seven month of this fiscal year. if this, ultimately, is passed and becomes law, i guess i'd like to hear from you how you even go about implementing that. how does this impact the constituents that i represent who rely on the wonderful community health centers that provide services in my area? i've heard that this will impact coverage to probably 11 million americans. it will result in job losses and closure of clinics. do you drive -- if you were forced to implement such draconian cut, how would you go about that? what would, what would we see at the local level? >> well, congresswoman, i share your view that the community health center footprint is

incredibly important and both with the recovery act and the budget investments and the affordable care act that footprint will double over the period of the next five years serving closer to 40 million people. we are already seeing that increase there, about ten million additional americans served thanks to the recovery act investments, and they are in the most underserved areas, and with those community health centers are providers and often providing a host of community services. so the effort to now deny care, fire health care providers who would lose their jobs and restrict access in the most underserved rural and urban communities to affordable, available health care will just put additional burdens on already strapped city and state budgets. those folks will come through the doors of emergency rooms in the larger numbers, they will be

sicker on the job, they will be unable to take care of their kids, there'll be students who won't do as well in school because their health needs won't be attended to, and i think that has a serious impact not only on the health of this nation, but on, certainly, the the prosperity of the nation. ..

the secretary of hhs has the authority over rules. yes and no. did you make the decision to publish the end of life payment rate without allowing public comment? >> yes, sir. >> i appreciate your forthrightness on that. a really do. it flies in the face of the response you just gave to my colleagues regarding the 1115 waiver program. google describing how informally worked between the department and the governor's office and calling for more oversight and public hearing and transparency. would you agree that in the future rather than making that decision unilaterally even though you have the power to do it, may be time for public comment would have been appropriate? >> the rule as you know follow

the outline that was directed in the affordable care act in terms of the provisions for a wellness visit. in addition we looked at the original welcome to medicare visit and the one element that wasn't -- >> i wish i had enough time to listen to your full answer if you could respond yes or no to that. >> that is what it is not part of the final rule. >> i would hope -- let me move on. in the president's fiscal year 2012 budget your department got $93 billion for information and education signing american workers up for the class act. the same program that you just recently told the senate finance committee few weeks ago that the program was unsustainable. those are your words do you believe it is appropriate for the administration to solicit money from american workers for

a health program that is, quote, totally unsustainable? >> my comment was that was unsustainable as the legislation was crafted but i was given considerable flexibility and we aaron the process of making the changes that will meet the criteria outlined in the law that makes it sustainable without taxpayer support. >> thank you but given the current budget process we have in this country and the think everybody would agree with this, we have a tremendous budget crisis. understanding that you are asking for money to sign people up for program that you say is unsustainable will you pledge today to work with this committee to ensure the class act is truly sustainable before the administration proceeds with program operations? >> i would be happy to do that. >> thank you. the last thing i wanted to

address and this is a follow-on to chairman dingell's questions regarding its are 1 --hr1 and you responded to every one of them yes, that $51 billion worth of cuts would hurt this program and that program and the other program, do you believe that we need to restore fiscal sanity to our budget? yes or no? >> yes, sir. >> do you believe that the $61 billion in discretionary cuts for fiscal year 2011 contained in h.r. 1 will help the government reduce its current budgetary deficit? >> i believe that the president has put a very responsible

budget for bridge? >> i am talking about h.r. 1 and the $61 billion worth of cuts that former chairman dingell was attacking. >> i support the notion we have to make smart and strategic cuts. >> so the answer is yes, i think. and i will yield back my 13 seconds. >> i don't think the answer was yes. >> the gentleman's time with expired and the chair recognizes the gentleman from new york, mr. wiener. >> thank you, madam secretary. as to this notion invited you to testify after passage of the bill had occurred, all i have to sit you is you are welcome. probably no member of the government, maybe even in history has had to spend so much of her time sliding away lies so let me run through things we can cover in 4 minutes and 33

seconds to try to get some truth and big questions of the day. this notion that if you give people a subsidy and incentive to purchase health insurance somehow that they won't want it. the individual mandate is somehow this huge burden. you might not be aware of this but i will tell you the number of people in ronnykaren massachusetts which also had a mandate which chose not to sign up after they had to pay for the penalty was 0.65%. meaning when you offer people incentive to get insurance for their families they take it. the idea that this mandate is here will somehow have a dramatic impact that 1% would be impacted, you can clear up for us. the requirement people get insurance when offering subsidies is because if they don't get it and they are uninsured, when they need

hospital care they pass along to the rest of society. is that right? the second thing is we heard a lot in the repeal efforts about the job killing bill. if we repeal the health-care bill with the subsidies going to small business and tax credits provide health care for their workers making those workers less expensive, with those subsidies disappear if we repeal the bill? >> yes. >> next is this notion about medicaid provided and fund a liability. is it not true that under the bill any additional people covered under medicaid which are poor people who won't be as port because we raise the limit of it, not too a lot bleaker turtle but $30,000 family income, it provides no additional -- until 2017. is that correct? >> that is correct. >> and in 2018, if the number of

