afghanistan pakistan which is a reduction from prior years and part of our ongoing effort. at the same time we have significantly increased funding for our programs in the asia-pacific region. that is up 8% since fyi 13 which directly supports the president's decision to rebalance the growing political and economic importance. the budget request to continue engaging with the united nations and other key multilateral organizations such as unicef. it also enables us to make urgent international peacekeeping needs including mali, south sudan, darfur, and that prc. and to connect directly to the people of the world the budget requests 1 billion for public diplomacy in citizen exchanges dramatically increasing the breadth and reach of american leaders in the world playing a -- laying a stronger stand --

link pages that endure beyond daily headlines. this allows us to implement policies that know no borders. the right and smartest way to promote stability and global prosperity. the macerations commitment to global health remains strong. our $8 billion request will help put an end to preventable child and maternal death and her continued support will sustain a strategic investments in care and treatment activities that keep us on the path to an aids-free generation. as the president announced on world aids day we intend to maximize the impact by partnering said develop joint hiv treatment goals. ..

>> and our prosperity and security all depend on the of work with survey work overseas this budget gives us the resources they need to do their job.

>> good morning. from president obama to secretary kerry to republicans and democrats in congress, we're fortunate to have had an exceptional set of leaders of both sides of the aisle who understand the importance of our nation's security and prosperity. by partnering with other nations and to promote democratic societies we help to transform countries to destabilize prosperity -- prosperous nations. we open markets for american businesses, prevent conflict and extremism from reaching our shores and helping our young people build skills in science and technology all for less than 1% of the overall federal budget. this year's president's budget request includes $20.1 billion that usaid manages are partially manages. these critical resources

allow us to ed reincarnations cool interest of responding to a pressing national security priorities from the middle east to afghanistan to south sudan. this afternoon, i want to discuss how we are meeting these challenges through a new model of development reflected in this budget. by leveraging public and private partnerships and harnessing innovation, we are able to deliver better and more focused results. we've made tough decisions to focus our resources where will have the greatest impact, reducing our total number of program areas by 29 percent since 2010. today, all of our major programs are independently evaluated, and those evaluations are available right now on in my phone app. and we've placed a new emphasis on building local capacity so we can, over time, work ourselves out of a job. four years ago, just 8% of

usaid resources were program to through this new model of highly leveraged partnerships and been changing allocations. today, it is above 40% and we hope to increase it over time. above all, this budget supports the president's priorities to deliver results and food security, global health, and improved access to low-cost clean energy. by fully funding the development assistance in global health, child survival accounts, we will keep up the momentum that has helped cut the rate of children dying from malaria in half and given millions of children the nutrition they need to survive. this is a critical moment in our fight we cannot afford to step back. that's why in this budget request, more than $1 billion is devoted to feed the future, president obama as global food security initiative.

this past year, these investments helped improve nutrition for were than 12 million children in helped more than 7 million farmers transform there family's income and livelihood. this year's budget request build on these results with the new integrated approach to nutrition that will reduce child stunting, also known as hidden hunger, by 20% and change the lives of 2 million children in target partner countries, tackling one of the leading causes of child that the also undermined country and global growth. this budget maintains our nations tremendous leadership in humanitarian response, with 4.$8 billion in state and usaid funding for humanitarian activities. in the last year, we've responded to an unprecedented number of crisis around the world from the philippines to syria. and today we face three category three level emergencies simultaneously, a tremendous burden by historic standards. thinks too strong bipartisan

support we have now important food aid reforms the lawless to reach an additional 800,000 hungry children every year with the same level of resources and our humanitarian programs. the need for this flexibility grows more urgent every day, as crisis deepened from syria to the central african republic to sell saddam. that's why this budget calls for the flexibility to use up to 25% of the food for peace program resources for lifesaving efforts, including doctors and local purchase of food, in order to reach 2 million additional children in humanitarian need no additional cost. in this budget $8 billion in usaid and cut far funding for global health is committed to eliminating in realizing goals that once seemed unimaginable. ending provincial -- preventable maternal and child that the anemic transmission of hiv/aids from mothers to their infant children. to achieve these ambitious

goals we're prioritizing 24 countries that account for 70 percent of maternal and child us in the developing world will also focusing on concrete targets to expand aids treatment word is most critically needed. word tea into the president's commitments to africa specifically allocating nearly $150 million in this budget to specific initiatives including trade and power africa, what should the president wants this summer during his visit to the continent. by securing partnerships with all the national companies a local entrepreneur is these resources as part of power africa will bring affordable clean energy to 20 million homes and businesses in the markets of the future. and with our modest investment were already leveraging billions of dollars of private sector commitments. we know we cannot prevent typhoons and drums for happening but we can work harder to make sure the consequences of those comic disasters don't devastate as

many families and communities. that's the goal behind a new emphasis on resilience that will help us use our resources in this budget to protect communities from future natural disasters. with $348 million from president obama as global climate change initiative initiative, usaid will effectively work to both protect and manage in private that supports this through a resilience programs. today we're applying this the model of work across all our work from promoting democratic governance to sustaining our gains in front-line states to improving the quality of education especially for girls and children who live in crisis. that's why dedicated more than $150 million in central funding in this budget for science technology and innovation and partnership initiatives. by collaborating with the world's brightest minds in companies, we can develop in scale new scientific breakthroughs like climate resiliency and mobile banking efforts have been the curve of progress and give us the capacity to achieve our goals and a lower cost.

finally and most importantly this budget and best and most of for an aspect of our work are on staff. with 1.$4 billion in usaid operating expenses, we will fund ever corporations at their current level and request the represents just a person ever told programming resources. the responsibilities abroad over the last decade, this particular investment in upgrading capabilities training in protecting your staff and programs, in having the ever structure to report in measure results effectively has proven essential to maintaining in taking forward our mission. failing to investor peopling capabilities today we'll cost is far more in the future so this is an important moment. with new tools and a global community of bibbers partners we can eradicate extreme poverty in the next generations, energy is in the global community in economy representing the best of our values around the world. the investments in the president's budget enable us to seize this moment and serve the interests of the american people by being

smart and effective and efficient and how we do our work today. thank you. >> the three elements of the triple package you can get it from different sources but they were destined for professional things the second element almost sidney lee the opposite way to is the daschle of the insecurity to offset the

feeling you have not done quite the cafe and the third element is impulse control with the ability to persevere in resist temptations. >> individuals who had these qualities crow up in america will predictably second generation who had interesting with their culture. as looking back at their parents and grandparents we don't want to do success we're not interested in those jobs but instead but yet when we found is aspirations can help achieve very different kinds of goals.

