes that are stagnant, and they have been stagnant in the academic literature for generations. while it's true, the east also has had little comprehension of what is now going on. and those that pursue their dominance international interest in the area, china, increasingly. >> by the way, china banned egypt news. >> china, but increasingly in india, they also fall under that. >> thank you. go ahead. another question. thank you. >> i'm a journalist from

finland, journally writer, journalist fellow from oxford. i will actually go back to the beginning, and what kind of role does the son of gadhafi play in this situation at the moment? is this a sort of a father/son joint venture thing? or most important allies for gadhafi at the moment? :

but the thing that struck me

had aside to him that we haven't seen since

>> but, at that moment of choice, he failed catastrophically. >> at the moment, i'm going to ask richard and someone who has met the gadhafi, was he putting on the front and going through the motions before? >> no, i think it was genuine. i think your explanation was that if your father's life is threatened, then you have to make a choice. you will do what you do.

most people would. i think there's one point that we should just mention, that speech also contained a promise that there would be a new political dialogue. in other words, he did offer genuinely or not, we can never tell, the process that the iranians began in the dialogue between rulers and people. those watching that speech thought there was precious little chance of the colonel agrees to that. we saw the libyan people that would regard it as far too little, far too late. that is, indeed, what happened. >> the offer of reform in that speech seems to me entirely uncompelling and plausible. if you are ravaged by a beast or form by any shape or form, and then the beast offered to take you to prada store and buy clothes. what does that mean?

the speech was violent and portrayed the protesters of drunks, then the offer is hidden by the language of violence. >> so the choice has already been made? >> absolutely. noman? >> it's very complicated questions. but it's -- yeah, i am 100% support the idea since like 2007, or maybe before that. let's say 2005 when he started to act as a political figure within the libyan scene. i think he took a lot of like very radical actions or moves which is always faces a lot of like obstacles and objections from not just his father, but the radical hard core in the libyan regime. i know as a matter of fact, not just because of my like personal contact with him, but other people as well, he included from his father they used to label him as someone, his mind being

corrupt by liberal values. including his father. they used to label him like this. someone being corrupt with liberal values. because the time he spent outside in australia or -- and in london. anyway. as professor david mentioned, he worked hard on the ground and the people in the west, they know that. they are involved with him in many projects. but it's all -- we should say it's the reform plan. but it was filled within the context of the -- colonel gadhafi's regime. say if you thought at time, maybe it's the safest way, you know, to start to reform the country and at the same time don't destroy the structure of power. >> okay, so you believe he was june june -- he was genuine at that time? >> yes, definitely.

i would like to say what happened on the 17th of february, he decide, that's his decision, and i believe that's a historical decision to, i think, stand not just with his father. it's very simple to say his father, you know, the radical, hard core of the libyan regime, you know? people they still believe they are revolutionary, they are like freedom fighters or whatever. and they decide we should carry on the fight. it's a conspiracy against libya. he decided by himself, i believ? i wish he'd decide otherwise. so now it's his decision. he switched himself to be a warrior rather than a soldier. >> let me disagree. 100%. just for the held -- hell of it. i would say 80, but for the

question. just because i'm talking to this audience. maybe i would talk to the same way to whatever audience that i'm talking to. there's something to say when you talk to one the oldest democracies and one the most ethical democracies in the country, the united kingdom. the people aren't going to solve the intelligence. on this question, i don't know if you are as cosmopolitan as i am, has anybody followed "keeping up with the kardashians"? this was sort of like that. sex, lies, and video tapes, you can add arms to it. the son's safe is the sexier one, the playboy, the one that hates the servants, the one that cheats on the money. we were keeping up with them for the last seven years. who the hell are they?

why does gadhafi -- he doesn't have a single political position. his father that fought the revolution, liberated the country, i don't know his father's buddies. who is he? why does he run a foundation? why does he get on the press conference and speak on the behave of libya? >> because he's from the part of the world -- >> we can't accept the safe value when the son of the dictator can play with money at the university, at the foundation, at the charity. he's giving. it's not his money. there is, aside from the kardashians, there is another thing. and it's not liberal. liberal is something completely different. to be a playboy is not liberal, to be a playboy is not to have any morals in that sense of the world. what's happening in libya is the same as i said started originally in egypt and tunisia and elsewhere in the arab world and the third world. i will follow from your point, david. we had his father pursuing the

regime, and son pursuing the washington consensus. father wanting from the top-down, army, tribes, whole towers, and maybe see how you can do state capitalism. son's graduating from the west, coming back with ideas of the washington consensus, opening up the market, opening up the oil industry, opening up everything, private as it is, giving it all to the british and the french and the italians and the spaniards, and the americans. >> i wish. >> this which wikileaks described the capacity to charm the west at the expense of the libyan people. that's what he did. that doesn't make him a good guy, a liberal guy, or a guy like his father, it makes him a thug, and a son of a dictator. i'm saying that objectively. not from an opinion point of

view. but going through the facts of this guy's being over the last ten or fifteen years, i cannot come up with another conclusion. son of a dictator, like father, like son. >> let's move away from gadhafi. i know there are lots of people waiting for questions. sir, to you, then the questions here. go ahead. >> my name is lana, i'm a freelance journalist. i firmly believe that these uprising throughout the arab world are going to lead to a completely different middle east, and there's no going back. >> keep it a bit closer to your mouth. >> okay. i think they've revealed that the arab people have a sense of justice and a common policy that's inherent to that culture. they have also revealed the historical hypocrisy of the west

and it's dealings with the middle east. the fact that it's a bottom up uprising in all of these countries is very important. because -- sorry. this is kind of distracting me. i'll just move on. can you please comment on the fact that on the one hand america can come around to condemning the dictators, but on the other will not veto -- will not support the condemnation of continued settlement building in israel? when clearly, you know, it has changed and there is no going back from this exposure of western hypocrisy and it's dealings with the middle east? >> okay. richard dalton, as somebody who served in jerusalem and elsewhere, can i ask you to respond before we move on to the next question? this feeling that you've -- that there would be condemnation of

israel settlement policy at the same time as support of these democracy movements? >> of course, they should be. and the american position was idiotic on the one hand vetoing the resolution, on the other hand saying, of course, we do condemn settlement building. if there was a display on the weakness and approach to the major international issue, this was it. on the broader question of high we progress the middle east process of nonpeace, between the israelis and others, i don't think we really want to get into that now. but my view is that we need to turn ourselves around 100%. chiefly in israel, but also in the united states. >> okay. gentleman at the back there. >> steve summerville, freelance. would any members of the panel, includes former ambassador, like

to give any credit at all to tony blair in his dealings in the dark in the tent in the desert in persuading colonel gadhafi to disabling his nuclear question? and supplement question, did he ever had a nuclear program? and are there any vestages of it to our knowledge? >> did he have a nuclear program? >> yes. and the government's involved in that negotiation. british and the united states and libyan deserve credit. i think the important thing in the history of involvement with libya is to look back over the slow and study way in which this change in libya's international behavior established itself from the mid 1990s, i won't give you a history lecture, but just register that much press writing about how it all happened all of the sudden in 2003 on the

weapons of mass destruction issue is nonsense. and the second thing that's also nonsense is that somehow tony blair had a special role. he was one the last european heads of government to go to libya. and to talk -- >> what about he said he went further than he had to. the foreign office wasn't saying you have to go personally. you know, he kind of did and decided to go further than others. >> that's not how i remember it. i mean i was in tehran at the time. but plain fact of the matter is that after the suspension of the sanctions in 1999, negotiating with the libyan government for oil concessions was legal and it was in the interest of europe to do that. and that's why everybody did it. while also the united states did it. and the way libya and other

countries work whether there's a heavy political element to trading is that on the biggest issues, the heads of government need to get involved. now it's entirely free to all of us to go to our members of parliament and say we don't like life if that's what life requires. so please stop it. don't, david cameron, go around the world with businessmen in training. that's not your job as our representative. if that's how you believe, you've got to use your own democratic system to establish that. >> thank you. i'm going to try to get a few more questions. then i think you had a couple of questions here at front. and yes. we'll take your question there. and then can we get the other microphone to the front? thank you. >> my name is samaya, i'm a phd student studying about tehran. i'm wondering egypt, the new

role that egypt might play in mideastern politics. do you think it's too early to see a stance from egypt on hamas and israel and iran? >> you know, the question has always been as we were speaking earlier, it's not who will replace mubarak, but what will replace the mubarak regime. although we have an affirmative on the first question, the second question is still a work in progress. what will replace the mubarak regime? just in the last 72 hours, there have been changes. assets being frozen, ministered being kicked out, prosecutor acting independently and so on and so forth. so there has been some movement. there's two ways of judging what egypt can do. once with the dominant role of the arab world, it can play like brazil or role of china, in a more positive way than china,

more like brazil. second to the domino effect. if it happened in egypt, it will continue to happen. even if libya poses to be a bit more difficult. i think sooner rather than later, they will have to lift the city of gaza. you can't have freedom for egyptians, and not freedom for palestinians. sooner or later, they will be rattled and they will have to start requesting the intelligence of the egyptian people more than the intelligence of mubarak, i think something will happen in the united states, washington in particular, it will start treating those countries like egypt and new sisters of tunisia and so forth, not like clients, but countries with whom they will have mutual interest and perhaps mutual security, mutual respect as president obama put it. >> thank you. i'm going to ask you to pass that microphone to the gentleman

here and come to the front row. >> i'm a freelance journalist. we've been hearing gadhafi talking repeatedly about an al qaeda threat. what do you make of that? and is it just another lie? or is there something else behind? >> is there an al qaeda threat, david, i was going to ask all of you briefly. noman? >> yeah. >> it's a refrain in the last few days. >> yeah, i think it's a symbol of that. first of all, i believe it's a pasteless statement. and just before that, let's say like four weeks ago, everybody knows and libya itself prides itself on one of fewest countries to get rid of al qaeda. how come out of the sudden al qaeda appears as the driving force behind it? i would like to put it in a different framework. now we have a coin with two faces, you know? there's opportunity and there's

a tip as well. the opportunity is for the libyan society with the help from the west as well or the international community to help the libyans to achieve what they want. which is like democratic states. so i think when we talked to the media or talk to the people, this is the message that we need to deliver. when we talk about the other side, i'm not naive to say no, it's safe. when you have chi -- chaos, especially like now, there's opportunity for al qaeda and aqim near the doors now and statements which are crystal clear. we don't need to go through arab lists, i believe they have force claimed when they said two days about the aqim we will help fight in libya. it's what gadhafi is using now.