poor people in the state goes down meaning the economy has improved and fewer people are poor enough to be eligible for medicaid more people working, those costs go down as well if there are fewer people on medicaid. >> that is correct. >> and i assume that the economy will keep getting better. we have republican governors is a cost will go through the roof. they only go through the roof if poverty in your state continues to go up. is that correct? never mind. beef up the crummy governor part. that is an editorial. the other thing my republican friends have said again and again is this is a trampling of states' rights. secretaries taking more and more control. i will give you a couple things here. is it not true that the exchanges will be run by the state? >> if they choose to do so. >> is not true that the tort laws that are state-by-state but

the people who wrote the law, not to trample on states' rights but the 50 states have their tort laws in effect? is also not true that state insurance commissioners and commissions and state governments of insurance was left intact? >> at the state level. >> we actually empower them. they have the ability to do things. so much for the notion of centralizing power in your office or the federal government. we went in the opposite direction. we did not go the direction i would like with expanding medicare which is a much better idea or spending medicare little by little. we went this way. one final point on the notion of expanding the power of your office these election 15 waivers you have given are an effort, each one is you saying we are going to be flexible to allow to respond to your expression of what is going on in the states and the marketplace and the business. so long as we get to the outcome we all aspire to which is more

people getting affordable coverage. reducing costs along the way. the waiver makes the point this is not the inflexible centralized monolith. it is a conversation going on between states and ises to make sure we get the outcomes we all want. >> i think the bill recognizes the framework that states know their markets best. they're the laboratories of innovation. >> waiver is an expression of that as well. in five minute we did 5, 6, 7, 9 live by the republicans. imagine if we had more time. >> the gentleman's time is expired. the chair recognizes the gentleman from ohio for five minute. >> thank you, mr. chairman for being with us today. unlike the saying -- change tracks a little bit. on page 800 the health safety and well-being of the american

people, child-support and initiative, the things i'm interested in, from three hundred five million since 2012, and $24 billion over ten years for child support and fatherhood admission, this initiative is designed to promote strong relationships by encouraging fathers to take responsibility for their children, changing policies so more fathers continue its commitment -- my first question is it states here that we're going to encourage fathers to take responsibility for their children. what encouragement are we offering? >> it refers to working with states and a more effective and vigorous enforcement of support orders and child-support orders from the outset and making sure there is a financial connection

between fathers and children that they have borne. >> let me follow up to that. is caught my attention. several lifetimes ago in the senate, i chaired the senate judiciary committee and we had a large bill that i sponsored in dealing with juvenile from juvenile crime etc.. one of the judges that appeared before us. it was 1819, the legislation that as we were going through it, it came down to this one judge who caught the essence. we're looking at is an abdication of parental responsibility. the next question would be to we have any current programs, models for success to work with? >> i'm sorry? >> do we have any current

programs or models that will -- if we're going to spend $2.5 billion over ten used we have anything that will show that this will work? >> this is part of the umbrella. i think we have data indicates there are strategies that are more effective than others and we're trying to improve this effort along the way to make sure child-support is not only effectively administered but more of these dollars will go to the children and not dropped a long way. it is a double improvement. >> it really comes down to can government really change folks in the way that you would say none parenting right now? even going back on a father lifetime, by remember when i was

working at a prosecutor's office i asked one gentleman if you go to jail for not paying support for child care? >> i wish there was a lot that would do just what you are suggesting that at a minimum will weaken do is be effective in terms of trying to make sure children and not penalized financially by a father who would walk away. but this also includes fatherhood engagements increases and increase taxes and visitation and those two things are tied together and. father is prohibited from connecting with his children. he is less likely to be a financial provider so it looks at the overall package of the family. >> my last minute here going back to the question that has

come in page 3. the budget limit of subsidies with graduate medical education and focusing instead on targeting those investments for primary care workers and a lot of people coming in to children's hospitals that i'm meeting with a their stepchildren and not getting the dollars from nih. they decrease primary-care work force. >> >> i don't think this is an easy catch to put on the table and i can guarantee you in the budget we had full resources, this would not be a preferred cut. cme dollars are being redirected to programs that have as an exclusive focus primary-care

provider network recognizing we are going to need additional primary-care dollars looking forward. >> my time has expired and the yield back. >> the chair recognizes the gentlelady from illinois for questions. >> thank you, mr. chairman. madam secretary. thank you for being here. we ask you to be a historic effort and i can't think of anyone better able to do that given your experience as an insurance industry regulator and as a governor. clearly you have the mind set of your business. we have asked you to rein in and out of control private insurance industry that on a daily basis denies coverage and benefits to health-care consumers.

i'm interested that my colleagues on the other side seem more interested in arranging your office structure than in rooting out those abuses. i'm interested in they have attacked the size of consumer information and insurance oversight. my calculation is the 972 positions requested in staff is the equivalent of 16 house offices. i know our staff's work very hard but i don't think that is an enormous number of people when we have to have them with setting a new standard and structures created under the affordable care act. let me also say that we heard from the other side of the aisle this notion that all americans want is for government to get out of the way when it comes to their health care. that is really not my impression in the least.