>> the headline says overall release is 3.9 trillion overbudget through the 2015 budget proposal. what part of this three-point 9 trillion goes to the health care a and implementation of the health care law? >> first of all, i will say it is about $77 billion of

discretionary spending for hhs of which goes to the health care law but frankly there were not very many surprises in this budget when it came to the implementation of the affordable care act it did not cut nor add substantial amounts of funds for the rollout effort which is interesting given the rollout has experienced so many problems. what we're seeing is a rehash what the president has previously proposed when it comes to the health care world. he wants to make certain changes in care of messaging facilities and drug companies to generate savings. >> host: as the budget is unveiled secretary sibelius reveals the hhs budget what is the health care levels of the proposed budget?

>> it was fairly predictable today to re-read written on the health care side. looking for that budget to be cut that cms medicare/medicaid have been spending money that congress is not completely in control of to shore up problems with the rollout we saw criticisms from republicans on that and and health provider groups were upset that would be the most acute care providers like skilled nursing providers that would see budgets cut in addition with the sequestration cuts for medicare. there were some new priorities for doctors in this budget to put new medical residents the

doctors' groups praise those but it was experience of the health care world. >>. >> host: dealing with the individual mandate will live this do? >> it would eliminate the individual mandate for the rest of the year. allowing americans without pace -- facing a fine next tax season it would be $95 or 1 percent of taxable income which does none seem like a lot but if your income is higher that could hit you. so what republicans are arguing is the obama administration is breaks to businesses that otherwise would have been required to offer health insurance to their employees.

there are delays associated with that mandate and republicans say it is not fair other individuals would be fined for not carrying health insurance if employers are not fine for not providing it. >> host: you wrote to the white house itself will announce further delays of the law. >> guest: we expect the white house to allow insurance companies to continue offering plans that does not meet the minimum coverage requirements. which we expect could be as soon as this week it will allow insurance companies to continue selling policies under obamacare rules for health care coverage so a policy that doesn't have

maternity care or mental-health services could continue to be sold. what we understand from that stage that we expected the white house is protecting the democratic allies from allegations but this is a continuing fallout from the statements coming back to haunt the democrats. >> host: elise viebeck 84 joining us and for the update. >> guest: thank you.

i am delighted to be joined by our talented and dedicated senior health leadership here at department of health and human services we can talk to them in just a minute but i just want to start to thank them for the incredible work they do every day. we represent tens of thousands hard-working men and women committed to expanding opportunities for millions of americans. as the president has said if you work hard and take responsibility should have the opportunity to build a better life for yourself and your family. this mission is important to make that idea a reality for those in every part of the country. the budget we are announcing

today is responsible on the mandatory side will contribute $369 billion to deficit reduction over the next decade. buy into devising high-quality and efficient care and by continuing to reduce health care cost with $450 million of net savings of for the next decade. but with the hospital insurance trust fund extended by five years and reduce the average in annual growth over the next decade from 6.3% to 5.3%. that also produces additional savings with the beneficiaries alike i want to call your attention to

opportunity and economic growth and security. the budget invests to empower americans to live healthier lives and obtain financial security to the affordable care act. the budget provides resources that continue to support these efforts including the operation of the marketplace to help individuals enroll in the best health insurance coverage option for themselves and their families. the overall investment of 1.8 dollars will allow americans to finally achieve the security of health insurance for their family is something that many have waited years to attain in for some their entire lives. the investment this budget makes america's community will make affordable health care available to a total of 31 million patients from 150

new sites. this investment is 4.$6 billion. to further expand opportunity the budget invest in job creation and a health care work force initiative. $14.62 billion over the next 10 years will be able to expand the national health service corps to 15,000 providers. will also be able to support 13,000 medical students in three year residencies and expand there primary-care increase through calendar year 2015. the budget makes critically important investments in our children's health and well-being and development. requesting 6.$1 billion of

discretionary funds for the child care development fund including $200 million dedicated to improving the quality of that care. the child-care request as 1.4 million children to receive assistance. that what could be served without additional funding. the budget also addresses the psychotropic medication in the foster care population by funding a cms demonstration at the state level. allows us to remove what is often a roadblock to opportunity and attainment. for 400,000 vulnerable children. in addition there is a $5 million investment of a new initiative assisting with developmental disabilities as they

transition from childhood environments into adulthood. this budget makes critically important investments in behavioral health and substance-abuse treatment and prevention. for example, to increase the number of licensed health professionals with addiction specialist and we continue to invest in the workforce the with the now is the type of initiative. these investments trade 5,000 additional mental-health professionals and increase the health service corps. edition the budget invest $26 million with the cbc to prevent prescription drug misuse and abuse and overdose. the budget to get safety and

security of taxpayers alike it includes $50 million of primary-care practice says nursing homes and other health care settings. it puts $25 million into older justice initiatives which are designed to reduce the negative effects of abuse, neglect and exploitation that far too many senior suffer. invest $428 million in the medicaid integrity program. both of which are proven to deliver results and fighting fraud. every dollar we invest returns $8.10 of the money we recover. we have announced we recovering 4.$3 billion. the budget of soda is critically important things of bio defense to invest in

funding to support the development and procurement of medical countermeasures and as a result can strengthen the nation's preparedness to the variety of threats. specifically to hundred $50 million to support the development of countermeasures to project to buy a shield and implements a prepared this. it also invest $45 million of the global help security activities along with 30 million to prevent the spread of pathogens. we're also investing to protect the safety of our food supplies and pharmaceutical products. this budget increases our investment by $263 million. and invest 25 million to expand oversight compounding.

from what occurred in 2012. before we open for questions and answers i want to call your attention to the additional hhs related investments that obama is proposing as his government wide opportunity and security initiative. by closing loopholes. to call for a greater investment birth through age three. with top care partnerships pay hundred million dollars that was said bring the total investment up at 1.$5 billion and more importantly provide more than 100,000 children with access to high-quality your early childhood education. the opportunity growth and

security initiative proposes an additional $970 million in funding for the national institutes of health. this supports research and discovery and innovation to win power scientist in researchers to find new cures technologies and other breakthroughs. as part of the growth initiative the president is requesting $50 million to support the advanced development of universal flu vaccine effective against varying strains of flu including those with pandemic potential. and last the president proposes to invest 200 million in projects with the indian health services construction in west. not only makes a difference of first american's but

supports construction jobs that benefit our overall economy. overall taken together with the security initiative would make important strides of opportunity and security for all americans. i would be pleased to answer some questions that you may have. >> that and secretary you talk about the implementation of the affordable care act. will you have enough money from user fees and other sources to cover the full cost this coming year? or will you have to seek more money from congress or reprogram existing funds at hhs? >> i think if congress funds

the president's budget that is written to the targets agreed upon by senator murray and representative ryan, this would fully fund the ongoing implementation of the affordable care act. we start with that proposal hoping indeed they will fund it. so what was the appropriate target for implementation covered by a user fee is. said the projected user fee income for 2015? if congress fails to pass a budget or implement the president's budget then we will look at other sources of funding for the full implementation that we intend to go forward by user fees are a significant

feature in the budget request. >> what percentage is user fees of the budget? is it an increase? >> i will call on walter. >> we have $61 million that the one is a. >> guest: is medical safety that 61 million small portion to the 5 million represents about. >> what is the figure? >> we can give it to you later now have a lot of detail but a great percentage comes from user fees. >> as long as you are here. >> excuse me. you can talk to the operating division.