there is a threat. i strongly suggest we don't need to talk about threats to the media, it will undermine the libyan revolution, all of the lives being sacrificed and the main issue of people protesting outside looking for freedom and the symbol of that and to start to talk about threats. we need to talk about threats, but behind closed doors. what is behind the libyan revolution, it's the libyan people. it's 100% transparent referendum from libya. >> later here, then i'll come to you. >> i'm from a news agency. gadhafi seems to have closer ties to subsahara and afghan countries, we have reports of him arming local tribes. how does that change the dynamic of the uprising in libya to the others that we've seen? and on a wider question, egypt, yemen, libya, they are all

presidents. what happens -- what the likelihood of success in the uprising in countries where they have essentially going against a ruling family? a royal family? >> okay. the links to subsahara africa, was that always there? i mean he's been nelson mandela in the past has called him his friend. >> yes, nelson mandela was crucial in persuading libya to hand over the trial in the netherlands in 1999. and if there was to be an attempt to persuade gadhafi, it would have to involve african states, and it would have to involve people that gadhafi may still respect and through the african union have an institutional connection with him. the libyan -- gadhafi wants a stage. and he decided that he was never

going to be to make it big on the arab stage after the bad history that so many arab countries have had with him. so he created an african stage for himself, in so doing, reviving the au, and turning it in a constructive direction through the creation of african union. whereas, while he listed some resentments for the way in which he tried to strong arm the african countries, on the whole, it's something that has resounded to his credit in africa. and the second issue, of course, is that if the hand of a libyan central authority is weakened for a prolonged period of time, we may get a resumed search of economic migrants, thinking this is diplomatic territory. >> all of the african leaders

that have been polled in recent days, noman, is it your understanding, i'm conscious that actually that we haven't talked much about that. i wonder whether there was initiative that is we missed? >> to be honest with you, i don't think it's the other way around. he's always telling gadhafi how he sees it. especially the african subsahara, sharing the borders with libya, they are in the position to influence colonel gadhafi's decision. he would say in libya, he would never want to leave. i think the most important thing regarding the african subsahara, not just the libyans, but other cities there, because we have two kinds there. some of them are libyans, there's a vast majority of them they have no stats. they have cards, but they not are not libyan.

some of them move. algeria is getting angry about that and the army near the border. if the situation carries on, we will start to see other conflicts there. >> let's talk briefly about the second part of the question. is he operating different in different parts if it's a ruling or monarchy essentially that a ruling family that people are up against. can we have a different tone? jordan and bahrain? >> i started to see the similarities, but i do' a common threat. it's baffling that the republicans with the willing family. republicans with the willing families and contradiction in term. they have absolutely no problem creating inheritance for the rule to be divided among the on,

that's the first layer, and then the end row and the second layer, or the tribe on the third layer. they call it a republic. there's something that republics we've seen will weather it's yemen, they were hoping for it, in egypt they were planning for it, in syria, it's happened. in libya, of course, it was happening and so on and so forth. you have the republics that have created de facto ruling families, not too different than monarchies. because they have the real monarchies, one actually more capable as in morocco and saudi arabia to hold on to power. while the absolute phony republics ruled by pseudoruling families, the gadhafi ans, to to

say. they were to transparently aggressive and democratic, and so transparently unrepublican. >> we begin to see a reform movement in morocco, jordan, iran, and saudi arabia. they published a manifesto for constitutional change in saudi arabia. if this is happening on saudi arabia now, on the serge, i think it's going to go a lot further than we currently anticipate. i think in morocco, the king has initiated a more liberal regime over the last several years. his position, i think, is relatively secure. but there will be significant constitutional changes on the back of this. the big change may affect that everyone thought the gulf wasn't going to be affected.

no one imagined that 1/3 of the bahrainian citizens would be on the street. now with the manifesto for change in saudi arabia, would they affect saudi arabia? would have enormous repercussion s for us. >> sorry. you have been waiting. >> yeah, we talked about arab and the social contract and the uprising have happened in countries where there was less transparency and worst regime. given the power that social networking that we talked about and satellite media, i'd be interested to hear the panels and ambassadors thoughts about how far the social uprising might well spread. i guess i'm talking about different regions, such as iran, given the social attention that we've seen there, do you see this as encouraging renewed

social upsizing from the ground roots up, and on the flip size, encouraging reform from the top down which may have it's own lead into revolution again coming up from the bottom as say in the form of soviet union. >> well, iran is one the countries that's been blocking some of the coverage of the events in egypt. >> that's the general point. electronic media facilitates oppression, and once the movement has begun, it helps inspire people, yes. but you are constantly trying to keep ahead if you are organizing the effect of a police state's ability to use those same tools against you and your fellows. second question -- second point. iranians like so many others in the middle east have family living in completely different situations from the ones which they are experiencing.

they know from annual visits what it's like to live under those poverties. so it's not the medium that makes the change to the arab spring. because this technology has been out there they are mall treated and there's a better way of doing things. it's the barrier of fear. and that has happened as a result of the success of revolutions beginning with tunisia. so, yes, i believe that an academic who spoke at chatham heist maybe right when he says this means the end of the stability. because the barrier of fear is down. now in iran, a present, the forces of the establishment are well ahead of the current of protest and rejection of

clerical rule. and short of some tremendous misstep by the authorities, such as major slaughter in a public care or group demonstrations, i think it'll be some time before the barrier of fear comes down far enough to get the people who are shouting on the roofs in anonymity in the dark into a more coherent, political force. it'll come. but whether it comes in a year or five years or ten years is impossible to say at the present. >> okay. david? >> yes, i would just add briefly that the -- the emergence of the i.t. revolutions and the new forms of social communications is just the beginning. these technologies are only ten, 15 years old. and new implications emerge from them all the time. they clearly have an extraordinary impact on the

authoritarian regimes. because authoritarian regimes want to control the information. once you get the network linkages, the capacity for the control of implications breaks down. this has implications for all autocratic regimes whether they are not middle east, iran, and further into the east. i should also say it's has radical implications to be worked out in the west as well. democracies on many respects. but the implications are not just autocracies. they are also for the west. if the united states is the model, or one the most advanced model of democracy, it lived with a congress which is gridlocked where most political issues can't find a winning coalition of support. this affects everything from climate change to financial reform. the impact on the technologies, i predict would be just as significant as the impact of the

old. >> i'm going to ask for closing thoughts on noman and wrap it up. >> just to say when we talk about the region, we have officially 22 countries, arab countries, you know, members of the arab countries. i'm wondering if anyone would disagree with me, none of them is a democratic modern state. none of them. all of them, they belong to the history who should be very afraid either we talk about republicans, or kingdoms, all of them in terms of the legitimacy, they belong to the history. but this is one the pain that we have to deal with as an alternative, otherwise we have to go to the iraqi situation or what's going in libya. if it's a real concept and values that we believe. you know why, because of one thing, the civic culture doesn't exist there. so to build a civic state, this is first of all i would like to clear it up. there's something very significant here about libya and

why the battle here is very strategic. you know why, what colonel gadhafi is doing now, how he countered the wave will not just affect libya. if he succeeds, it's stopping the wave. it's not going to be peaceful anymore. and it will really, really, i think, affect what's going to happen in iran and syria as well. if he managed to be a civil war, and started to be an international conflict, i think he will be capable of stopping this wave to be spread as a very peaceful, people will get further and they don't accept so-called the social contract or corrupt contract. in terms of like, okay, provide to us security and accept as a subject. this is the situation. what's going on now, i would like to say the people, they decide because all of the past like experience, it's failed. like nationalist, markettist,

they have failed. they decided to go out and claim the nation's states. >> noman, thank you. manwar, i know you can do this. you have 30 seconds. i wouldn't do this to the others. to you, i think it's fine. >> yeah. let's just say i'm very optimistic about what's going on. this is good new. it's good news in the sense that it happened. it's good news in a sense that it's a work in progress. we are moving in the right direction. there are no guarantees. this would be a long way. actually the hard work is ahead of us, not behind us. but we are here and we are heading in that direction. it's not simply because there's social media and there's young people. suddenly there's nothing sudden about it. i think we should pay respect due to the hundreds of thousands of arabs who were tortured, jailed, picketed, demonstrated with the hunger strike. why the arab world were not reported, those are the

invisible arabs. the hundreds and millions that were displaced by their regimes from iraq to morocco, those -- the torture, the prison, the strike, the activist, the young and the old, the man and the woman, they are the ones who should be thankful. i think in that sense, that's why i'm hopeful and optimistic that's it's going in the right direction. >> okay. thank you. [inaudible] >> everyone, thank you for being here. thank you for taking part in the debate. i wish we had more time. please join me in thanking your panel for tonight.

for her department.