we certainly don't need more evidence than the popularity of medicare, the importance of medicaid, leaving the affordable character side. is it your sense that what the american people want is to reject health -- help from the government to cover health care? >> medicare is enormously popular. probably the second most popular insurance program, children health insurance program both of which are government based programs delivering vital services to millions of americans. >> i think it is important to say over and over again that far from being a government takeover of health care, the affordable care act, some of us feel it shouldn't be this way, lies

entire leon the private insurance companies with some help from the government. this is up private-sector plan that we do, that we are doing. let me ask a few questions on behalf of my constituents. if you were denied funding to implement the affordable health care act, affordable care, will health-insurance purchasers know that at least 80% of their premium dollars will be on medical care purchases? will we have any guarantee that that will happen? >> it would be difficult to implement the medical loss ratio you describe. >> in states like illinois without any rate approval requirements, how would rates that are out of line be enforced? >> it would be one of the

requirement, that we helped to identify excessive rates and post them so consumers have some way of judging. but that would not be available to consumers. >> with the affordable care act we would get some help in illinois. without it, we are totally at the mercy of the insurance company. what does it mean for seniors and people with disabilities who are counting on the phase out of the doughnut hole if the affordable care act were repealed? >> clearly those additional benefits for seniors which include annual well as visits, elimination of co-pays for preventive screenings and health and as you say gradual elimination of the doughnut hole starting with a 50% discount, that would cease to be a

medicare benefit. >> those things just disappear. let me quickly say. a wonder because of processes that are attacked. tell us the process by which hhs adopted the rules that deal with the 80% loss ratio? >> congresswoman, we were directed and followed this carefully, working with the nation's insurance commissioners to ask for their input and advice on the outline of a medical loss ratio. what element should be included in the medical portion of the 80% and what should be outside that? made a unanimous recommendation to our office. we adopted 100% of what they recommended to us and that is the rule that this is not an hhs

rule so far as we did not design as a nation 50 insurance commissioners may be recommendation which we adopted. >> time is expired. chair recognize perhaps the gentleman from new jersey mr. lance for five minute for questioned. >> thank you and good morning. i am new to the committee and look forward to working with you on issues of mutual concern. i have the honor of representing a district that was arguably the medicine chest of the nation and our would like to think -- i would like to thank the entire world. regarding the president's budget there is a suggestion of data exclusivity, 12 years to seven years. i personally propose that. there has been extensive economic modeling on this at

duke university. there's a range between 12 to 15 years of the time needed in by 0 pharma to bring to market needed medicine in this regard. madam secretary of like your comments regarding suggestion, reduction in fiscal year 2012 budget. from 12 to seven years. >> there is great importance in making sure. your state is renowned for being a great leader on that.

if they're not profitable they will continue the research but, it continues to exist. based on information and i know there are competing experts on how long and how much evergreening should go beyond the protection. seven years would indeed accomplished, returning profit and continuing research. >> thank you for your response. the last time in this committee examined this issue in

overwhelmingly bipartisan fashion the committee chose to retain the 12 years with continuing discussions with your department. regarding pdufa there's a challenge with its reauthorization. the most recent reauthorization included the risk-management and mitigation strategy. at least in some instancess it is my judgment that this has been a challenge. johnson and johnson have a product on the market for 20 years and was required to submit a gram that took 20 minutes to resolve. your comments, madam secretary, as we go about reauthorize think pdufa over the next year. >> it is an area where we are

mindful of time delays on behalf of not only companies but also consumers. at the same time mindful of their important safety efforts. i look forward to working with you on striking the right balance. >> i appreciate your comments in these important areas that go to the heart that we have to work in these areas and make sure that the notion's health is protected and we remain the medicine chest of the entire world. i yield back the balance of my time. >> thanks, gentlemen. recognize the gentleman from louisiana for five minutes for questions. >> madam secretary, i want to thank mr. malone because he is committed to work on equity for federal support of care and i will submit two articles for the

record. talking about the current equity in that situation. >> without objection so ordered. >> what i am about to say is striking. here we have a report from ben bernanke saying medicaid and other entitlements are long-term deficits. you in your opening remarks mentioned the administration's concern and yet when i look at all the literature given, federal spending and medicaid will increase by $674 billion. federal -- state spending will go up $190 billion and if you include the latest estimates probably more like $250 billion over the next ten years. clearly you are concerned about

it. i have a copy of your letter which suggests there's a way they can do it. they could eliminate optional benefits like other pharmacy coverage. as the budget chairman says the current medicaid growth is single. i have a report but i will submit for the record that estimates 50% of new york's state budget may go through medicaid by 2030. all this says, it seems as if there is concern for the deficit in this bill and regarding maintenance of effort you mention your hands are tied. you commit to working with congress, to help the governor so that they don't have to necessarily cut dental benefits in massachusetts or something else in new york. ..