i will take a couple questions then turned it over. any more questions for me? >> i'd like to ask the extent to which you have attempted to eliminate duplication of programs within the various hhs agencies. specifically of the aggressive alcohol program running at cdc which seems to be duplicate efforts by nih or other agencies could you address that? said he is here to talk about those specifics. i can tell you not only at budget time but basically each and every day in a different ways to streamline the efficiencies to push more resources toward

programs that benefit the people we serve. our discretionary budget proposal is over $1 billion lower them the discretionary budget in 2014. we were targeting a number that's assume to a reduction and redundancies is one area. they don't have a lot of direct programs and that pushes out block grant money to states and localities it is hard to imagine those funding streams even dealing with so-called are duplicative but again i will let the agency directors specifically respond to that. i will turn over the podium to the assistant secretary here at hhs to does a

spectacular job. >> any other questions? this is pretty easy. [laughter] >> just a follow-up on the tax credit and cost sharing does that appear with the hhs budget or another department? garett department of treasury. >> do you know, that number? >> we can get that to you but that is in their document. >> could i have mr. harris again? >>. >> get the oversight hearing what the fda sets aside for the whistle blowing

employees? >> so to do the proper rollout we think we currently have the right amount of resources but we were looking at a set of processes in using the resources we currently have to make sure we do the right things. >> you don't have a set money figure? of million dollars? >> i was not expecting this question but we now will protect whistle-blowers. >> i am wondering if you could talk more the attempt to prevent medicare fried or restrictions for those to get medicare are of legal

residents? >> i will turn that over. >> i thought you were talking about the articles over the rules. back in 1996 what is in place for medicare a and medicare me to make sure individuals receiving medicare benefits were citizens or residents. this extends that program to the us the nt platform this was work started one year ago in follow-up so now extending it across the medicare programs. >> has reported this as part of the budget and not the legislative proposal or a rule to clarify. any other questions?

>> can you talk about the implementation of the user fees? that are included in the proposal? how will this be implemented without the user fees? congress did not seem to have much of an appetite for them. >> we have requested additional 25 million from the fda and the user fees from years past and hope to work with congress. >> of the increase for that area 239 will go to the user fees and 44 million we have taken a serious approach but if you ask me if that is the nav? no. more has to come down the

line but this is enough to start the program looking to additional conversations. >> from "the wall street journal", could somebody go into detail 1.8 billion for marketplace? i assume it is technology but does that include grants? >> all hhs cms cost for the federal marketplace information technology and call center, of reach, a premium plan support offset by 1.2 billion dollars of user fees fiscal 2015. >> i have a question for

francis collins is the end cap money more or less than last year? >> there is in the budget and increase for the acceleration network that is now boosted up that 30 million. this is the part that allows us to tackle some of the most challenging problems in terms of obstacles with the drug development pathway. our advisory board that has a remarkable group of academics small business and big forma have generated a substantial was too well exceed the dollars that are proposed. we have a lot of ideas how to use that money. but in a very bold and innovative than pro-active way to make it far too slow

to develop drugs despite the remarkable advances so we're very pleased to have that additional booster. >> any other questions? >> this is for dr. collins. what was touted in the president's request is this an increase to the high risk high reward or is it the do program from growth and sustainability initiative or the other budget? >> this is out of the budget within the right anne-marie envelope, $30 million to be utilized within the common fund the projects particularly appropriate for a data model where you have

a project manager to identify a bold innovative strategy to attack a problem then has the freedom to go out and recruit those who may contribute. individual academics, a small companies to put together in a team that not taking the year or two to go through the usual solicitation not always get the team that you hoped for but the project manager is of the stronger position. in that has been a successful model like gps and the internet that have turned out pretty well. we hear pleased to have the authority to tackle projects of that sort. the one we're thinking about is scientific opportunity the notion that one might be able to design technologies to both record and send signals to the peripheral

nervous system to modulate the immune system, body blood pressure to deal with pain issues, a real exciting opportunity here. this is different than the brain initiatives focusing on the central nervous system to figure out ways we could modulate that. a great opportunity for people who know about physiology, neuroscience and that you're able to record and stimulate the body that suits your carotid artery to dial and the blood pressure electrically. maybe we don't need drugs because you to do that so accurately with the sensor. but that is the kind of thing we hope to pursue with this flexibility.

>> i just want to ask as we get past the functionality programs of health care is starting to set goals what are your priorities in terms of what you want the consumer to experience differently? >> that is a great question. most of our work from april through fall will be spent improving the consumer experience while we have been pleased with the progress we would like to have a more consumer friendly application that is easier to navigate so we do work in that area also you are aware with our financial management system to be fully developed over the summer. those are the top two priorities but it is making

the application to go back and modify a much easier process. we look forward to another open enrollment. thank you. >> i was wondering if you could talk about the budget request is not approved by congress what amounts do you have an ability to move money to implement the affordable care act? >> we do have the authority to make secretarial transfer and also the expense fund that i spoke about last year that allows us to take money from expired accounts for itt and other capital investments. we will book at other resources as this year but our expectation and hope is that congress will provide the dollars we need possibly