>> health and human services secretary kathleen sebelius testified thursday before health energy and subcommittee on her department's 2012 budget request. and implementation of the health care law. the health care legislation was signed into law by the president in march 2010. on monday, president obama told the nation's governors that he's willing to give states an opportunity to opt out of certain requirements of the health care law by 2014 rather than 2017. if they could find their own ways to accomplish its goal. this hearing is two hours and 40 minutes. >> so every member of this subcommittee may have time to answer questions we will be strict in enforcing our time limits today. that's five minutes for questioning, and that's questioning and answers so don't ask a five minute question and

then ask the secretary them to try to respond in the remaining seconds. we've agreed to three minute opening statement. the chair will recognize himself for opening statements for three minutes. i would like to welcome our distinguished witness today, the honorable kathleen sebelius, secretary of the u.s. department of health and human services. madam secretary, thank you for your time and your testimony today. the department of health and human services is a large department with broad authority and jurisdiction with the enactment of the patient protection and affordable care act, a pocket. we have found there are several sections of this new law that require mandatory funding, bypassing the normal appropriations process. today's hearing will give us a chance to examine these provisions and consider the budgetary implications for implementation, and administration of this new law. one aspect that i am concerned

with is the office of consumer information and insurance oversight. less than a month after ppaca passed last year, the department moved regulation of health insurance from the centers for medicare and medicaid services where it had been for years to a new office, ciio, which reports directed to the secretary. an enchanter of this year, the secretary announced that ciio would be moving and would now be housed at cms. this is interesting because ciio implements and regulates many of the new health care's private insurance provisions and cms runs the nation's public health programs. the office has been in the news lately for granting over 900 waivers to private health plans unable to meet various standards set by obamacare. it is important to note that the ociio was not authorized nor even mentioned in obamacare, yet the president's budget requests

includes a $1 billion increase for program management discretionary administration at cms. it appears that this additional $1 billion the funding of ociio. i will be interested in learning more about this new office and the role it plays, and i look for choosing more transparency in the department's budget. and for my remaining time a yield to the generally from tennessee, ms. blackburn. >> thank you, mr. chairman, and i do want to thank the secretary, and i will pick up right where it your chairman left off, with transparency. and i think what is outstanding to me is the lack of transparency in this process and the difficulty with getting information. we know that our states have fought the battle, indeed not only companies but states are receiving waivers. what we see in front of us, madam secretary, seems to be a confused process, our states are frustrated. we've heard from state legislators, from governors,

there are beginning to agree with your former colleague, governor bredesen, who call this the mother of all unfunded mandates, and with others who said it's too expensive to afford, and this is something that would bankrupt the states. there is just truly a dissatisfaction, and one of the things i will highlight with you today and question with you is my concern over lack of response and asked what response to questions. yield back. >> the chair thanks the gentleman be and yields to the ranking member, mr. blum, for three minutes. >> thank you chairman pitts, and a much welcome secretary sebelius. in these tough economic times i recognize how difficult a budgetary and spending decisions are for the president and congress. i commend the president for his responsible budget. i would hope we can work together to move this country forward to create jobs and to foster economic growth. i want to commend secretary sebelius for your agencies hard

work this past year to implement the affordable care act. i will continue to fight against the republican effort to defunded this important landmark law. i can't agree more with president obama that as we continue to work our way out of the recession for the thriving economy that offers economic opportunities for all americans, that we must out-innovate, not educate and out build the rest of the world, and to do that i blew the federal government has a vital role to play. at the core of innovation is research and development. it is r&d that propels the signs, the businesses health care. in fact, a recent report shows health care r&d support 211,000 jobs and 60 million jobs in economic activity in my state of new jersey. but r&d required resources. investments made by government and health research projects get off the ground and leverage resource of the private sector and academia. and that's why i was very pleased to see that the president's budget includes government investments in health care r&d. is budget recognizes the key

agencies like nih and fda are essential to facilitate an environment where americans can continue to innovate. i did want to mention my disappointment in one program, that's the termination of the children's hospital medical education program. this has reversed decline kbr training programs and threatens the stability of the pediatric workforce, and the small hospitals that receive and which was the children's house hospital in my district represents about 1% of hospitals nationwide, but trained approximately 40% of all pediatricians. eliminating this program would have a major negative impact on access to primary care and impact access to specially care for children. and i want to mention that i'm committed to reauthorizing and funding this program and introducing a bill to do that soon. but really, i wanted to stress, madam secretary, that are really do think that as we move forward with the affordable care act, i know the anniversary is coming

up i believe on march 23, just a couple of weeks, already there so many of my constituents and so may people that i talk to that talk about the benefits of eliminating preexisting conditions, of being able to put their children on their policies, what we've done for seniors in terms of cutting back, eliminating the donut hole, eliminating co-pays for preventative care. people are very much aware of the benefits of this, and more and more i think as he continues to be implement it will be. and i'm very much opposed to any effort to this fund the program, particularly since we see the positive benefits from this. thank you, mr. chairman. >> the chair thanks the gentleman and yields three minutes to the chair of the committee, mr. upton. >> thank you, mr. chairman. two days ago we heard from some of the nations governors on the negative impacts the new law will have on the states and quality of health care. what we heard is similar to what most memos here anytime they

speak with the governor. expressed the concern that mandates coming out of d.c. are hindering their ability to deal with the states problems. the president did offer i think some flexibility on monday by declaring that the states could opt out of certain aspects of the health reform law a few years early as long as they met every one of the goals. i'm concerned that the state will only be allowed to take advantage of the so-called flexibility if they construct a program that looks almost exactly like the system that was set up in health care law. states need real flexibility without all the strings and caveats attached. the president did call on the governors to come up with bipartisan proposal on medicaid. dozens of governors have asked for relief from maintenance of effort requirements so that the contract medicaid funds to those most in need and need to constitutional responsibility to balance the state budget. if states are instead enforce to impose steep reductions in

payments to providers, they will likely drive more doctors and other providers out of the medicaid program and in some cases out of the practice of medicine altogether. i believe that's detrimental to both patient and to the quality of care that they can expect to receive. the president wants bipartisan medicaid proposals and we need to repeal the maintenance of effort is the place to start and i hope the administration will work with members of this committee to expeditiously repeal those requirements. i do also like to hear from the secretary what programs at hhs she believes are redundant and duplicative. with federal deficits as far as the eye can see, $1.6 billion in the presence budget for 2012 we must go through the budget with a fine tooth comb. yesterday's report from the genome revealed the subcommittee on oversight investigation the federal government is wasting tens of billions of dollars on duplication, overlap and fragmented programs. we cannot fund programs because what we did last year or the a before. every program has to be scrutinized and i look forward

to working with you, and i yield the balance of my time to mr. cassidy from louisiana. >> governor deval patrick testified tuesday that massachusetts develop a model for obamacare and the massachusetts gives a vision of her future. i agree. we were told almost anything else though he said was faulted were told that because of this model that he dashing er visits are down. it turns out significantly according to the urban institute 20% of western massachusetts, were told the private insurance market is unaffected. fewer businesses are offering insurance because premiums are up above the national average. we're told the cost of the issue is being addressed. according to the globe and the "national journal," people are being disenrollment and quote benefits are being slashed to hundreds of thousands threatening their access. indeed, the democratic state treasurer said if the united states and put the plan like massachusetts, we will go

bankrupt. the question before us today is whether we believe the vision of which we were told is the vision we see. i yield back. >> that chair thanks the german. yield three minutes to the ranking member of the committee, mr. waxman. >> madam secretary, it's a pleasure to welcome you back to our committee. first, i want to commend you on the work you're doing to implement the affordable care act. that's the name of the law. the job you're given by congress and the present is imposing but you have met it with leadership with steadfast commitment. today's hearing is meant to address the president's budget proposal for hhs for fiscal year 2012. you would know by the opening statements. .. -- you wouldn't know it by the opening statements. ..

>> the chair thanks the gentleman, and at this time we will go to our witness. i would like to introduce our witness, the secretary of health and human services, kathleen sebelius. secretary sebelius was first elected to the kansas house of representatives in 1986. in 1994, secretary sebelius was elected state insurance commissioner for the state of kansas. and in 2002, she was elected to be the state's governor. madam secretary, we welcome you to the committee. we look forward to your testimony.

>> thank you very much, chairman pitts, ranking member pallone, and members of the committee, thank you for inviting me here today to discuss the 2012 budget for the department of health and human services. in the present state of the union address, he outlined his vision for how the states can win the future by out educating, outbuilding and out innovating the world. so we can give every family and business the chance to thrive it and i think our 2012 budget is a blueprint for putting a portion of the vision into action. it makes investment for the future so that we grow our economy and create jobs. but we also recognize that we can't build less prosperity on a mountain of debt. years of deficits have put us in a position where we need to make tough choices. we need to live within our means. so in developing the budget we look closely at every program in our department and when we found

ways to cut it, when programs weren't working well, we redesigned and to put a new focus on results. and in some cases we cut programs we wouldn't have cut in better fiscal times. and i look forward to answering your questions, but, mr. chairman, i would like to share some highlights. over the last 11 months we worked around the clock with our partners in congress, and states deliver on the promise of the affordable care act. thanks to the law, children are no longer deny coverage because of their pre-existing health conditions. families have protections and the new patient's bill of rights but businesses are getting relief from the soaring health care costs and seniors have lower cost access for prescription drugs and preventive care. this budget builds on the progress by supporting innovative new models of care that will improve patient safety and quality while reducing the rising health costs on families, businesses, cities and states. we make new investments in health care workforce and

community health centers to make quality, affordable care available to millions more americans and create hundreds of thousands of new jobs across the country. at the same time the budget include additional proposals that strengthen program integrity and medicare, promote lower medicine costs and improve medicare program operations, and reform the quality improvement organizations which help providers improve care. the budget also includes savings proposals to strengthen medicaid. it includes funding for the transitional medical assistance program assistance for low income beneficiary. programs which help keep health costs over low income individuals and keep their vital coverage. to make sure america continues to lead the world and innovation, our budget includes funding increases for the national institutes of health. new frontiers of researchers like cell-based derby have the promise to unlock treatments and

cures for diseases ranging from alzheimer's to cancer to autism. our budget will allow the world's leading scientists to continue to pursue discovery. but keeping america at the forefront of iowa medical research. and because we know there's nothing more important to our future than healthy development of our children, our budget include significant increases in funding for childcare and headstart. science shows that success in school is significantly enhanced a high quality early learning opportunities. these investments are some of the wisest that we can make in her future. our budget does more than provide additional resources. it also aims to raise the bar on quality and childcare programs, supporting key reforms to transform the nation's child care system into one that fosters healthy development, and get children ready for school. proposes a new our e-learning challenge fund, a partnership

with the department of education that promotes state innovation in early education. and these initiatives combined with the quality efforts already underway in headstart are an important part of the present education agenda to help every child reach his or hers academic achievement and make art nation more competitive. supports child support and fatherhood initiative that encourages fathers to take responsibility for their children, change his policies so that of that support reaches the children and maintains a commitment to vigorous enforcement promoting healthy relationships between fathers and their children. would also fund new performance driven incentives for states to improve outcomes for children in foster care. such as reducing long-term fosters states and the recurrence of child maltreatment. these children also need to be part of our better future.