>> from 21%, to 37%. that's why they are now slashing. so it seems like this will control costs. >> i think the massachusetts program is a great example. and i think it's a great example of what is possible on the

exchange side and with coverage, which congressman weiner mentioned. but it also had a missing component. governor romney and certainly governor patrick would be the first to tell you that when massachusetts designed their program, they focused on access and not on cost containment, and they're revisiting -- >> i'm with you on that and i just know and i have limited time. when i look at what they're proposing, none of which has been proven to control costs. so theoretical, but not been proven. i think the governor at one point proposed provider fee, provided the and that was thrown out by a judge. so it seems that this cost control mechanism which again is in ppaca has not been established. >> i think the affordable care act has as an underlying premise a huge number of underlying cost control, both delivery system

changes, but i think more importantly and, unfortunately, the congressional budget office hasn't scored this, but the effort to look at the drivers of chronic disease, which is where we spend about 75 cents of every health dollar, obesity and smoking can have the most enormous -- >> i wish i had five more minutes. let me interrupt you. i am at a time. you mentioned the class act are concerned about it, $75 billion scored by cbo towards the credit side of ppaca. on the other hand, you mentioned it's unsustainable. it seems disingenuous for something which long-term is not sustainable, then claim it as a kind of credit in terms of proving the cost worthiness of the bill. >> the deficit commission recommendation were that we either should look at repealing the class act, or reforming it. and we have the flexibility administratively to do the latter.

that's exactly what we intend to do. and i look forward to visiting with this committee as i pledged to do to tell you the outlines of what we think will be a sustainable program. >> and could i ask you, one question at the beginning, would you pledge to work with us with the states? >> we are in the process of doing that now. >> the gentleman's time has expired. mr. guthrie for five minutes for questions. >> thank you, mr. chairman. thank you, madam secretary. i think i may be the last on the battle. one thing that mr. weiner brought up, if you expand medicaid you will bring on children and the parents, but also bring on the disabled and the elderly. in big proportions. so, and if the economy does grow, if we think it can grow out of it, the most extensive people that participate in medicaid are the elderly and disabled.

they will still be with us. so the fact we can just grow out of this is not necessarily. i just want to make a point. when you make your opening remarks, you listed a lot of things that people have been listing that people don't like for the health care act. he also said and i think i quote businesses are getting relief. are are also business getting relief to rising health care cost. i can take from businesses i know that because of the new benefits that are mandated, premiums are rising and they have already started rising. so business costs are decreasing. we haven't seen that. hopefully you have. that i can share with businesses. >> short term, congressman, as you know small business owners are eligible for a tax credit which helps provide some relief to the costs of covering their employees. and what i hear from small business owners across the country is that often the biggest bottom line cost and weight they lose the best employees to their larger

competitors, that that provide short-term relief. long-term relief comes in 2014 with a new market. they will finally have the leverage buying power that their large competitors have. businesses on average, small business owners spend about 25% more on exactly the same coverage as does someone with market power. and in 2014, those rates and begin cbo and other actuaries have said those rates will come down fairly dramatically. >> medium-sized businesses are seeing i know business with 400 employees, they have seen an increase because of the mandated benefits. you can increased benefits. you can increased benefits you also, there's a cost to that. and it's reflected in the premium businesses are paying. >> again, the actuarial reports that i have seen indicate that there is a relatively insignificant impact at this point on the kinds of benefits

going forward here and as you know, we are trying to -- the waiver program that has been mentioned a number of times which dealt with one feature of the bill, the annual limit, was designed to try and insulate businesses in the short term from the kind of rate shock that they may see. so we are in a balancing act getting between now and 2014. >> obviously businesses plan for the long-term success. you understand that. i had a couple of physicians, can i give you a minute? yield a minute to the gentleman from -- >> thank you. madam secretary, again thank you for being here. now you know we are don't make yourself so scarce. going back for just a moment, the mandatory funding for the construction of the clinics, the discretionary funding for the staffing of the clinics, there was no request in the budget for the discretionary money on

funding of the clinics. so are we likely to be left with a situation where we are required to build them under mandatory funding but no one stassen under discretionary funding speak with these are the school clinics. >> all i can say is the budget does include in the health resources that services of the administration, i request for increased funding with regard to community health centers for the workforce, for new national health new national health service corps provided a new primary -- >> specifically school-based clinics. >> those are part of -- >> maybe you can get it back in in writing. i yield back to the gentleman from kentucky. >> i want to yield the remainder of my time. >> one more question, madam secretary. a follow-up on a question. since it's my understanding where raising medicare premiums because to close at doughnut hole, what will seniors do if

they're able to get their own money as opposed to closing the doughnut hole? >> sorry, we are raising medicare premiums? >> it's my understanding they're going up to close the doughnut hole. is that not to? >> no, sir. i don't think that is accurate. >> and i will follow-up with that at a later point. i yield back. >> will you yield to meet? >> i yield to the texas. we have to get talked about the sustainable growth rate formula. and i was one of the big open shows for tranny. all of the money taken out of medicare and not a single dime for a down payment for buying us out of the sgr reductions. what are your plan for getting us out of the sgr? >> well, as you know, congressman, the sgr dates back to 2002, and has been an issue that has not been effectively dealt with. this president, said his first budget, has recommended a long-term fix. he has proposed and issues budget not only working with

congress for a tenure resolution, but also put more than two years of funding into the budget. so we would look forward to working with this committee to find a long-term fix. i agree with you. it's probably the single most threatening issue to medicare beneficiaries on the horizon. >> a gentle this time is expired. the chair recognizes the gentleman from new york, mr. towns, for five minutes spee-2 thank you very much, mr. chairman. secretary sebelius, thank you so much for testifying before the committee. subcommittee. i know your time is valuable, and so i will be brief with my questions your first, i should note that i'm pleased to see the direction that the administration is taken on the budget request. i am concerned that should the cuts proposed by h.r. onepass, hhs would not be able to deliver on key services and programs that benefit the public.