600 million to fully fund the exchange's in 2015 but we are determined to implement to the affordable care act despite the challenges. >> my question is with the emphasis on new health care workers there are holdings with minority health professionals i would like you to address the of this this with the president's budget holding programs what that means for minority health professionals? >> thank you for that question. the cuts if you are probably talking about or what has

been impacted our the health care occupation program are those the two that you try to understand? the support for diversity run strongly we have been building on that focused the the work force program with the last three years. we have traditional programs that help strengthen the focus with individuals of different backgrounds and from various minority groups that are long standing programs. the scholarships for disadvantaged students continues at the same funding level as 2014. centers of excellence programs continuing forward with the same funding level

but in addition what we're doing with the workforce programs, i should mention is one other of the continued commitment commitment, diversity in nursing aides to seven program we are continuing for the same level. that is the program that has the focus that we strongly support and they are continuing for word. in addition a couple of other comments, we have been looking at the funding opportunity announcements across all work force programs and where we can we have been strengthening that focus on disadvantaged students. we have examples now of announcements working with an encouraging universities and apologies -- and colleges to engage

individuals with disadvantaged backgrounds with career opportunities. that is an internal strategy that is important because they are illustrative of the focus directing where we can never resources. but what is important probably with the biggest impact is data from that program is very exciting with students better medical students from other primary-care careers that are interested to have their loans paid back or are seeking scholarship because fundamentally they could not afford to attend primary care training program. the data shows a much larger proportion of minority students coming into the

national health service corps than in the work force across the key health discipline. i have a higher proportion of african-american physicians that are coming through the national health service corps then across the general population. what that tells us is this is an important program to get out diversity issues that are of concern to us as well. the national health service corps that the secretary referenced as a robust high priority and important focus with the budget on primary care. one of the key features could markedly expand.

we have 8600 clinicians in the field right now. more than doubled since the start of the affordable care act. we expect to move that up that 15,000 in the field fiscal year 2015. think of that as a pipeline to provide scholarships a and loan repayment in exchange for a minimum of two years of service an underserved communities it is a signature program that makes the major commitment to minority and other disadvantaged students to get into a health care -- careers. >> we also have a minority fellowship program that was double with the now is the time proposal and is maintained as well. >> thank you very much. we will see you next year. [inaudible conversations]

>> it is only appropriate everybody take your telephone device and take a

photo of yourself. [laughter] because anybody that would start a meeting before a:00 on the eastern time zone cannot be all there. i am assuming that most of you had the opportunity to get at least your first cup of $10 starbucks down your belly and feeling good. good morning. first of all, i want to make knowledge somebody before you yesterday. fit campbell for the job he did 2013 the passion and disorganization for our industry has been incredible and part of what this is all about is the type of person that vic is the effort is a

guiding light for those of us that will have to follow me with all the things that he did. please stand up everybody give him a round of applause [applause] ladies and gentlemen, this morning i was supposed to be sharing the stage with jim the chairman of the american hospital association and president and ceo of presbyterian health services n new mexico. he was supposed to be here with us but unfortunately the weather eliminated his ability to make it. the reason he was going to be here is we are fierce competitors in in new mexico and it just happened in being the chairman of the hospital association and the of the federation we thought we would have a good time up here today to talk and

banter but unfortunately he could not make it so we will have to share the stage together another time. but even without him we will still have the especially valuable time for all of us. as we hear directly from the political and policy leaders who would shape and impact on industry in the months and years to come, from the comments i have heard yesterday this meeting is already a success for many of you. i heard you talk about the you a bite to get a big bottle of scotch to sit down with the generals with -- for two hours to find out what he really knows. [applause] but also about the buyers exposition i had the opportunity to walk through the halls this today at lunch and none of you were

there. [laughter] they q for your role with the success of this exposition and a special thanks to our sponsors their names will be scrolling across the screen hoping to take the opportunity to a knowledge who they are. i have been to this event for about 25 years. it seems odd i remember the cherry blossoms blooming. it may be later but there is a stark difference to what is going on today that it is about 16 degrees versus when there was so much pollen in the air you could hardly breathe. but think of the transition from the winter to spring we continue to be in

transition. but we are not the only industry that always goes through a transition. whether banking or the opposite may be the video industry. how many of you out there today think three years or five years ago had a card in your pocket and it was a blockbuster card. how many had one? on the views still do? [laughter] they are taking up space if you still have one today. by blockbuster was a dominant leader in that industry. but it was capital intensive , brick and mortar and employees. then this organization netflix comes up the

business model was a little different. was capital, a large distribution centers and few were employees. then they introduce streaming video to cut more capital to do more with their employees. them last week they announced a big deal with comcast to get directly to the cable customer to deliver even faster speeds. during the hours of netflix subscribers generate 30% of the downloading activity on the internet. between nine and 11:00 p.m. 30 percent of that activity goes through netflix video. that is expected to continue to increase with the comcast transaction.

all this was was a simple disruptive transition one business model going to another. for us whether the affordable care act or all the other things there is a great deal of uncertainty as we begin our own transformation with tremendous financial and operational pressures brought on this by the largest player, the federal government and a much more powerful customer. the best ideas all come from washington d.c. if you don't believe me ask them. [laughter] . .

we have all the same cost better paid one-third of what we used to. that's not right. but that is what is happening to our hospitals. ladies and gentleman for

those of you in this room that are suppliers, vendors and partners of our hospital , the more money they take from us the less money we have to spend with you. as we continue to educate policy leaders regulations don't make sense. . .

this notion that medicare is that the bank for every other program that lacks funding is not the solution. our industry was asked, our industry was asked to provide better services to medicare customers. we have done that. our industry was asked to improve our quality. if you look at our core measures, our hospital conditions, readmission rates, everything has improved. we did what they asked. we were asked to improve efficiencies. he looked at the facilities and operations today, we did what they asked. rearrested take cuts to help fund the four will carry act. ladies and dillon, we did that as well. please take the time to write or visit your congressional representative and let them know

that there actions have consequences. those consequences to our industry can be devastating if done the wrong way. i encourage you to access the federation blog which is up right now and twitter accounts, and if you need information as it relates to providing a congressional leaders with information about what their actions are doing to our industry, i would encourage you to check our blog, check the quick twitter. people will get back to you and provide blue in the information necessary, and we can educate those individuals that adversely impacting as today. we will have a great rest of the day and i would like to introduce the presidency of the federation.