our budget recognizes that it's time when so many americans are making every dollar count, we need to do the same. that's why the budget provides new support for president obama's unprecedented push to stamp out waste, fraud, and abuse in our health care system. and effort that more than pays for itself returning a record of $4 billion to taxpayers last year alone. in addition, the budget includes a robust package of administrative improvements for medicare and medicaid. the proposals include prepayment scrutiny, expanded auditing, increased penalties for improper actions and strengthen cms ability to intimate corrective action and address state activities that increase federal spending. over 10 years on a conservative estimate, they should deliver over $32 billion in savings. across our department, we've made in many waste, fraud, and abuse the top early, but we know

that isn't enough. over the last few months we've also gone through departments budget program by program to find additional savings and opportunities where we can make our resources go further. in 2009, congress created a grant program to help states expand health care coverage, and we've eliminated that program because it's duplicative. cdc funding has been helping states reduce chronic disease, but the funding was split between different diseases. won ground for heart disease, another for diabetes. it didn't make sense since a lot of those conditions have the same risk factors like obesity and smoking. and now states will get one comprehensive grant that allows them more flex builder to address chronic disease in their home territories more effectively. the 20 oh budget we are releasing today makes tough choices and smart targeted investments. today so we have a stronger, healthier and more competitive

america tomorrow. that's what it will take to win the future, and that's where determined to do. so thank you, thank you. i look forward to answering your questions. >> the chair thanks the generally, and recognizes himself for five minutes for questions. madam secretary, section 4002 of ppaca creates, creates a fund to provide funding for programs authorized by the public health service act for prevention, wellness and public health activities. from the period fiscal year 12 through fiscal year 21, there will be 17 points $75 billion deposited in the fund. my question is, who has the authority to determine how these funds are spent? >> mr. chairman, our department in consultation with congress, we have a fund for your at a

time. .. >> a major lever for them to consider as they try to balance the budget. can you give me a yes or no answer as to whether there will be an opportunity to waive that provision to help pennsylvania and other states close their budget holes? >> mr. chairman, that question doesn't lendist to yes or no -- lend itself to yes or no. we are -- have the ability to grant 1115 waivers to states that improve the medicaid program, and we're working very actively with governors across

the country. i've met with all the new governors, we've been in 19 states so far. we are working a budget at a time to look at the flexibility that governors are requesting. >> given that the supreme court will be looking at this new law in the coming months or years, we as a congress have to prepare for the possibility that a portion of ppaca might be invalidated while other parts remain. if individual mandate were set aside and the remaining portions of the bill were left intact, what would be the impact in the total number of uninsured, and assuming that number would grow, would the administration seek to find a new way to cover these folks through medicaid? >> well, mr. chairman, we're confident that the personal responsibility portion will be upheld. there are 12 judges who have dismissed cases so far, three federal judges including one as recently as last week who have held the entire law

constitutional. one judge in virginia who found a portion, the individual responsibility portion, unconstitutional but declared its severable and refused to grant an injunction. and a florida judge was ruled another way. so our team is confident at the end of the day that the law will be held constitutional. we are looking at a variety of options, and those were examined as the affordable care act was being considered about the best way if you eliminate pre-existing conditions to make sure that you have a stable and secure insurance pool. as you know, the personal responsibility section actually came from the insurance industry, from the american association of health insurance plans who felt the way to have a solvent pool in an insurance market is to make sure that you can balance risk. and that proposal really comes from the insurance industry. >> if you could give me a yes or no, will you approve a medicaid

block grant program? >> mr. chairman, there isn't a block grant program that is being suggested at this point, but i know that there is some interest in that. i can't tell you what the parameters might be. i think a block grant has the real danger of shifting enormous burdens onto already-strapped states. >> thank you. i'll yield the balance of my time to dr. cassidy. >> thank you, mr. secretary. one of my concerns is how the state budgets are going to be supplemented. currently, there appear to be crepe i says how much -- says how much a state does get and should get. jonathan gruber, i think, published an article that said in his state about 1.7 million people will be added to medicaid under this plan, so it's going to stress it further. do you see concerns with how the current fmap, smap is

constructed? i say that because mississippi gets with a higher fmap about $3,000 per beneficiary. any thoughts about that 124. >> i though there are constant -- i know there are constant concerns about the allocation formula. mississippi has the highest match rate -- >> they only get $3,000 from the federal government, so they have an 83% fmap, but they only get $3,000 per beneficiary. >> and i won't dispute that, i don't know the numbers. i do know they have the highest fmap rate in the country. i think that there is a constant analysis of changing demographics, changing populations. i know in the state of louisiana it became an issue after katrina in new orleans and the changing demographics of that city changed dramatically, their share of the federal budget. so there have been concerns over the past, and we would look at congress to look at updating the

fmap on a regular basis. >> my time has expired. yield five minutes to the ranking member. >> thank you, mr. chairman. i would mention to you that if you would entertain the possibility of upping fmap or doing more with fmap, i'd be glad to oblige. we'd be more than -- to increase funding. i wanted to ask about innovation, madam secretary. america's competitiveness depends on our ability to innovate and keep american number one, but instead the republicans included over a billion in cuts to nih and over 240 to the food and drug administration. and i believe this represents a significant setback because key agencies are essential to facilitating an environment where americans can continue to innovate. last week we heard about cdrh's

newly-announced medical device initiative, a new voluntary priority review program by fda to help innovator companies bring their products to market. but in the cuts -- if cuts in the republican cr are enacted, fda did not think they would have the funds to implement the initiative, and this is just an example of the impacts we would see if fda's budget is cut by over $240 million. i believe a cut of 17% will slow the approvals for devices, drugs and other innovative products. isn't that correct? isn't that what we're going to face if this cr becomes law? >> well, i think, congressman, the president shares your belief that investments in both the food and drug administration and the national institutes of health are wise and strategic investments for the safety and security of our food supply and

our acceleration of devices and drugs getting to the market and to keep america at the forefront of the biomedical industry which we have been for decades. so he has made recommendations about investments, enhancements to both the national institutes of health budget and for the food and drug administration and believe strongly that that's really keeping a commitment with not only the american public, but growing jobs and the economy that we desperately need and that the failure to fund those agencies to the full extent both jeopardize some of the important responsibilities they have as well as threaten -- i think the last detail i saw from d. collins at nih is for every dollar in research grants, $7 is generated in a local community so that it has an enormous ripple effect when research grants are put out in university

communities across this country as well as the lifesaving cure possibility that results. >> and, i mean, the same is true. i mean, the cr -- with nih. the cr proposes over a billion dollars in cuts for the nih's budget. it appears a matter of -- majority of the cuts will come out of new grants from the budget of 3.9 billion. that would mean thousands of fewer nih awards this year. again, i mean, the cut to the nih would be devastating on the cutting-edge research into new cures and treatments for diseases. if you'd just comment on that briefly because i do want to ask another question. >> as you know, congressman, the nih budget had a dramatic increase in funding thanks to the investment and the recovery act feeling that scientific investment was a major innovation effort for the united states. so they are already struggling

with that grant funding which is coming to an end. and i can tell you it will have a very chilling impact on research grants across this country if, indeed, the nih budget is not adequately funded in 2012. >> all right, let me ask you this about the children's graduate medical education because the president's budget zeroed that out. in new jersey we have the highest rate of autism this country, 1 in 94 children. in my district children's specialized hospital provides services to children with disabilities and clinical services to, like, 4,000 kids. my concern is that, you know, we have very few sub-specialties in pediatrics right now, and in the budget, the president's budget, it basically justifies zeroing it out by saying they want to focus on primary care. but we actually need more sub-specialists, not, you know, more so by every, you know,

physicians' group. so how do you justify that? it seems to not make sense to me. >> well, i would say, mr. chairman, your concern about this program we have heard from a number of people, and i can assure you in any different budget time this would not have been one of the recommendations. the goal was to try and focus as many gme dollars as possible into the work force for primary care jeer ontology and to put it into programs where the vast majority is training primary care doctors, but this trade-off is difficult. >> thank you, mr. chairman. >> recognize mr. upton for five minutes. >> thank you, mr. chairman. i want to start off initially by following up on a question that you asked regarding the maintenance of effort. the president said earlier this week that if states could

present a bipartisan proposal on medicaid, that he would like to support it, and if there is broad, bipartisan support to repeal the maintenance of effort, would that be something you'd like to work with us on to see it happen? >> well, the president has directed me, chairman upton, to work with the governors around this proposal, so i'll be very actively involved. and he is eager to see their, their ideas. i think what we are eager to do and have pointed out to a number of governors is the focus of the, a lot of the cost drivers is the so-called dual eligible which is why congress was wise enough to include a new office of dual eligibles as part of the affordable care act structure. it's about 15% of the population of medicaid beneficiaries and over close to 40% of the cost

nationwide. so we are really eager to work on those issues. >> now, i know this happened all earlier this week, so there's not been a lot of time, but have you identified a subset of republican and democratic governors that'll be the lead that you're going to work with yet? >> that is not, believe me, i'm very deferential to my former colleagues. the national governors' association, governor heinemann from nebraska is the vice chair this year. they've been asked to put together a governors' group. >> okay. let me ask you, in your testimony you discussed the state-based health insurance exchanges that were created by the new law. as noted in your budget, you are provided a mandatory appropriation, not simply an authorization of such sums as necessary to issue grants to states. is there any monetary limitations to the grant-making authority? >> no, sir.