let me, one area i'm very concerned about is the community health centers. they provide an extremely valuable service in my district. as i imagine they do for many members on both sides of the aisle, even though some might not admit it. i understand that they propose cuts in h.r. 1 would have a devastated impact on community health centers, possibly closing up to 127 health centers, and cutting off 11 million patients over the next year. in contrast, how has the hhs budget request dealt with these very valuable center's? >> well, congressman, i share your appreciation for the critical services that health centers provide in our most

underserved areas, and between the investment and the recovery act, presidents budget and affordable care act, the goal is to really double the number of americans who have access to those vital high quality, lower costs, preventive services your and the president has made a budget request for an increase support for community health centers, including for providers who serve and those centers, training 50,000 new providers over the course of the next five years, and having those folks available. absent that expanded footprint, we will have far more people accessing health care in the least -- i mean the most expensive, least effective way through the doors of emergency rooms who are just not getting health care at all. >> let me say, i was watching tv for the hearings here, and i saw

a member raising a booklet saying that this is why, you know, you in the minority. i hope you're not affected by that anyway because sometimes it takes some people are little longer to figure out what's going on. and i think that we need to just move forward because i think that there's no question in my mind that this is going to save a lot of lives, and eventually save a lot of money. there's a question about it. so i'm hoping that you don't let this deter you in anyway. you continue to move forward, let that encourage you. because let's face it, eventually they will get the message as well. i want to thank you very, very much for the work that you're doing, and we look forward to continuing to work with you. i think the only thing i would hope that if we be able to put together more private and public partnerships, maybe even around the committee health center, to see in terms of what we might be able to do to sort of keep them

open because they provide such a valuable service in many, many neighborhoods. >> everyplace i ago i tried to visit the committee health center that is closest, and i have seen some extraordinary providers across this country who not only are providing life-saving medicare, but incredible family -- family support. i don't disagree that it is proven over and over again to be not only very high quality care, but at a far lower cost than any variety of options. so i would look forward to working with you to make sure that this incredibly important public support stays in place. >> thank you very much. and on that note i yield back. >> the chair thanks the gentleman. the gentleman from kentucky is recognized for five minutes for questioning. >> thank you, mr. chairman, and secretary sebelius, thank you for being with us today. one comment that i just wanted to make, which probably doesn't

have to be made, but i'm sure you've felt a lot of animosity come even a lot of frustration towards this whole health care bill as many in america have fell. and one of the reasons that people have felt that way is that they have brought a 2400 page bill to the house floor last year, and we were not able to offer one an amendment on the house floor. and i don't think the american people appreciate bills of that magnitude, having impact on this country, and the legislative body not being able to offer one amendment on the house floor. certainly not your fault. you are not the speaker. but, from that background and

because of that process, they're still very strong feelings about the issue. but one of the questions i would just like to ask you, many members of congress, be honest, did not have much of an idea of what was even in the bill when we voted on it. and as secretary of hhs, i assume that in the process of developing the bill you must have at least been consulted, you were hopefully able to suggest ideas and have some input in the process. so, my first question would be, did you have an opportunity to have input into the process? >> yes, congressman, i did. and as you know there were five committees, three in the house and two in the senate -- >> i know that now. in fact, we adopted a eminence in the energy commerce committee, all of them were stripped out before it went to the floor.

and democrats and republicans adopted those amendments. they all were stripped out and we were not offered, were able to offer one an image on the floor. so here is the question i have. we know that there's going to be about 20 million more people on the medicaid program, according to all of the numbers that we've seen by the year 2014, whatever. and every government that i talked to, both democrat and republican, say that one of the reasons they're having financial difficulty in the states, not the oil reason, but one, is the fact of the cost of the medicaid program. now, the states are having very financial difficulties. the federal government goes without saying. we had a $14 trillion federal debt. how was it concluded that the federal government would pick up 100% of the cost of those additional 20 million people on medicaid?

now, i've heard some comment, well, the states are not going to be hit with this additional cost. the reason they're not going to be hit with it is because the federal government is. so my question would be, how was it determined that the federal government should do that? when we are in worse shape at the federal level than some of the states are at the state level. >> congressman, i think it was seen as a way to have a partnership going forward, and for the first time ever have a benefit level that regardless of where you live in this country, you are eligible for health insurance so that uniformly now across the country as families at 130% of poverty or less would qualify. and for the additional population, some states are well above that right now. some states are well below it, but for the additional population, at least for the first three years it was seen at the federal government should