>> thank you, david. that was great. regulators are of the morning. good morning to everyone in the audience. thank you for coming. senator, our first speaker is on the way. i want to wish you a good morning. i also remind you, as david just did, follow us on twitter and fe damer hospital. or on my twitter. also, go to an oblong. we have a terrific program this morning. i do have one thing to say. unfortunately our congressman ryan was caught in the weather, one of our casualties comanche is actually in a planner now. we're going to miss him, but he is promised that he will come next year. i'm sure all of you will be here next year, and we will have congressman ryan for you, but

will beat you have is a new chairman ron wyden, senator blonde, md. taverner, cms administrator and sinister to me it will be up this morning. before we get to the program i want to make an announcement, you need for this program. provides an opportunity. today we can put up the slide, today is budget day in washington. it is the day at the white house release is the president's budget for fiscal year 2015. the federation is releasing a new report on this day on national spending trends in health care, and its implications for medicare policy and the federal budget. this report was prepared by a health economist alan dobson updating a previous report that al did for us in june 2013.

dobson examined the forces driving the historic trends of health care growth and developed estimates of potential additional savings in medicare if the current trends continue. it has been less than a year now, but much has happened since that last report. there are new, empirical studies and new cms data. most importantly there are new congressional budget office analysis and budget forecasts. all of these are documented in that dobson report. taken together, this new information gives us even greater confidence that the force is transforming healthcare finance and delivery are structural and systematic. initially some suggested the slowdown was fueled by cyclical economic activity driven by the great depression -- great recession. although i'm sure some of like it was a great depression.

new economic research suggests that the economy may have had an even smaller impact on health care spending than earlier felt. the report that we were released showed that sustained slowdown is adorable and additional savings are more likely to materialize but even as the economy continues its recovery. let's go to the numbers. i will start with the punch line . $900 billion in additional medicare savings is within reach if we stay the course. what do i mean, and what does this chart show? medicare spending per beneficiary, medicare beneficiary has slowed beyond anyone's expectations and has remained low for several years. this led to a cbo, the congressional budget office lowering its annual 10-year forecast a medicare program spending for the sixth

consecutive year. the cbo most recent budget forecast issued last month lowered medicare spending by another $154 billion beyond its previous forecast which it issued just nine months ago. many may know that several years ago i was staff director of the house ways and means health subcommittee. it was my job to closely follow and adhere to the cbo, cost estimates, budget forecast coming every report it issued. cbo is what congress relies on, the gold standard. dobson used cbo data and averaged the medicare per beneficiary growth rate from 2010-2013. then he applied that rate to the most recent cbo baseline of medicare spending. his conclusion, medicare spending of the next ten years

could drop by as much as $9 billion beyond the cbo current forecast. this means something, especially after we look under the hood and closely examine the moving parts driving the data. we are now entering the fifth year of record low growth in national health expenditures. the projection for just 13 -- 2013 growth is just under 4%. health care expenditures are continuing their historic slow rate of growth in spite of a slow, but still recovering economy. many are unaware of that dated trans that really hammer home that the -- the spending trend and offers further evidence that the slowdown will be sustained. this stated trend is reflected in a stunning drop in health care prices. health care prices have fallen 6% in 2009 to a near record low

of just under 2% last year, the second lowest level in the last 50 years. when i say prices, i mean the payments for services, not something reflective of the charge master. these are the actual payments for services. hospital price growth which fell by more than half since 2009 to one and a half% in 2013 is leading the way. more evidence of hospitals leading role in slowing health care cost growth is captured in this chart. it shows the steady decline in medicare hospital spending measured on a per beneficiary basis of. look at the bar on the far right in 2012 there was near zero growth in hospital spending. medicare inpatient spending per beneficiary actually declined to estimate to a half percentage.

what is going on? what is driving these trans? james carville many years ago said it is the economy, stupid. now at least in terms of health care is the structure. the slow economy starting with the recession, the great recession does play a role, but dobson knows, new economic research suggests that the economy may have had an even smaller impact on health care spending than thought as recently as one year ago. what matters more and more are the structural changes taking hold in the delivery and financing of health care. this undoubtedly is what the head of the cbo man to and ' did you see here. you see that he references beneficiary and provider behavior as contriving the

slowdown and discounts financial turmoil and the recession. i am sure this is no surprise to any of you. all of you know this. all of you are creating change every day in hospitals through reduced rea admissions, building integrated care networks, the playing sophisticated information technology systems and expanding the use of electronic health records. it is all about efficiency and enhancing values. our mission now should be to stay the course with the structural innovations and the reforms that are driving the slowdown. in so doing we will keep within reach the $900 billion in additional medicare savings that dobson sites. this is why this morning i am sending the dobson report to the house and senate budget committee who will be analyzing the white house budget. i will also send them a letter

urging congress to exercise caution and avoid burdensome policy mandates and a new hospital payment cuts. enough is enough. hospitals already must absorb 117 and a half billion dollars in cuts imposed just since 2010. at the same time the medicare payment advisory commission which advises congress about medicare estimates that medicare margins per hospitals will fall to-8% in 2014. that is an all-time low. let me conclude by making two key points. clearly any further cuts will jeopardize access to care. the second, for it any further cuts it would be it jeopardize of investments hospitals must make to accelerate the structural changes driving the new era of low-cost growth.

i encourage you to read there report in full, which you can get access to the a policy blocks. fah policy. now we will move on in the program. and thank you for your patience with me, senator widen. also, to look back to the high side from bonnie to see whether the center is here. >> he is walking in. he will be here in a moment. in so that gives me a chance to get my notes together.

[silence] >> our first speaker this morning is center ron wyden, the new chairman of the senate finance committee -- i should say the powerful senate finance committee. he has been a public servant in washington for 32 years. he has recently taken the helm as chairman of the senate finance committee, elected to the senate in 1996 and elected to the house of representatives first in 1980. i have known center widen for much of his capitol hill career, and i have always had a deep admiration for him. he has tremendous dedication, i great leader in health care, committed to getting things done, has a willingness to reach across the aisle to seek

consensus and if some times causing his democratic colleagues anxiety, he just tells them that they have to live with it. but what strikes me most about him is the effort that he puts into policymaking. he is all about the details, and he is all about doing whatever it takes to get good policy made by the congress. i can remember in the middle 80's when i was the republican health council on the ways and means committee, sitting in my office one afternoon. i got a call -- the phone rang, and on the other end was congressman wyden. first, as a staffer, i very rarely got calls from congressman. to, i don't remember ever getting a call from a congressman who was not on my committee and i served. three, i don't remember any democratic congressman ever

calling me in my entire career on capitol hill. it was quite striking. that did not quite know what to say. i said yes, sir. then he started into a bill he was working on that you wanted to explain and make sure that i and a step that had some questions for me about what we might think about it. that was striking to me. it was unusual. he is an unusual senator, unusual congressman, and is the kind of person you really want in washington. today marks his maiden speech before a major organization since becoming chairman of the senate finance committee, and we are extremely grateful for him to take time from his schedule to come down and see us here and speak to you this morning. ladies and gentlemen, i want to welcome my friend, the chairman of one or -- ron wyden. [applause]