>> the -- >> with the exception that the exchanges have a series of legal parameters that have to be met in order to draw down funds. >> under section 1311h it authorizes your department to force doctors, hospitals and other providers to meet new quality requirements or face expulsion from contracting with any qualified health plans offered in the exchange. has hhs started to draft any regulations yet on that, those provisions? >> mr. chair -- >> you're aware of? >> mr. chairman, i am not aware of any mandatory provider provisions or expulsion. i will be glad to answer that question in writing. i don't -- i'm not familiar with the section that you're speaking of off the top of my head, i'm sorry. >> okay. before the house budget committee two weeks ago i want to say richard foster, cms, was

asked about two of the main claims that the supporters of pppaca talked about. first he was asked about whether the claim that the law would hold down costs, whether it was true or false, he said false more so than true. and second, he was asked whether americans, whether they could keep their health care plans if they liked them, and he indicated that it was not true in all cases. so those are his words. do you agree or disagree with some of the things that he said? >> mr. chairman, i've read mr. foster's testimony, and i think that what he has indicated is that he does not feel it is like hi that congress followed the outlines of the law. if, indeed, the law is changed, there will be a different result. we believe the congressional budget office analysis that -- which was updated just, i think,

ten days ago that $230 billion would be saved over the next ten years and a trillion dollars over the two decades is an accurate assessment. if, indeed, the law is changed, there needs to be a different assessment. >> last question i have is regarding the grandfather status on the health care plans. by some estimates provided in your department, anywhere between 87 million and 117 million americans will not be able to keep their health care plan. does the administration continue to claim that the health care law will, in fact, allow their plan, allow americans to keep their plan if they like it? >> mr. chairman, the law is built around the private insurance market, and as you know, employers voluntarily enter that market and make decisions a year at a time on plan design, on provider issues,

on network issues. the grandfather clause is designed to make sure that as much as possible without shifting major financial burdens onto consumers or dramatically changing benefits that plans can, indeed, keep exactly the plan moving forward making adjustments in premiums as they go along. but nothing precludes what has been part of a dynamic market in the private sector all along which is that employers choose year in and year out moving in and out of a marketplace. >> the gentleman's time has expired. chair recognized the ranking member of the full committee, mr. waxman, for fife minutes. -- five minutes. >> thank you, mr. chairman. as i mentioned in my opening statement, i'm deeply concerned about the cuts proposed for the republicans for the remaining seven months of this fiscal year in their continuing resolution,

h.r. swz 1. i have a letter, mr. chairman, i'd like to insert in the record with unanimous consent from the social security administration to its employees. >> without objection, so ordered. >> this letter states that the social security administration may have to initiate furloughs if budget cuts being considered by the house become law. why would that matter to medicare? madam secretary? >> that the social security administration -- >> right. well, the social security administration processes the new enrollments into medicare. furloughs at the social security administration would lead to backlogs in processing new enrollment and gaps in coverage for nearly half a million new medicare beneficiaries. so that should be of concern not just for social security, but for the medicare program. >> well, and, mr. waxman, as you know this year the first of the baby boomers became

medicare-eligible, so we are seeing an expanded medicare beneficiary class this year and every year of the immediate future. so enrolling people in a timely and accurate fashion is hugely important. >> so that would really bop the baby boomers who are becoming -- >> 2011 is the first baby boomer medicare-eligible class. >> mr. chairman, i have an analysis from the democratic staff that i'd like to ask for unanimous consent to insert into the record. >> without objection, so ordered. >> this memo documents the size of the cuts proposed by the republicans. some of these numbers are just shocking for programs overseen by your committee. republicans propose to reduce funding for cms, the agency that runs the medicare and medicaid and the children's health insurance program by 23% once you consider the fact that the year is almost halfway finished. this is not a little haircut or a matter of finding some efficiencies. that kind of a cut could prevent

cms from performing it core duties; paying for the health care needs of seniors, persons with disabilities, mothers and kids in medicare and medicaid and c.h.i.p.. madam secretary, would you be concerned about the impact of a proposed 23% cut combined with delays in processing the new enrollments? >> mr. chair -- i mean, yes, congressman. [laughter] it would be very difficult to continue the services to the american people. as you know, the administrative costs for medicare in the budget year 2010 included no affordable care act implementation because there was no affordable care act. so what we're talking about is an enormous reduction in the overall ability to administer medicare, medicaid, the children's insurance program at a time when there are significantly more beneficiaries in each of those proms around

the country. -- programs around the country. >> and it's not limited to cms. vital public safety functions would be jeopardized across your department. for instance, fda would be cut and face an effective cut of 17% for the remainder of this year. wouldn't this be a cut of -- wouldn't a cut of this magnitude seriously undermine fda's responsibilities to rapidly identify and respond to food-related health threats in it mission to protect patients from faulty or substandard drugs or devices? >> well, congressman, the president has recommended about a 31% increase in the food and drug administration because of the new responsibilities with the historic food safety act -- >> but he didn't anticipate this kind of a cut in this year. he was proposing more money for next year. >> no, sir. >> the republicans are proposing to cut a billion dollars in funding to the community health centers as part of a shocking nearly 50% reduction for programs administered by the

health resources and services administration. hrsa. that cut could result in the closure -- no, would result in the closure of 127 health centers and countless layoffs. wouldn't that jeopardize access to patient care? >> well, community health centers have long been a bipartisan effort to build a public health infrastructure delivering low-cost, high quality preventive care around the country, and that would seriously impact people's health services. >> and for my last question, every state has a different medicaid program, there's flexibility already in that program. at tuesday's hearing governor barbour and herbert exinltded the -- talked about flexibility. don't allow government -- in addition, no cost-hairing

measures can be -- cost-sharing measures can be imposed. madam secretary, can you talk about the flexibility that is already in the system and how that is balanced against the minimal levels of beneficiary and provider protections with regard to cost sharing access to providers and more? >> the medicaid program, as you say, is a federal/state partnership, and the program does look different in states around the country. the program already has enormous plex about -- flexibility, and the affordable care act gives even more flexibility. designing benefit packages, designing for some of the upper income beneficiaries, cost sharing, making sure that optional services in some states are part of the package, this other states they are not. so there's a wide variety of program designs. some are entirely in managed care, others are not.

we are working actively, as you know, the nation has a host of brand new governors and working actively with each of those states to not only give them a snapshot of what their program looks like, but also the strategies that have been implemented in other parts of the country that have been very effective in delivering care and saving cost. >> thank you, the gentleman's time has expired, and we'll yield five minutes to the vice chairman of the committee, dr. burgess. >> thank you, mr. chairmanment chairmanment -- mr. chairman. the democrats did have an entire year with which to come up with their budget and appropriations, and it's only because they failed to do their work that we're doing this cr right now. let me direct your attention once again. i know -- >> the house passed it, the -- >> chairman. reclaiming my time, chairman pitts' referenced judge vincent's ruling in florida from

earlier in february, and i sent you a letter on february 10th asking you about the implementation plans of hhs to which i have not yet received an answer. my concern is judge vincent in his ruling said that a declaratory judgment is the functional equivalent of an injunction, and he went on to say that officials of the executive branch will adhere to the law as declared by the court. as a result, the declaratory judgment is a functional equivalent -- the declaratory judgment is a functional equivalent of an injunction, there is no reason to conclude that this should not apply here. you, apparently, feel differently, and we heard from our governors earlier this week that they are, in fact, feel like they're on -- i think governor herbert said shifting sands. you feel ultimately the individual mandate will be upheld as constitutional by the supreme court. judge vincent felt otherwise. we are in a period where i wish

we could accelerate or expedite the supreme court, but apparently i don't get my wish. the supreme court will likely rule in june of 2012, and that is a long time for the states to look at this and wonder which direction do we go. you could certainly provide some guidance and some help by saying, you know, we're going to look seriously at what judge vincent said. so i still await a response from your letter, but could you briefly give me some, some comfort that you're going to comply with the judge's order? >> congressman, i think it's far from clear what judge vincent's order indicates, so the justice department has gone back to the judge to ask him for a clarification of his order -- >> yeah. reclaiming my time, again, i think he stated as clearly as he could he is going to restate that, and i look forward to his decision as well. but, honestly, the decision of a member of the executive branch not to adhere to the directive of the court is -- >> did not file an injunction,

as you know, which is the standard procedure, and we've asked him to clarify and look forward to -- >> but governors all across this country right now including my state of texas, and i know attorney general greg abbott is very concerned about, you know, what do we do now because we don't know? >> there isn't anything now done -- >> i look forward to your written response to the letter i spent you a month ago, and i hope you will provide that for us. we heard some of the questions have already centered around some of the issues of mandatory funding within the law that was signed last year. and i'm particularly concerned about section 4101 both a and b, 4101a provides mandatory spending for the or construction and only the construction of school clinics. 4101b creates new discretionary funding for paying the doctors and nurses who are going to work in those school clinics. i guess the question is, why is

the construction mandatory and paying the staff discretionary? >> that's the way the bill was constructed by members of congress. >> by members of the senate finance committee staff. and to take up where chairman upton was talking just a moment ago, i would draw your anticipation in the law to -- attention in the law to section 1311 it's on page 79, 78 of my copy of the law where under enhancing patient safety beginning on january 1, 2015, a qualified health plan may contract with, part b, a health care provider only if such provider implements such mechanisms to improve health care quality as the secretary may by regulation require. i mean, that's pretty specific too. so where are you going with this, what have you directed your staff to look at? again, providers all over the

country are asking me, what does this mean for us? well, again, perhaps i could get that response in writing. >> i'm -- >> but, you know, i think -- look, we switched sides here in january. the reason we switched sides was because of this law. it is precisely because of this type of language in this law that the american people looked at this and rejected the notion of what was forced upon them last year. there is unprecedented power now that goes to your office, unprecedented spending that goes to your office. these are decisions that are made exclusively by the secretary of health and human services. at no other time in our history has so much power gone to one federal agency. can you understand why the american people are understandably concern by what has happened to them? >> congressman, i think the american public should should be alarmed if we are paying taxpayer dollars to any provider or hospital bed of over 50 which doesn't have a quality system in place. >> but is quality determined by

the secretary? is quality determined by the secretary and no other -- no right of appeal, no secondary motion may be be made, only by the secretary. >> within the cms guidelines in terms of payments for medicare payees that when that rule is promulgated, there'll be plenty of public input. but, again, i think it would be alarming if we paid taxpayer dollars -- >> the rules have gone without public comment. >> gentleman's time has expired. yield five minutes to the ranking member emeritus, mr. dingell. >> thank you for your courtesy. welcome, madam secretary. it's a pleasure to see you here. your old dad who served on this committee with me and worked in this room would be very proud of what you're doing, thank you. questions. with regard to the affordable care act, the continuing resolution, h.r. 1, makes a number of blunt, reckless cuts in programs that are critical to