pick up the lion's share and congratulate the state would participate. >> if i had been i think i would have disagreed with that, but nevertheless, that's what it is. the thing that bothers me when you talk to primary care physicians today they are already upset about the low reimbursement rates for medicaid patients. and i don't think i'm exaggerating. we have to dr. schear, maybe some over there, most of the primary care physicians i talked to say we're not going to take any more medicaid patients. if you put 20 more million people on there, then go right back to the emergency room. >> well, at least the dr. joye talk to across the country, and i do this with a lot of them, are not happy with the medicaid reimbursement rates, but the vast majority of people we're talking about have no reimbursement rates, are not seeing a doctor, are using the health care system in a very inefficient way. i think one of the reasons that again, the affordable care act

suggests that medicaid doctors, for release the first over years will be paid at medicare rates is a recognition that the medicaid rates across the country are insufficiently low. and that is again part of the a formal care act structure. >> the gentle this time is expired. we have one other member, not a member of the subcommittee, a member of the full committee. he has waited patiently. would you stay for five minutes? >> yes. >> mr. green for five minutes. >> i appreciate the courtesy. this is my first term on the energy commerce committee. i have been on the health subcommittee so i appreciate the chance to be here. welcome, madam secretary, and i just want to remind folks, medicaid reimbursement rates are set by the states. >> that's correct. >> we had three governors here yesterday or a couple days ago whether oversight and investigation. and they want more flexibility.

they have a lot of flexibility on reimbursement rates, and there's some decisions to be made because, and i think we are right. we understand doctors, medicaid pays less than medicare. frankly, in my part of the country, try care pays less than medicare. although in the houston area we don't have a big basil a lot of physicians will take try care because its -- that's a state issue. we don't want the state and federal government to set medicare rates because we would have more governors after complaining. the other issue i want to ask is on the health care reform bill. the impact on the teaching health centers. our medical schools are associated what is the impact addressing honor teaching health centers? we are fortunate at least in houston area to have three that serve our metropolitan area, and michael is to encourage them to get out in our team unity, face the health centers and partner with them because that way i also want those residents to understand they can make a good

living in a community-based health center. >> recently i had a chance to visit again with the head of the association of academic health centers. and he joined a group of providers talking about what he sees is an enormously important opportunity to begin to transform health care delivery with the affordable care act at the patient-centered, provider centered opportunities with the kind of payment models that are part of the affordable care act, everything from primary medical home models, which actually reimburse physicians for keeping their patients healthy in the first place, and you don't have to wait until the go to the hospital to get paid, to bundling care, teasing the most innovative strategies they see as a wonderful opportunity. and as you say, in many areas already, there is a lot of discussion with academic health

centers and community health centers about becoming accountable care organizations and combining the strategies to deliver better care to more people. >> i know that h.r. 1 propose that 1.3 billion from health centers program, and understand health centers services resources administration has announced its intention to award new access points, new health centers and decides of existing centers. this is funny opportunity made possible by provisions and health reform law. and the president's request, and, frankly, i work with administration under president bush many to expand health centers funding. can you tell us how many applications for new health centers to have receded how many a words they intend to fund and how many awards would hrsa make it h.r. one was enacted to 1.3 billion protect? i know that may not be possible now.

>> i would love to give you the specifics in writing, but suffice it to say, the loss of the investment and anticipated would severely curtail this program. >> you have better information than i do but we understood there are about 800 applications for 350 possible awards. but again, you had the exact numbers. that's what we have heard. mr. chairman, i know i'm a little bit less. it's well documented health centers provide high cost, effective and high quality patient directive care and reduces overall costs in health care system. can you describe the overarching impact of the health care system and the continued health care expansion outlined in the president's fy 12 budget request? >> well, i think, congressman, the anticipation is that we would be able to gradually move from serving 20 million americans to 40 million americans. and as you know, the health services resources

administration mapped pretty carefully where is the underserved need, where are the access points that need to be filled. summer is a very rural areas, so are in urban areas. that expansion has provided enormously important care to families across this country. >> thank you, and i appreciate it. i know i'm almost out of time. in houston area we started on can he centers much later than most parts of the country. so we are considered i think and under underserved area. the committee health centers are not refusing medicaid patients. so if doctors cannot afford in the practice to take them, that's why we expansion of community -- >> some are uninsured, some are medicaid. but a number of people are fully insured and choose a committee held send as their health care. >> the gentleman's time has expired. in conclusion, i would like to thank secretary sebelius and the members for participating in today's hearing. i remind members that they have

10 business days to submit questions for the record, and i ask secretary sebelius to respond properly to the questions. members should submit their questions by the close of business on march 17 expect mr. chairman, will ye yield for a moment for unanimous consent request? >> yes. >> i have the letter i wrote to secretary sebelius. >> without objection it will be entered into the record. if there's nothing further before the committee, this subcommittee hearing is adjourned. [inaudible conversations] [inaudible conversations] the [inaudible conversations]