>> what an inflationary introduction. and chip, thank you. without making this a brocade tossing contest, let me tell you what you already know. you are so lucky to have chipcom who has enormous credibility. there was a reason that i called him back when i was a young congressman and had a full head a fair and rugged good looks. he is a straight shooter, and we are lucky to have him. thank you for that kind introduction. let me start by saying at think it would be cruel and unusual punishment to give you a big filibuster. a lot of you had to brave the elements. i thought what i would do is offer a few thousand particularly well chosen words. my staff wrote this wonderful speech. i can put it in the congressional record and mail it to you, but to give you a little bit of a sense of where i think that we are on health policy and

then throw it open to questions. suffice it to say, most of health policy really is not health policy and all. it is essentially budget policy. and so that congress just ducks on so many of the big issues and then sub putting together something that in the parliaments of washington might be called a patch. maybe it is an extension. maybe it is called a stop gap, but the fact is, it ducks the big issue. it repeatedly ducks the big issue, particularly on medicare when you have 10,000 people eligible for medicare every year -- every day. there is a very real cost attached with the. so now the challenge is to try to find a way to move beyond this sick -- fixation on

budgeting. it would be one thing if it was sound budget policy, but so often as i have indicated we don't get at the structural kinds of issues. and move beyond this sort of large from one kind of budget calamity to another and come up with some sensible budget policies. now, we have an opportunity to begin that with the legislation that, of course, involves reimbursement for physicians, what is called the fg our bill. of course this is enormously important to hospitals as well because you all employ so many physicians. now, finally we have got an opportunity to start moving medicare in the right direction because in effect we are assessing the first real day, the first real date for getting serious about moving away from fee-for-service medicine starting in 2017 as a result of

this legislation, providers would be rewarded for pursuing the delivery model that no longer is built just around fee-for-service medicine. instead, providers in other kinds of coordinates models would have an opportunity to, and in fact, when when they were able to provide better quality versus the old model of volume driven madison. those that decide against participating can continue to practice, but they're not going to have the same kind of financial reward. so in effect it is a pretty straightforward choice. quality care and an advance payment model with the potential for those kinds of financial rewards or basically business as usual, status quo, volume driven kinds of medicine.

so in my view, getting a date will we're going to say we're finally serious about setting aside a fly ball strikes me as a very useful step. it is particularly valuable because of the challenge that i envision for medicare in the days ahead. back when i was co-director of the oregon grape panthers even before i was calling chip nights and weekends when he was a young staffer as well to my we did not have the medicare program that we have today. today medicare is all about crack disease, diabetes, cancer, stroke, heart, that would really dominate all of the spending in medicare, well over 80 percent. the reality is the system has not kept up with it. and if you are having trouble sleeping tonight, we put on our website a kind of detailed explanation of what the

challenges, created a person that we call mrs. jones who is really the typical chronic care patient and is essentially after mrs. jones gets her free physical from medicare, thank you, a cnn that point, the whole system kind of goes off the rails almost until the time where mr. jones will end up in a hospital emergency room with that $1,100 deductible that she has to figure out how to pay and at that point cannot even remember all of the providers that she saw on that odyssey through the health care system. so, the fact that we are now moving with the fg our bill in a coordinated care push means that when we get sg our past and start those incentives for coordinated care when naturally

can segue into a better delivery system for chronic care patients in fact, we really jump-start the effort to pursue more thoughtful policies in the fgr bill because in and the fg our bill this he snips, what are called diachronic special needs plans that have not worked out particularly well, we would also see some improvement in those starting quickly because in the bill we provide that the sea snips would, in effect, start locking in the individual care plans which is so important if you are going to move to a more coordinated model committed to physicians and croupier's and nurses and pharmacists together. so the fgr bill which has has indicated is a big plot in terms of the real date for moving away from fee-for-service also gives us a chance to begin the effort

to more coordinated care services for the chronic care population who, in my view, are going to be with medicare is all about. there is one other part that i want to mention, and we will wrap up with a couple of thoughts on the ac a. senator grassley is a republican senator from iowa. if any folks are out there for my luck will make sure you give a special pad on the back. he and i have been prosecuting the case for opening up the medicare database for many years so that we could get that information of services and providers which has largely been included. my view is when that information becomes public, that, in effect, will be a new base line for health care cost and services in our country because not only

will it be a value in the medicare context, but my sense is anybody who has an employer plan, anybody who has an age as a plan, let's say you live in denver, for example, like the kind of information with respect to building in services and quality that this legislation is going to make more available and transparent. if you have an age as a plan or employer plan you will say, why can't i have that same rate and those kind of benefits that you have with medicare. i think this will be a big plus for the entire health care system, and it has been included let me wrap up with a question -- common to on the dca because, of course, we will be looking at it in the senate finance committee, a variety of issues, oversight with the administration presented its budget. my general approach to this is going to be much like my

approach when i voted for george w. bush's medicare program and medicare part b. i was one of nine democrats who voted in the united states senate. i still have the wealth on my back to show for. there were a lot of friends in the gray panthers days when i worked with seniors to said, wrong, that's it. we're not going to support you anymore. once you do of this bipartisan stuff which is fine. that program is a boondoggle, i give away to bake pharma. he should not have voted for it. that is that. frankly, i cannot recall an occasion where i got more slack. as you know, it has turned out to be an extraordinary success story. they have come in 45%,

45 percent below projected cost. and there really is not anybody in the congress here now talks about repeal or derailing it. that is because an enormous number of seniors and families have peace of mind and security as a result of making the program work. i bring this up only by way of saying that a lot of the stories a day of the ac a first few months show a remarkable resemblance to the stories about part de in its few months. western civilization is going to hand. the bureaucracy is torturing us. back-and-forth the debate went. what i will try to do on the finance committee is bring the same bipartisan approach that i did in terms of working when a republican president got his major health initiative through and bring that same approach that i used the party to try to

work with colleagues in a bipartisan way on the dca as we move forward. let me use that as a kind of opening salvo. questions are welcome when you're pretty much right off the plan from oregon. thank you for the work they do. you play a pivotal role in the health care delivery system in our country. i've enjoyed working with you in the past. we have a lot to do in the days ahead. i look forward to continuing their relationship. [applause] ..