the health and well being of the american people. at the same time, the affordable care act has begun implementing historic consumer protections including insuring coverage for children with pre-existing conditions, prohibiting rescissions on coverage by insurance companies, allowing children up to 26 to stay on their parents' insurance amongst others. under h.r. r. 1 cms would receie a cut of 458 million or more than 23% of that agency's 2010 budget. will h.r. 1 delay or impede the implementation of the consumer protection provisions of the health reform act, yes or no? >> yes, sir. >> madam secretary, would you please give us, for the record, a statement as to how and where these cuts will come and what will be the effect on the, on the programs involved? madam secretary, the affordable care act provides seniors on medicare with a 50% discount on

brand name drugs, a critical step towards increasing the coverage under medicare part d. will h.r. 1 they or present -- delay or prevent the seniors from receiving this discount, yes or no? >> mr. chairman, the cuts to medicare services will -- >> but it is a danger? >> pardon me? >> but it is a danger that it will effect those provisions? some yes, sir. >> all right. madam secretary, just yesterday we heard from integrity group directer john spiegel regarding antifraud efforts at cms including the new tools provided by aca to prevent fraud before it occurs. will h.r. 1 delay or harm efforts to prevent fraud, waste and abuse in medicaid or medicare, yes or no? >> yes, sir. >> would you submit for the record a statement as to how and why? >> i will. >> madam secretary, with regard to food safety, as you know,

another important undertaking is the implementation of fda food safety modernization act. this legislation made historic investments in our food safety system and provided new authorities to help fda to prevent food safety programs before they occur throughout the food supply. h.r. 1 included $241 million in cuts from the fda. will this cut or these cuts impede fda's ability to implement the food safety modernization act, yes or no? >> yes, sir, they will. >> would you, please, explain that for the record, if you please, madam secretary? is. >> yes, sir. >> madam secretary, last congress i am joining with my colleagues, mr. waxman, mr. stupak to introduce legislation that would give the fda resources it needs to protect consumers from unsafe drugs and to monetary the safety

of our drug supply. will h.r. 1 impede fda's center for drug evaluation and research from evaluating and monitoring drugs for safety and effectiveness, yes or no? >> yes, sir. >> madam -- would you submit an explanation as to why that is so? madam secretary, the fda has consistently -- is consistently and chronically underfunded, and i continue to hope that fda will get needed registration fees to help fully implement the food safety law. i know that those fees would have -- were approved by and supported by the industry. do you believe that registration fees are necessary to implementing the food safety modernization act, yes or no? >> yes, sir. >> madam secretary, you have been requested or the department has been requested to produce documents for the benefit of

this committee. i would note, madam secretary, that hhs has produced over 50,000 documents. i note at significant expense in response to the committee's requests related to the waiver process and the creation of ccio. would you submit to the statement or, rather, submit to the committee a statement as to how you have complied with that request for papers and documents and what, what seemed to be the problems, if any, that exist with regard to the committee's requests for information? >> i, i'd be happy to submit that. >> madam secretary, we have completed our business with 11 seconds over. >> thank you. >> the gentleman's time has expired. we recognize mr. barton. >> thank you, mr. chairman.

welcome, madam secretary. congratulations to your jayhawks for beating my texas aggies last night in basketball. y'all were the better team. i think dr. burgess asked this question, but i may ask it in a little different way. i think you're very well aware that a federal court has recently ruled that the health care law that became law last year is unconstitutional. as the chief administrative executive in charge of implementing that law, was your position -- what is your position on agreeing to the court order and ceasing to implement the new law? to you intend to agree with it -- do you intend to agree with it? are you going to ignore it? are you going to appeal it? could you enlighten us as to what your position is on this recent court ruling? >> well, congressman barton, thank you on behalf of the hawks. >> yeah. >> we have sought a clarification from judge vincent

about the implication both for the plaintiff state thes as well as -- states as well as the membership of the nfib which is one of the plaintiffs in the florida case. once we get that clarification, we intend then to take next steps. in the meantime, we are actively implementing the law because as you know, judge vincent is now an outlier in terms of what the other federal judges, four other judges who have ruled have ruled very differently than the judge. so we're seeking clarification and continuing -- >> what's your timeline on that? >> well, the plaintiffs and the -- we expect to hear back from the judge soon. the doj has filed their clarification request, the plaintiffs have responded. this weekend the judge indicated he would rule very quickly. >> is it once that information is received from the judges, who's decision is it?

is it your decision, is it the attorney general's decision, is it the president's decision or all of the above on how to proceed? >> well, our legal team is led by the department of justice, so we defer to their legal counsel. >> do you, do you have official input into the decision? in other words -- >> to the legal counsel's -- >> well, you you are the secrety of health and human services. >> i understand. our legal counsel is involved with the justice team, but they are proceeding to have this dialogue with the court. >> okay. i would disagree with you that the judge's decision was an outlier. my understanding is that if you're keeping score it's 2-2. so i don't -- >> no, it's 3-2 -- >> have we had another one? [laughter] >> i have to keep an accurate score. of and as i say, there are 12 who have dismissed the case outright. so -- >> all right.

>> and, congressman, the clarification i would make is that in the other decision which came out of a court in virginia where the judge found an individual responsibility to be the one portion of the law that he found unconstitutional, he disagreed with judge vincent's description that it was essential to strike down the entire law, and that's what i meant in terms of the outlier. >> i'm aware of that. i guess one last question on that. is it conceivable that the obama administration would appeal direct -- if decision is to appeal -- would appeal directly to the supreme court so that we get this thing solved, hopefully, before the next presidential election? >> congressman, the attorney general of the state of virginia has filed an expedited appeal to the united states supreme court

asking them to grant cert in the case in virginia. the administration has opposed that decision to expedite, but that is now before the court. so that's ripe, and the court will make a decision on whether or not they intend to expedite this case. >> my time's just about expired. i've got a number of questions for the record i will submit in writing. my final question is on the nih. several years ago we passed a reform bill through this committee that was signed into law. that bill was a reauthorization bill. it lapsed several year ago, and it's up for renewal. i'm going to encourage chairman upton to have a hearing and, hopefully, do a reauthorization on that later this year or next year. but in that was the creation of a common fund to try to get more cross-insemination between the various nih organizations. have you followed that, and if

so, could you give us an update on how you believe that common fund is operating? >> well, mr. chairman, i know that the new directer of the national institutes of health has taken a great interest in the common fund and has been actively involved in not only seeking to fill gaps in research, but directing it to the most promising options he feels in the research field. so i think it has been something that has been definitely a stream of funding that has been very important and one that i would be happy to get some detail from dr. collins on exactly where those funds are being directed. but it's something that he takes very seriously. >> thank you, madam secretary, and thank you -- >> gentleman's time has expired.

chair yields five minutes to the gentleman from new york, mr. engel, for questions. >> thank you, mr. chairman. i've been listening to the whining and complaining on the other side of the aisle, and it just really boggles my mind. madam secretary, the bottom line is do we want to provide american citizens with health care or don't we? i know there hasn't been any enthusiasm for the affordable care act on the other side of the aisle, but, you know, let's try to improve it rather than try to destroy it. i noted with a bit of a chuckle the assault on the massachusetts law. the fact is that the governor of massachusetts came here and said that the law is working, and i wonder if governor romney is going to run on his strong implementation of ha law in the republican -- that law in the republican primaries when he runs for president? madam secretary, what are the most dangerous things in the republican cuts as you see it

from your very important point of view of providing health care for americans and all the other things that are in the republican plans for funding the government? what do you see as the most draconian of the cuts and how it would effect the health of the american people? >> congressman, president feels strongly that education, innovation, building are key blocks for the future, so the investment in early childhood education which pays huge dividends down the road, the investment in scientific research to keep us at the front of biomedical innovation, the infrastructure for public health delivery with community health centers and funding the training of providers, all of those are jeopardized without, you know, having adequate funding in the future as well as essential services. the center for medicare and

medicaid are looking at increased beneficiaries and a very restricted budget, and our efforts to have new fraud, and abuse efforts which are really paying off are very much in accept jeopardy. very much in jeopardy. >> you know, what i see in terms of the republican plan for funding the government, it's not a matter of the fact that we need to cut to balance our budget. we do need to balance our budget, and i find it odd that we're giving these huge tax breaks to wealthy people that blows a hole in the budget, and i find that very interesting, but it's an attempt as i can see it to get rid of all the programs republicans haven't like canned to try and tie it in and try to use the budget problems to do that. you know, we see it on the state level in wisconsin, we see it all over the country, and we see it on a national level as well. we had governor barbour here, and he complained that he didn't, he didn't like the affordable health care act, and

he would agree to a block grant. do you think the people of mississippi would be percent off four years from now -- would be better off four years from now under the governor's block grant or the affordable care act? >> congressman, i don't know a lot of the details about the mississippi health care situation. i do know that they have a population that by poverty level qualifies them for the highest fmap rate, and one of the challenges of any kind of block grant is if you would look at the recent economic downturn when millions more americans qualified for medicaid because they lost their jobs or their incomes took drastic downturn. no state would have any help from the federal government in responding to that. it shifts huge burdens, frankly, onto state basis and doesn't have a federal partnership moving forward expwh.

>> let me ask you this, there have been a number of criticisms about the preinsurance program. first there was concern over whether there would be enough money, then we heard very few have enrolled. how many people have enrolled and what changes have you made to the program in response, and let me throw out another question tying in the with this. governor barbour at tuesday's hearing asserted they were unable to run the program. so were state given the opportunity to run the program? could they have run it in combination with existing high-risk pools in the states? a high-risk pool was essentially a tattered feature in the republican proposal for health reform debated right in this very committee last year. i wonder if you could comment on those things. >> well, there are now approximately 12,000 people across this country who are enrolled in their state or the federal high-risk pool, and the

enrollment increased by about 50% over the last couple of months. many states are finally got their programs set up, are doing aggressive outreach, are informing people. but as you know, there's some pretty strict requirements. you have to be uninsured for six months which is a barrier to a lot of folks, and the insurance even though it's capped at market rates is still not inexpensive coverage. this was always ce -- designed as a bridge strategy to try to get to 2014 when the market rules will change, and for the first time ever in the history of this country we will have insurance available without regard to people's pre-existing health conditions. they will be able to participate in a broad-based pool. >> gentleman's time has expired. chair recognizes the gentleman from illinois, mr. shimkus, for five minutes for questions. >> thank you, mr. chairman. madam secretary, welcome. we've been waiting to visit with you for a long time. i would just state that, you

know, it's funny that you mentioned nfib which is a national federation of independent businessmen were plaintiffs when i thought they've got such great small business tax credits that i wouldn't really expect them to be in opposition to this law. i'm just surprised to hear that. the other thing, you were a governor of a state, and i would imagine that had you been governing -- did you ever pass -- when, under your governorship, was budgets passed? did you pass budgets when you were governor? >> yes, sir. >> was the chambers held by just democrats in the senate and the house? or did you have -- >> never. >> what's that? >> never. >> never. and can you passed budgets? >> we did. >> and in the last congress we held, democrats held the house of representatives. that's true, right? >> and the house passed a budget. >> and they also passed the

senate? >> they did. >> and we have a democratic president? >> yes, we do. >> and we didn't pass a budget? >> i think the house passed a budget -- >> my -- i'm, i guess i am trying to be a little cute. the point is the democratic attack on the cr is because of their failure to pass a budget. so they can, they can position all they want. you know, we're in the majority because they can't pass a budge. >> will the gentleman yield -- >> no, i will not. we're in the majority because they passed this bill, became law. we're in the the majority because they passed cap and trade. our frustration is the last time you visited this committee was february 4, 2010. the last time. this bill was not even the law of the land. i became ranking member of the health subcommittee after that vote nathan diehl left, and i

think i asked the then-chairman waxman and frank malone who really is a great friend 19 times to ask you to come visit us. you never came. why? why didn't you come after the law to help us understand the provisions and the implementation of this law? >> congressman, i responded to the requests that i got. >> so you're saying we never requested you to come back? >> yes, sir. >> okay. so chairman l waxman did not ask you to come back to help explain this law? >> would the gentleman yield? >> no, i will not. >> referencing the -- >> no, i will not. >> and it's not -- >> i will not. will you answer the question, madam secretary? chairman waxman -- >> congressman, i will go back. i need to look at the record.

>> okay. will you submit the answer for the record in writing? >> i will be happy to. >> thank you very much. let me go -- this is really a budget -- our frustration is there's so many particular problems and concerns we haven't had a chance to really talk to you. this is a budget hearing, so let's talk about a budget issue. in that february 4, 2010, hearing i asked you a question. it was kind of the same way. and then you admitted that the $500 billion medicare cuts -- there were there are 5000 billion in medicare cuts, is that correct? >> no, sir, it is not correct. >> well -- >> the 500 -- >> reclaiming my time, i would refer you to the transcript. >> sir? >> and i'll read it, if you want me to. >> the growth rate -- >> mr. shimkus, so the president supports cutting $500 billion in medicare, yes or no? secretary sebelius, the president is supportive of the health reform legislation. is that a yes? secretary sebelius: i said, yes, sir.

so our problem in this whole debate -- >> the decision didn't include 500 -- >> madam, my concern is the budget hearing. so there is a, there is an issue here on the budget because your own actuary has said you can't double count. you can't count 500 -- they're attacking medicare on the cr when their bill, your law cut $500 billion in medicare. then you're also using the same $500 billion to what? say you're funding health care. your own actuary says you can't do both. so my simple question, i have 26 seconds left, what's the $500 billion cuts for; preserving medicare or funding health care law? which is it? >> sir, the affordable care act has 12 years the medicare trust fund according to every actuary, and the clash 500 -- 500 billion

represents a slowdown from what was projected at 8% to -- >> so is it medicare is using it to save medicare? or are you using it to fund health care reform? which one? >> both. >> the gentleman's -- >> so you're double counting. i yield back my time. >> gentleman's time has expired. chair recognizes the gentle lady from california -- >> i'm pleased to yield ten seconds to the ranking member of the subcommittee. >> i just wanted to say, mr. shimkus, you shouldn't be asking the secretary about whether we invited her. fact of the matter is, mr. waxman and myself did not invite her after the health care bill passed, and you could simply address that to us, and the answer is, no, we didn't invite her. it's not that she failed to come. we did not invite her. >> thank you. >> thank you. >> thank you, mr. pallone. thank you for your testimony, madam secretary, and welcome to our subcommittee. i want to acknowledge and support the interest that was

expressed by former chairman barton in the common fund. he's describing and you answered how much the current secretary of nih or chairman of nih is supporting it as well was his idea, you got it funded in 2006 and point out to my colleagues that h.r. 1, the continuing resolution, cuts $48.5 million from the common fund. you know, these are tight fiscal times, and i think the president's budget identified various smart investments that will pay off improvements in the nation's health and economic stability. the president's called on our nation to come together to outeducate, outinnovate and outbuild our competitors. as a nurse, i'm concerned about strengthening the health work force. we face a primary care shortage now, and as we move into implementation of health reform, we're going to need an even more robust work force. the act lays out a path for that

work force creating work force enhancement, providing primary care providers a pay increase through medicare and medicaid and providing enough funding to more than triple the national health service core. but we need to support these programs, so i am very concerned that the house continuing resolution would cut work force programs by about $145 million from the fiscal year 2010 level slashing vital title vii and viii programs by a third. i'm particularly worried about title viii programs. we have a nursing shortage. last year over 50,000 qualified applicants were turned away from nursing schools due to budget constraints and the lack of faculty to train them. madam secretary, you understand this. the president's budget provided an increase in these same programs. can you discuss the steps taken in the budget to strengthen our health care work force? and increase the numbers of jobs

which will result there that? >> well, congresswoman, i think there's no doubt that the president shares your concern about the health work force of the future which is why he has made it a focus each year in his budget and why, i think, the affordable care act also focused on work force enhancement. so the budget would include support, as you say, to train about 10,600 national health service of core providers, train an additional 4,000 new primary care providers over the next five years. the prevention and public health fund allocation would also increase the number of nurse practitioners, 600 nurse practitioners would be trained, 600 new physician assistants across the country would be available with the establishment of new community health centers,

there would be providers available in the most underserved areas. so there are a whole series of work force enhancements that would be jeopardized either by defunding the affordable care act or not passing the recommended president's budget. >> and what concerns me is that the house continuing resolution would be a reduction of 54% cutting our work force programs by more than half of in all of the areas that you specified. i think this is going to devastate our health care work force, and i hope you'll just quickly agree with me. >> yes. >> thank you. [laughter] i needed that for the record. what puzzles me is that i know my colleagues across the aisle have expressed concerns that we don't have enough health care work force, but i share their concern, and the key to addressing this problem is right in front of us. and yet they propose cuts that will make the situation worse. their budget will hamper efforts to fill the gaps that we have today. and just as the demand for health care professionals

increases. in my last minute i'd like to address something you mentioned in your remarks which are the $4 billion in waste, fraud and abuse that hhs and the department of justice has recovered just in this past year. $4 billion that was saved for american taxpayers. when i'm home meeting with my seniors and health care advocates about how they can be active participants now in looking for waste, fraud and abuse -- we want this to continue. some of it is in the medicare payments. would you expand upon this $4 billion in savings and ways that we can look to increase this amount over the future? >> well, the president's budget, again, has requested additional resources. this is an enormous payoff in terms -- >> yes. >> -- dollars returned for dollars spent. we're building new data systems that can allow us to spot billing irregularities in a much more timely fashion,

recredentialing providers, we'd like to expand strike forces which have been enormously helpful in the fraud hot spots. but this collaborative effort with not only our partners at justice, but local attorneys general and states have been enormously effective so far, and we hope to be able to broaden and expand that outreach. >> chair recognizes the gentleman from pennsylvania, dr. murphy, for five minutes for questions. >> thank you. and thank you, madam secretary. three things i'm going to try and put out that we agree on. first of all, pitt and kansas both deserve to be in the final four. [laughter] a yes would be good. i'll take that as a yes. >> yes. >> number two, this committee worked very hard together and my friend and colleague gene green and i worked on, and it passed the house 417-1, a bill to allow doctors to volunteer at community centers. huge numbers of people will go to the health centers.

the cbo, however, just said that using the federal torts claim act and using only those numbers, i think the cost over several years was 30 million. but i'm asking if your department could work with us in coming up with a more detailed analysis if we allowed doctors to volunteer at community health centers, what would the cost savings be in terms of allowing more patients to -- >> i'd be glad to work with you. that'd be extremely helpful. -- >> that'd be extremely helpful. that'd be very helpful, and i have no doubt that this committee and this house will pads it again. will you help nudge the senators, help them understand the great value in this as well? we don't try and put pressure on them, but perhaps you can add some wisdom to them. second thing -- third thing, the national traumatic stress network, it's a group of academic and community-based centers that give, that

disseminate excellence in care of traumatized children. when i read your budget proposal, however, it seems like the administration -- although you were supportive of the program, there were some cuts to the program. actually, it cut the funding from 40 million to ten million, but at the same time the budget's calling for major increases in this spend anything a number of other areas such as for military families' initiatives for service grants, some things for homeless, some things for health information technology programs, four million there even though we put 20 billion on h.i.t. and other areas. and certainly you know that with regard to homelessness, there is a high correlation between childhood trauma and homelessness, and in my own experience of working with servicemen and women at bethesda naval hospital, my own clinical experience as a psychologist also tells me there is a higher risk for people with ptsd and

homelessness and other trauma if they themself expire a great deal of trauma in their lives when they were younger. and i think you have, like, 2.37 billion in homeless fronts through hud and other things for veterans, although i believe the va should be handling some of this. is this something you're able to relook at and see that perhaps we should be spending more in the early treatment and prevention, let the va handle some of the other things for veterans, but to revisit that to make sure we're not cutting some of the treatment programs out of the childhood treatment of trauma? >> well, i would be glad to have that discussion with pam hyatt who is the directer of the substance abuse and mental health services. i can tell you she's absolutely committed to prevention as being the most effective treatment possibility, so i will, i will certainly circle back with her about your concern about that particular program. >> thank you. i know that the va, for example, has 14 homeless programs and

initiatives, and although i do want to support all those, i also recognize that we're, we would do well to help prevent some of these problems for a lot of them too. finally, in the area of of medicare and medicaid, those programs were designed in 1965, and i often times liken it to none of us are driving a 1965 car, and if we had one, we'd put a lot of patches and repairs over time. whenever i talk to cardiologists, 40% of our money is spent own cardiovascular decide. when we -- disease. when we ask the question were you to design medicare today, would it look anything like the medicare of 1965, and i'm assuming you would agree, no. can you tell me what major initiatives you have in mind particularly for some of the major disease entities such as cardiovascular, lung disease, cancer, etc. >> well, congressman, affordable care act actually includes a

major direction that the medicare incentives be redesigned and aligned with quality outcomes and health care strategies that we know are not only more patient-centered outcomes like medical home models and bundling care to prevent unnecessary hospital readmissions, but the medicare incentives i would say are right now aligned to volume and not value. so we are in the process through the centers for innovation, through working with providers across this country to try and capture the best possible patient practices -- >> i hope you'll do that. my time's up, they have standards and protocols, and i hope you'll look to them for guidance. >> we're working very closely with them, thank you. >> thank you, mr. chairman. thank you, madam secretary. >> the chair thanks gentleman. the gentleman's times has expired. chair recognized the gentleman

from texas, mr. gonzales, for five minutes of questions. >> thank you very much, mr. chairman. welcome, madam secretary. i do want to address a comment that was made by a fellow texan that the uncertainty that is out there regarding the constitutionality of the mandate and wondering what the texas attorney general has to do, he's wondering what he has to do as well as our governor, rick perry, what those two gentlemen also represent me, and i do have a suggestion as to what they could be doing in the meantime. they could be coming up with a solution to make health care insurance affordable for texans. so that employers have access to it at a reasonable price to offer it to their employees and that texas, its citizens, have affordable insurance products available to them. so that we don't lead the nation in the uninsured. that's what they could be doing. that's just a suggestion.

i'm sure they've thought of it. we've heard that the american people want us to balance the budget, reduce the national debt, and we all agree, and i think the president's fiscal year 2012 budget places us in a good place to accomplish that. but i don't think the american people said, and while you're doing this, expose us to dangerous drugs. or continue a health care insurance industry that does not provide us adequate, affordable, accessible coverage. i don't think they said that. so i join you, and i join the administration, and i believe that i join members on the other side of the aisle in that objective. and we may have different plans on how to get there, but the truth is nothing was done until we passed the affordable care act. the discussion is ongoing, and

it will be a continuing debate. but the need still exists, the problems still exist. we can debate this thing and just continue to hemorrhage. so i will ask you this, madam secretary, we hear so much about market forces and just let the free markets take care of all of this. and i think in large measure we all agree with that, to a point. until the markets are dysfunctional, until the markets don't deliver what is necessary without the incentives and the direction sometimes and a push and a shove, but mostly a collaborative effort which i think is what the president is seeking to do. when it comes to the fda, why not just let an industry police itself? why don't we just let 'em to that? >> well, mr.-- congressman,

we've seen, i think, the result of a lack of regulation in way too many areas that have just gone terribly awry. i think the fda is, certainly, seeking to make sure that the 25 cents of every consumer dollar which comes in a product that is under the umbrella of that agency, whether it's drugs and d.c.s or our -- devices or our food supply is safe and secure. and, frankly, i think in many cases the industry is very supportive of those efforts in the food debate for the new food safety bill that we gist had, the -- just had, the industry ultimately takes the economic hit from an unsafe product being available to consumers. there's a huge ripple effect that ends up penalizing the food industry. so they are eager for regulatory oversight, and they're willing and able to actually help finance that regulatory oversight. >> and i do believe it's a

collaborative. it's a partnership. but i think government has a responsibility. to protect the welfare and safety and health of our constituents. that's what we were hired to do and provide them with opportunities. finish the last question is and i'm very concerned about nih because i'm having all of my universities, they're all coming -- and these are democrats and republicans, and they all have, basically, the same question: what's going to happen to replace those particular funds that are so essential? again, why is nih so necessary? why don't we just allow the public -- the private sector to make those funds available to our universities? >> well, congressman, as you know, one of the areas that the united states leads the world is biomedical research, and it has been an enormously important partnership between the commercial industry and the

research that goes on in universities across the country funded in large part by nih which is why, i think, the president has recommended a, an increase to the nih budget which is already looking at a, losing the two years of enhanced funding from the recovery act and trying to make sure that we continue those breakthroughs that are happening all across this country. >> thank you very much. thank you, mr. chairman, for your indulgence. >> gentleman's time has expired. the chair recognizes the gentle lady from tennessee, ms. blackburn, for five minutes for questions. >> thank you, mr. chairman, and thank you, madam secretary, for being with us. i found your opening statement a little bit curious. you mentioned that you think that it's the responsibility of the administration to give every family and business the chance to thrive while making the investments that will grow our economy and create jobs.

and i, i just have to tell you being out there and holding listening sessions in my district and with some of my colleagues the american people do not want to be dependent on the federal government for their cars, their loans, their home loans, their housing, their education and their health care. what they would like to do is see the regulation reduced and to see the federal government get out of the way. so i would ask you, do you have any data that shows that businesses are actually getting relief on the cost of the insurance that they are paying every year? do you have any data that is verified that says this is lowering costs? because we are hearing the opposite and are actually being shown bills and estimates for that. >> congresswoman, if you're talking about data as a result of the affordable care act -- >> yes, of obamacare. yes, ma'am. >> law was signed just about a

year ago. what we have seen is with the enhanced rate regulation there are numbers of states that actually have used those new tools to lower the 'em pact of -- impact of rate increase -- >> could you supply that? >> i would be with happy to supply that. >> we are not seeing that in tennessee, and i know tennessee had o to come to you for one of the 900 waivers. i know they're appreciative. when you grant a waiver, and be it seems like all of you are doing more of that, is that waiver, does that take the elected officials in that state out of the decision making equation? is that waiver granted to the governor's office between cms and the governor's office? because that's the way ten care was done. we as state legislators were taken out of the equation. >> actually, congresswoman with, with -- congresswoman, the traditional waiver was a dialogue between cms and the governor's office. the affordable care act changes

that so now there is a note requirement, there are public hearing requirements, there is input opportunity so the waiver process actually has been amended by the affordable care act to include far more transparent -- >> okay. i'd like to call to your attention, this is the reason it's so important to me. today's wall "wall street journ, obama's health waiver gambit. and it talks about ms. cutter and ms. depaul saying privately to your liberal interest groups that this is a way to increase centralization. for instance, with a state-based public option or even single-payer. and i tell you why this is of concern to me. we had governor patrick in here this week. and his state medicaid directer is on the record having said that when you look at the way the market medicaid works that he's beginning to favor a single-payer. and i would just submit to you this is not what the american people want. they do not want the federal

government that can't tend to the items that are on their plate making the decisions for their health care. and we hear it from them every single day and, ma'am, it is of concern. >> congresswoman, that is not at all -- first of all, we don't design any waiver. the state comes to -- >> i've seen the applications from my state, and i respect that, and i understand that. >> the rules aren't even developed for the program -- >> i do want to move on. fraud. you mentioned fraud. are you able to quantify the amount of fraud there is in medicare and med -- >> no, ma'am. >> okay. so the four billion that you feel like you saved, you don't have a way to quantify what the problem is -- >> if we knew how big it was, we'd hope friday shut it down. >> and -- hopefully shut it down. >> and what percentage of your energy this year is going to go to preventing that fraud? >> what percent of my energy? >> yeah. your resources and energy. when we hear organized crime

getting into medicare and medicaid fraud, i i think it should cause us all. so if you could just let us know your resources -- >> there are significant resources requested in the budget. >> okay. >> for fraud and abuse. >> your '08 budget which we would love to return to those numbers was 708 billion, and you mentioned that you have cut, in your testimony, four programs. but are you -- or you list four programs that you cut. are those the only cuts that you all made, or were there others? >> no, congresswoman. there are about $5 billion worth of cuts. our budget proposal -- >> do you mind getting that list to us? >> i would be happy to us. >> that would be great. you're below 2010 but not down '08. >> chair thanks -- >> mr. chairman, a point of personal privilege here or whatever -- >> yeah, let me just say -- >> the secretary should be allowed to answer the question. >> that's correct. the gentle lady's time has

expired. madam secretary, do you wish to add additional response? you may continue to respond in writing as well be you feel like you've not adequately -- >> thank you, mr. chair. >> the chair recognizes the gentle lady from wisconsin, ms. baldwin, for five minutes for questions. >> thank you, thank you, madam secretary, for being here. earlier i wanted to start by reacting to some of the other comments that were made. i think it was dr. burgess who noted that we switched sides, and it was because of this law referring to the affordable care act or health care reform. and i disagree. i think the last election was about jobs, jobs, jobs. but instead of focusing on jobs, the new majority has made it their first order of business to repeal the affordable care act. that was one of the first votes

we took this session. which is already, in my community, providing life saving coverage to many who didn't have it before and improving their access and the affordability of their health care. and instead of focusing on jobs, the new majority has attempted, also, to deny funding to continue implementing the affordable care act, the health care reform bill we passed last session. instead of focusing in on jobs, the new majority has offered house resolution 1 that moody's earlier this week said would lead to the loss of 700,000 jobs in the united states. and instead of focusing in on jobs, some of our new governors are presenting budgets embedded with policies that would gut medicaid and would this ward --

thwart at the state level the implementation of the affordable care act. precisely what's happening in my home state of wisconsin which used to have a reputation as being a leader in health care and a leader in preparation for the implementation of the affordable care act. now, i don't envy you your job right now. it is, you know, working to implement these vital lifesaving, important reforms when so many are working so hard to see that legislation thwarted, road blocks placed, etc. but i want to focus back on house resolution 1, the continuing resolution that passed in the house a couple weeks ago. i brought an amendment to the floor to restore funding to the community health centers. my amendment was pulley paid for -- fully paid for but, unfortunately, the republicans barred me from offering, offering that. but h.r. 1 slashes over a