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>> the u.s. senate is about the gavel and on this friday morning. general speeches throughout the day with no legislative work is scheduled. earlier this week lawmakers passed a short-term extension of federal spending of owning a partial government shutdown. they also worked on a passage law overhaul. final vote is expected next week. live coverage from the senate here on c-span2. the presiding officer: the senate will come to order. the chaplain, dr. barry black, will lead the senate in prayer. the chaplain: let us pray. o god, you created us in your image and gave us consciences o enable us to realize our

accountability to you. help the members of this body to be responsible stewards of their influence and opportunities. may they not miss opportunities to join you in your liberation thrust in our world, persevering in the right, as you give them the light to see it. empower them to be true to you and true to themselves, even though they must travel on the road of pain and sacrifice. strengthen them to work today with the confidence that you are

with them. we pray in your merciful name. amen. the presiding officer: please join me in reciting the pledge of allegiance to the flag. i pledge allegiance to the flag of the united states of america and to the republic for which it stands, one nation under god, indivisible, with liberty and justice for all. the presiding officer: the clerk will read a communication to the senate. the clerk: washington, d.c, march 4, 2011. to the senate: under the provisions of rule 1, paragraph 3, of the standing rules of the senate, i hereby appoint the honorable mark r. warner, a senator from the commonwealth of virginia, to perform the duties of the chai. signed: daniel k. inouye, president pro tempore. mr. reid: madam president?

i mean, mr. president? the presiding officer: the majority leader. mr. reid: following leader remarks, mr. president, the will proceed to 00 period of morning business with senators permitted to speak for up to 10 minutes each. as a reminder, cloture was filed on s. 23, the america invents act. filing deadline for first-degree amendments is 1:00 p.m. friday, march 4. there will be no roll call votes today. we should expect at least three roll call votes at 5:30 on monday, march 7. the first two votes will be on the confirmation of judges, and the third vote will be on the motion to invoke cloture on s. 23, the patent bill. would the chair announce morning business. the presiding officer: under the previous order, leadership time is reserved. the senate will be in a period of morning business with senators permitted to speak therein for up to ten minutes each. mr. reid: mr. president, i would note the absence of a quorum. the presiding officer: the clerk will call the roll.

quorum call:

quorum call:

mr. mcconnell: mr. president? the presiding officer: the republican leader. mr. mcconnell: mr. president, i ask further proceedings under the quorum call be dispensed with. the presiding officer: without objection. mr. mcconnell: earlier this week republicans showed that we can change the status quo in washington. the american people made their position quite clear. reverse the reckless spending and out-of-control spanks of government -- ex-pa*pbgz papbgs of government.

stop growing government and the jobs that come along with that. republicans made a small first step in that direction. democrats have taken a different approach to these concerns. they've sat on the sidelines hoping the public's concerns would pass or hoping that if they made enough of a stink over small cuts, they'd seem bigger than they are. in other words, the democrats' whole approach is to see what they can get away with rather than to actually do something about the debt and jobs crisis americans want us to address. the white house proposal yesterday is equally unserious. house republicans have proposed a plan that would reduce spending by $61 billion in this year's budget. earlier this week we voted on a two-week piece of that bill that reduces spending by $4 billion. the white house proposal is to cut another $6 billion and call it a day. even more outrageous they say is the proposal meets us halfway.

i won't get into their towered justification. -- their tortured justification. "politico" says it is enough for americans to suspend disbelief. "the washington post" was equally unmoved by the white house logic. they said democrats are disingenious -- disingenuous in suggesting they worked hard to reduce spending, and they agree that calling the latest proposal an effort to meet us halfway is nonsense. that's "the washington post," mr. president. they agree that calling this latest proposal an effort to meet us halfway nonsense. so amid all the fanfare yesterday, what the prowess is proposing is little more than one more proposal to maintain the status quo to give the appearance of action where there is none. the latest proposal is unacceptable and it's indefensible. the american people are tired of hearing the same tired talking

points from our democratic friends. they would like action. in fact, they demand action. they want us to cut spending to help create a better environment for job creation. it's time for washington democrats to get serious. mr. president, i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

mr. durbin: mr. president? the presiding officer: the senator from illinois. mr. durbin: i ask consent the quorum call be suspended. the presiding officer: without objection. mr. durbin: mr. president, the american economy is struggling. we are coming out of a recession, unfortunately too slowly for most of us, but we are emerging. i can recall the ominous days when we first learned of the terrible economic crisis facing our country. some of us who served in the senate chamber were called into a meeting with the chairman of the federal reserve, mr. bernanke, then-secretary of the treasury mr. paulson, and they told us the grim news if we

didn't act quickly we could see the american economy sink lower and perhaps even a global depression. it was a frightening time. it was time before this current president came to office, and we had to act together on a bipartisan basis. decisions were made by many of us trusting those in the bush administration who told us that if we didn't act and act quickly, jobs would be lost and businesses would fail. people would lose their savings. it would be catastrophic. and so we went forward with a plan that initially i thought to be flawed, but the only show in town. tried to help financial institutions survive the terrible economy and to turn this situation around. we can say now that most of the money, virtually all of the money that was invested in these financial institutions has been repaid with interest to the federal government, which is the right thing. and we continue to pursue those like a.i.g. where the government