>> i am supportive of those who comes from a state like oregon. sort of a procedure path on a spell. first of all, i am kind of the parachuting in the last moment. in other words, the discussion was largely conduct did on each side by chairman bachus. the basic lay of the land has been on the procedural aspect of it. still the heavy lifting department in terms of this and a lot of people are

automatically saving, where we going to go forward. in an ideal world if i had my way, we would tackle some of these military weapons system that i don't think are relevant as we generate the savings. and that would be a possible part to pay for it. that's not on the table right now. we have some tough decisions ahead. since i am a newly minted chair, we went right after valentine's day, i spent time with the chairman of the finance committee for leval for days. discussions with the house. i have been supportive of those programs and i am going to continue to be. obviously we're going to have to make a call as for a cost-effective way to pay for

them. >> that was a real deal. >> we have used this last program for $100 billion in programs. these cuts occurred in 2010, they have a real impact on service we provide them jobs as well. as the new chairman, what is your view at hospitals pay for other programs? >> what is striking about it is that it used to be providers had to face tough decisions in terms of taking cuts for health care. and so people would swallow hard and say okay, maybe if we take a hit, elisa goes to benefit the overall health system. at some point i would wash up on our shores in a favorable way. now, we have moved beyond the and health care savings and

cuts, essentially being targeted, goes to entire other areas of the budget as you can probably tell. i'm not holding any rallies for that particular approach. this is going to be a very challenging time. there is no way to pretend anything else. and it used to be that the chairman of the senate finance committee was going to show up and visit with the numbers and had a to the antic and magically pay for this. can probably remember those days when the democratic and republican chairs of the finance committee and the ways and means committee would literally do that. it would be the revenue raisers in our states were a number of years.

that is not the way that budgeting is done anymore. so part of what happens is when you can't make a permanent policy change, which is what i want, i want a family fix from one to another and it provided the certainty that is needed and it's moved away from the fee-for-service and i very much want to address this permanent way. but it does mean that we will have some tough budget calls. and i'm going to do everything i can specifically to make sure that elyse health care reductions aren't used treadmill up another part of the budget.

and so it is really fascinating to see the role of the budget once one all this. it's. >> i just want to take a second, we have always had great bipartisan ideas and prospects for tax reform. what are your prospects for the election? >> cures my sense of where we are. and the chairman is where we are. trying to build on some of the ideas science or do. and he moved in and cleaned out special interest rates to hold down the rate and restoring progress. and what i think the challenge is going to be is to look at where the house and senate turn

the table and make at least some progress in terms of building towards tax reform. what happened last november, and it was widely publicized, is the house leadership essentially said that obamacare was going to be their course for 2014. that is what they were going to put the focus on. and when they do that, that really changed the timetable. so the chairman was still chairman of the senate finance committee. but of course he is retiring in 2014. i had to make some decisions about where we are. even one the chairman talked about how it would affect tax reform.

and so the house and the senate have to deal with something called the tactics standards. and this is about 55 provisions, number of which affects health care. and there are a lot of spenders and involving energy speaking hypothetically with five provisions on energy. two of them would be enough to obtain your objective in part of this to generate the savings so that you're making a jump start to tax reform. now this kind of illustrative of

my philosophy, between now and the election of my pharmacy. there are three major pieces of legislation that have a date stamp on them. this is the republican from new hampshire and they had this date stamp on them and then shortly we will run out of money on the highway trust fund. and you can't worry about so in each of those three areas, the

centers and the transportation, my hope is to use those bills as a springboard to broader reform. if we can make this cost defensive policy with respect to its vendors, that is a jump start to tax reform. and i have to give some of the private sector money off the sideline and get it back to the transportation finance system. and that's a very important time and we have to be concerned about these other judgments that are going to be made my pledges

to work with you on these kinds of issues to try to come up with sensible bipartisan policy and this includes health and transportation, to try to make sure that we see those decisions in the kind of prism that we are doing. and we are using it as a springboard for the broader reform. to be continued. thank you. [inaudible conversations]

[inaudible conversations] >> okay. the senator is in the wings, and he is in our next lineup for the speakers. senator roy blunt is the senator from missouri. he has served in the leadership and it is unusual he was elected to the senate in 2010, before that starting in 1996 he was elected first of in terms as a

member of the house representatives. as a member of the house his colleagues elected him three times to serve as the house majority whip and the republican whip, the second ranking highest republican in the house. he is extremely familiar with health policy or hospital policy i have known the senator since he was in the house and i'm not sure that i ever thanked him for anything other than that day. i remember many years ago around 2001 i was leaving the health

insurance association of america, and he was kind enough to come down to a going away party that my colleagues and the board were having that day. it took me back if he was gracious enough to come downtown and say goodbye to someone. and it just struck me that it reflects an unusual kind of person and a real understanding of the importance of a developing relationship. so i deeply appreciate him and i know that you will appreciate him. so let me introduce senator roy blunt of misery. >> thank you for letting me come this morning. thank you for that generous introduction. in the most important domestic issues which are clearly the

health issues and we need a lot of python and understanding the real world circumstances and when it might be. and i'm on the other side of the aisle, i ranking democrat on that side. but ron wyden is a person who reaches out and too many people hold it, if i don't give 100% of what i want, i just assume not have anything, which is almost certain not to get anything.

and we the that happens day after day. ..

i had to come up with alternatives, and at some point in that, i said we could claim some victory if by the time we were done every member in the house knew the difference between medicare and medicaid. [laughter] i'm pretty sure every member of the house and senate does know the difference in in medicare and medicaid, but that was not the case necessarily when we entered this debate. you'd be better at it, we would be better at it, and the country would be insistent we figure out how to do this the right way, and i firmly believe surely we would not in a blanket bill try to manage everybody's health care coverage in a new way and restructure 16 or 17% of the economy. now, whether we can get back to the appointment or not, i don't know, but i know it's a better debate if we did. i also know that some sort of instrumental implementation

would have been a better thing, and i introduced the bill in the house that kept 3 million people on their parents' insurance a little bit longer, and there's some people who criticize that and say, oh, that's the slacker provision. these are people that don't want to pay for insurance, and, you know, the truth is that every state let people stay on their parents' ininsurance, and others like them stay on their insurance until 23, and i had a bill at 25, administration picked it up, and put it in that 26 00-page bill to make it 26 instead of 25, and took a largely uninsured group and moved them from the uninsured column to the insured. senator reid said a fourth of the people got health care that didn't have it before the passage of this bill were people who were now op their parents' insurance. i got the bill back out.

i wantedded to see the bill introduced. it was three and a third pages. i should have introduced 14 pages and had everybody covered. three and a third paging very simple, straightforward, probably insured 3 million people not insured before, but the question i would have is what about the other 2597 pages or whatever is in the 2600-page bill, the law of unintended consequences having big impact now. i met with the hospital executives in st. louis, missouri days ago and said the fastest growing unpaid debt group is now among the insured with high deductibles. deductibles so high frankly that many cannot pay it, and so that sliver of health care is a problem. it is a bigger problem, has been before, because deductibles are

higher than they have been before to get the same coverage and expand this to coverage you or your family don't need, deductible had to go up and often premiums go up as well. these are critical issues, issues we have to deal with, and i want to talk just a little bit about the medicare issues that need to be dealt with and what we can do to deal with them, certainly, i was concerned as were 379 -- 39 of my colleagues, signing a letter to the president and cmh before the medicare advantage cuts were announcedded or as they were announced, and don't cut the program anymore. adopt make it harder anymore for people to supplement insurance or make it harder in a noncompetitive marketplace to have competitors to allow them it pay that part of the bill. i think what will happen is you

reduce medicare advantage, you'll see seniors that are not covered that are currently covered. you'll see prescription premium increases and a lot of seniors are not going to have this coverage that they had before. this is where the market place actually in helping to create a market place rather than create a system is a place where the government does good. we saw that in medicare part d. it was the first program in health care that the government ever -- the federal government ever got involved in where the goal was not to operate a system but create a market place, and to see that happen and see like the early results at least until recent changes, i don't know what the changes mean, but medicare part d came in year after year 40% lower than the lowest possible estimate of cost than when the bill was passed

because the marketplace can and does work. medicare bad debt is another area where if we think there's no impact on hospitals and health care providers, we are making a big mistake, and we need to continue to look at medicare bad debt. it shouldn't become a pay-for for other health care services. i think we have to be very thoughtful that we understand that medicare bad debt is a program for hospitals that are already operating on narrow margins, and we don't need to make those margins so narrow that hospitals can't stay in existtense leading me to rural hospitals. the rural hospitals extending medicare dependent hospitals and low volume payments through the end of the fiscal year. we have to be thoughtful if we think we're going to move into a

different environment next year where rural hospitals don't need that kind of assistance. i was pleased to be the principle response sore of the medicare audit improvement act. sometimes this is called the rack, and from the middle ages until about 17 # 00 in europe. the rick was widely used, and the purpose was just to stretch you until you timely admitted whatever had to be admitted so they stop stretching the rack, and seems to me there's an awful lot of that principle in the recovery audit program where the recovery audit program, particularly for small hospitals or hospitals that can't just perm inaptly have somebody or a team dedicated to this do not fight back, and even if they do, the fight takes so long that it appears over and over again the goal of the federal government is to get you to give up or get you to negotiate quickly to get

it over with, and unfortunately, generally, in the settlements whether it's here or other federal agencies, is the very aggressive stand early in the discussion. we have more time, more lawyers, and more money than you do settle or continue to fight? we have to look at this and be sure that nobodiments taxpayer money wasted or spent in fraudulent ways, but there's a better way than how we pursue now to see that that doesn't happen. another issue that you worked on as you are more and more impacted by doctor compensation is the sgr.

i think we have to permanently fix this. i was a freshman in the house of representatives when the legislation passed that created annual cutting of compensation, and i voted against it. i don't know how many there were that voted against it, not have many, but i said many times, may have been the best vote i cast. i look at this and looks like two things here. we're making any mistake a crime. surely, that can't be what the government wants to do, and then we create a big pay-for that i believe will never be used. it really never has been used. i think one time in the decade the sgr was actually allowed to go into force, but it takes energy from health care, doctors, and others who come to washington to do everything they can to see their compensation is no lower than it was the year before. this can't be a good way to

pursue this for lots of reasons. the cbo has -- congressional budget office, has come up with a lower number to permanently fix this, than we with have ever seen before, and we should take advantage of the lower number and permanently fix it however we need to. it was always in my view a phony pay-for, and surely, there were people who were smarter than me who could have figured out when the bill was on the floor that we were not going to be cutting compensation every year so what would we do? just use this as an excuse to have health care providers come back and say, okay, if you don't want the cut, what else can you give us? that can't be the best way to move forward. it's time to stop kicking that can down the road and do as much as we k. i think chairman wyden will look at that carefully whether we get that done

thissier or not. i don't know, but we should, and we should have got it done closer to the beginning of the process than right now because it's just created in many ways annual embarrassment where providers take time every year to say, okay, this is why we have to be paid, at least as much as we were paid five years ago, six years ago, and seven years ago, and now we are where we are. i'd also like to talk a little bit about medical liability reform. on the list of things, that i introduced or sponsored or cosponsored in 2009 when, by the way, there's a wide view by the administration that there was no other alternative out there, well, there were plenty alternatives out this, just not 2600 page bill. there were things like liability reform, creating the market place, expanding the market place buying across state lines,

more transparency by health care providers, the ability to expand high risk pools. i get contacts every day from missourians who when the 4,000 people on the high risk pool when it went out of existence december 31, virtually they don't have insurance that's not substantially higher than it was in the high risk pool, and in our state, in the high risk pool, you pay 135% of the normal premium, and, remember, you had a preexisting condition, 135% of the normal premium was what you paid then, virtually everybody pays more than that now. expanding the high risk pool, knowing the groups you were dealing with, figuring out tow -- how to fund that in a more substantial way would have been one of the ways to create the answer to the problem what happens if i don't have insurance and i have a

preexisting condition. nobodiments people to be in that -- nobody wants people in that trap, there's a better way to do this. the biggest one was 75 pages long, and they would have all had positive impacts on the system. one of them was medical liability reform. still something that is now with current administration, something that doesn't get talk about as much as it should, but you understand the driving liability system better than any group i can probably talk to other than doctors themselves, and we have to do something about that. i introduced legislation again in the last congress, and this congress that has companion legislation in the house that would essentially restructure liability reform. also in the last congress, i introduced legislation where if people come to the emergency room without insurance, you'd have the same liability exposure in federally qualified clinics,

which is no liability exposure for most cases. it's people come in, don't have insurance, you're required to treat them the same liability exposure in federally qualified clinics could expand to the emergency room as well. i think that 21st century can be a and will be a rapidly and positively changing time unless we don't em brace everything that could happen. we'll look back two decades from now and realize in our lifetime what a truly infant science health care was. everything from smart phones to 3-d printing can impact health care in ways i think are not anticipated yet. we need to be sure that federal government is involved enough to protect consumers, but not so involved that we slow down the innovations that happen.

between all the technology that's out there and hopefully increased research at nih, doubled nih funding between 1995 and 2005, i'd like to see it doubled again, and nih funding and other research can make a tremendous difference in how we deal with people's health care challenges, howie prevent challenges, and from becoming as big as they otherwise might be, what we can do can make this really a great decade and great future for health care and for those who provide health care and, clearly, at the front of all of that argument, we're going to see hospitals and the changing role of hospitals. i look forward to being part of that as your role changes, but i look forward to being part of the immediate challenges faced by trying to be sure that trying to start a new program we don't make it