has a substantial ownership in an effort to make certain that taxpayers recoup the investment that saved a major insurance company. that is a good thing. meanwhile our economy moves forward at a slow pace, but at least it continues to move forward. the reports this morning, new unemployment numbers for illinois were released yesterday and the new federal numbers released this morning. in illinois in the month of january, the unemployment rate was 9% down from 9.3%. 599,400 illinoisans looking for work, that's down from 620,000 last month. nationally in the month of february the unemployment rate was 8.9%, down from 9.0 last month. and significantly down from where it was just a few months ago. 13.7 million americans are looking for work. that's down from 13.9 million last month. and the economy in this report

added 192,000 new jobs. unfortunately, the response of congress has not taken into consideration how fragile this economy is and how important the recovery is. we hear from the other side, senator mcconnell this morning and others, that the biggest problem facing america today is our deficit. i would say to the presiding officer who joins me in a bipartisan effort to try to deal with this deficit, that we we concede that point, the deficit is a major issue. but we want to take care that the way we solve the deficit issue is sensitive to the state of the economy and our need to work together to end this recession. and so that's why h.r. 1, the house republican budget, is a bill which i can't support. it really is not a good budget bill because it takes money out of key investments in our economy at a time when we need them the most, when we need to have better trained workers with skills for new jobs, the house

budget out of the republican side devastates worker training programs. why would you do that in the midst of a recession with so many people out of work? at a time when we need more students graduating from college with diplomas and new skills and new opportunities, the house republican budget cuts the pell grants, the amount of money given to those students from low-income families, by over $800 a year. many young people will have to give up on education and delay it because of that. how does that help us in our recovery? the answer is, it doesn't. equally troubling is the house republican budget, which makes devastating cuts in areas of research and innovation. i'm not saying that the best jobs in america are going to be government jobs. they aren't. they shouldn't be. they're going to be private-sector jobs. but time and again, our private sector turns to our national

laboratories and research for the products they need to compete in the world. the rollout of the chevy volt was announced all across the nation. general motors was so proud. here is an all-electric vehicle they are going to sell to america. i'm glad they're doing it. it is not only environmentally responsible, it reduces our dependence on foreign energy. we will, how did general motors, this great corporation, develop the chevy volt? the first stop was the argonne national laboratory outside of chicago where they sat down and worked with government scientists to build the battery to put in the chevy volt. that's important. what's going to happen to the argonne national laboratory because of the house republican budget? they will be forced to lay off one-third of their scientists, engineers and support staff for the remai remainder of the yeard they will cancel up to 50% of their research activities, not just in new battery technology

but in developing the next generation of computers. where is the fastest computer in the world today? it isn't in the u.s.a. it is in china. we are trying to step ahead to make sure that the next-fastest computer which can be used to drive technology, invention, innovation, new companies, new jobs is right her i here in ame. yet the house republicans end up with devastating cuts on the national research laboratories like argonne. how can we justify it? at the same time, they're cutting money to the national institutes of health. mr. president, if there's one thing we all have in common, all of us, every single one, republicans, democrats, and independents, it is our own vulnerability to illness, disease. i mean, it is a fact. and when it 457 happens, you wao make sure that you or your loved one is in the hands of the best doctor, the best hospital, with the best medicine and technology. how do we ghat? we get at that by investing in

medical research. what does the house republican budget do? it cuts medical research. how could we possibly cut back on research on cancer, alzheimer's, aids, diabetes? how could we do that when so many americans are afflicted and so many costs are associated with those diseases? it is so shortsighted and it is an indication that when they came to write the budget, the house republican leadership didn't focus thoughtfully on what we need to cut to reduce the deficit and what we need to invest in to build the economy. they put it all in the same and said, it makes no dins. if you cut -- it makes no difference. if you cut government spending, it makes no difference what you cut. nnot true. there are roads, bridges, airportairports that are essentr our economy.

in my home state of illinois, investments where we won in a national competition to modernize our rail system around chicago to make sur certain thae have rail snfs parts of our state that we currently don't and to modernize and make safer, airports and things that are critically seaning for our future. i'd say to my friends on the republican side, yes, the disft an issue. but first and foremost, understand we will never, never balance the budget with 15 million americans out of work. to put the entire budget on the table, that's what the deficit commission did, which i served on. that's what we need to do as a nation. and we need to do it in a bipartisan fashion. i'm happy to continue to join my colleagues who sit down, including the presiding officer, senator warner of virginia. there are six of us, three republicans and three democrats.

it is the most unlikely gathering of politicians you can imagine, to think in one room that we would try to come up with a solution. but we are people of good will and we know our historic responsibility. we are working through some of the hardest issues and hardest questions that any member of congress can face bh it comes to this yo -- when it comes this ts issue. if we're successful -- and i underline "if" -- i hope we can move this country forward with a responsible way, putting the recession behind us and starting to get our house in order. we can no longer sustain a budget where we borrow 40 cents for every dollar we spend. whether you are on the left side of the spectrum where i live politically and value such things as help for education, help for the most vulnerable in america, or whether you are on the other side of the spectrum and probably value national security issues and the investment in the military is a very high priority, both of are in this together. we both have to understand there won't be enough money left for

anything if we don't focus on doing this dramatic, historic job of coming up with a way to reduce or debt and reduce our deficit. i thank you, mr. president. i yield the floor. i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

quorum call:stphrao quorum call: