>> this is a human tragedy and honestly one of the fastest expensive and so we would urge you to work on that. finally, i would like to make my last 24 seconds recognizing this through. last sunday on 60 minutes, there was a feature on a clinic called the health wagon in west virginia. it all started back in the 1980s by a sister who in an

old vw would travel around and provide medical services. there was a certain governor early in the decade actually included this program in the state budget and she has served six counties and my folks and assistive 11,000 folks in an area that is dramatically affected by poverty. the grants are very important and i would commend this remarkable story documented for every dollar of the federal money, we get a hundred dollars rack of health care services. >> thank you, mr. chairman and thank you, secretary sebelius. i would like to echo the

senator's comments. i also was absent when senators have now brought this up. but it bears repeating that we have made so much progress on all of the chronic diseases that threaten and take people's lives, especially in the older years, cancer, stroke and many of them are frequently not fatal. they can be fatal but they are not always. we have so much better survival rates we have no treatment or cure. so as people live longer and longer and fortunately they are no longer dying from these other diseases and increasingly they are being afflicted by alzheimer's. so i, for one, cannot think of a more worthy cause and i appreciate your interest in us and your commitment and i hope

that we will make this a high priority. and i do have a technical issue that i would like to raise with you. this arises and i am still trying to wrap my brain around the many ways in which we have socialized this with the health insurance market we have the mandatory payments that have subsidization based on the risk prioritization and the famous bellybutton tax that covers the cost of paying for the high risk patients that we have. and then we have the risk corridors by which the government gets 80% of the upside and taxpayers get hit with 80% of the loss beyond certain parameters which cms gets to define. so what i found very curious is that in the 2015th undermine understanding is that omb has

moved to which funding will go and from which untoward which other expenses are covered. i'm wondering why that was done. >> senator, i would tell you that the cms budget and a lot of the employees who are in administrative work dealing with the marketplace issues are also dealing with a range of other issues and there's a lot that are part of this and they are implicated across the board. but why exactly that budget design is there any more than for the efficiencies of making it clear that that is what workers do.

we are now operating under this budget. any payments from insurers into this fun go into an account and immediately goes to the treasury general fund and is used to reduce the size of the deficit and what would otherwise be. since it is reclassified into the more general program management fund, it remains available to spend on other things. and this includes other sources of revenue that could be spent on other things. it could be hard pressed to understand what is happening in matt the experts tell me, because i didn't want to give union correct answer, that it can only be used -- this meant that the account is a general

program management accountant have revenues that come from other sources area and we can give you a direct reporting on what is coming in. but my understanding is that it can only be used in this way. so we have these authorizations and that umbrella so we are using now. but it can only be used in this quarter. >> so any surpluses to come into this account by virtue of the government take on insurance companies profits or any expenditures and texture bella and have losses, any of that would be precisely quantified and we would be able to track that? >> yes, sir. >> thank you, senator nelson. >> i'm secretary, for so i want to compliment you. you have been through about one of the roughest patches that any department could go through and

it is working. and we are starting to see that there is a realization and there are a lot of young people that were included because they can be on their parents policies and now there is a realization of what is going on with the significant number that you have enrolled in the exchanges. in addition people are catching on to medicaid expansion. so unfortunately they took the position and now they are starting to feel the heat

between the chamber of commerce and the hospitals and starting to realize that this means more out of floridians pockets because people will still go to the emergency room on insurance. and so i want to thank you for your flexibility and what we are trying to present are some ideas of flexibility that the data order could propose to you and so forth. so what i have done is send a letter that would entertain a new plan and this would supply

the state's 10% part in the fourth year and the feds will provide 90% states 10%. and it is compounding on this that is now going on in a state legislator recession worthy appropriators include the extension of the medicaid waiver for managed care. and it is my understanding that there is a basic agreement of one year, and the course of this can be done and if they can get that out now it will be helpful to the state appropriators in

time for the legislator to incorporate this and i don't expect you to have any details of this. >> there isn't any final resolution and those discussions are very much underway. >> on medicare managed we have had some complaints about insurance companies suddenly obliterating a bunch of doctors from a plan and obliterating hospitals from a plan. the question is the definition

of significant change and what i would like is to call to your attention that when they are planning network changes that an insurer or being significant, there needs to be some communication of this fact to the poor insurance as you and i and. >> i agree with you, senator. we will concerned on this issue arose first in connecticut and we are watching it very

carefully and it is my understanding that we have provided formal communication with insurers that a notification is, indeed, part of the responsibility and that we are going to be watching that a lot more loosely to make sure that if a plan to institute changes that beneficiaries can then make other choices based on that plan decision. >> especially if they need to make sure that they have the specialist that they want. >> thank you. senator nelson? >> thank you, mr. chairman. welcome. i joined in the very much with what has been said by several senators starting with ben cardin. it is extraordinary that we have

a program here which is the first of its kind in history to actually work in the past, and it's working. and all they can do is to take out newspaper clippings and it was smart when you talked about having from los angeles times heard that is what they do and to make a living of it and so they do that on fox news and it makes life very difficult for you, but always know that there are many who have been at the very beginning and will stay that way felt absolutely perfect. and that is simply the way things happen in america and one is on the children's health insurance plan and that is always my top priority and it

becomes important because the funding runs out at the most inconvenient time. so we are funded through this year and part of next year. so in the president budget, the feeling of hhs is to keep this for a period of years and years and their 8 million americans

involved and the budget is. >> well, senator and we would look forward to working with you on what the future looks like and it has not really been something that we haven't rolled and we haven't had children who are gaining benefits ever before that should've been signed up because they just weren't. because states are now taking

down some of the blockades and barriers and states are making it far easier for people and i would really be happy, and if the president just mentioned it. it is just odd to me with these commitments that he just simply hasn't mentioned it at all. >> i will share that. >> thank you. and obviously this is most important for west virginia. and it is capped at what anyone sticking up for that. west virginia spent $400,000 worry temple reason.

we have an awful lot of coal miners in all a lot of cool more coal miners before. so it's huge. and there are various ways with the standards as well. with what you can't treat or cure but you can prevent it only by having a clean area and we're the only state that is affected by this initiative. and it is not pleasing to me because we work very hard on it and we have an awful lot of people because that has been part of our history. what i would like you to do is to weigh west virginia.

>> the cap is not for a statement in them decay. in many states there are multiple entities who are receiving funding. and we probably should've given the level of disease in the program. >> one of the effects of the rules and regulations would be we have to divide this among clinics in two different lumps and we have 900 and the state. and my final point is senator

isakson one to reduce the deficit and we all want to do that. what i'm going to bring a probably has no chance of passing because it's very strong on the finance committee. that the easiest way to do that to simply go back to what we were doing with the dual-eligibles, 9 million of them when they were under medicaid. it was all rebated pricing. with an enormous amount of money saved in the pharmaceutical companies now say that we have to stop doing research in all the rest of it. but of course back then when it was in effect under medicaid, they were doing just fine. so now all this is under medicare. we made that switch medicare part d, but we didn't switch the

rebate pricing. if we were to so do that, we would save 100 be $1.2 billion over 10 years senator, that's why we need to pass the president's budget. because our recommendations in the budget. >> yes. >> i agree. >> we are going to rush to get all senators and. >> thank you, secretary. very nice to see you again and thank you for your leadership and it is so encouraging. thank you. the things i look forward to seeing every thursday this report from the department of labor and every thursday morning the number of people who file for unemployment insurance the previous week, the week that barack obama was nominated as the president and vice president, the number of folks

who filed with 620,000 people. i read read the news today announced it was 300,000 exactly. and so when you think about job creation in this country, any time that number is under 400,000, we are creating those jobs are added and the numbers go up and down we keep an average of about 320,000 and we need to create an economy that has a marker even more. one of the keys to doing that and the 800-pound gorilla is in

the room and we get our heads around the health care cost and be able to wrestle them to the ground and just by health care providers and companies in this lot of smart stuff moving him secure systems and health care systems and focusing on prevention and wellness in making better use of technologies. and so a question, if i could. allen said was that morning what we need to do to continue to make progress and he said find out what works and do more of that. and i said find out what doesn't

work any and the less of that? and he said yes. so obesity, it can eat us alive. we are trying very hard to reduce the size of our current and lose weight and be able to start ratcheting down those. and the president's budget with respect obesity, we need to do more there and also medication adherence, we need to talk to those who take the medications they're supposed to and so forth. just those two points.

>> this includes the entire personally these initiatives which are making a significant difference. the efforts to work with our partners at the department of education to revamp everything school lunches to exercise programs are important. the new fda rules and requirements it is under process and will be out shortly and then ongoing research on what exactly works in addition to the prevention fund effort around community projects. what really works and we know a lot about smoking that we don't know a lot about obesity and what actually is the most effective thing to get people engaged in actually have them make different than about exercise and eating.

and there's a lot that's working on the obesity front. i would say on disease inherent is one of the key target and it is also a piece of what the effort is about, collecting the data. it is stunning how many patients are not monitored on a regular basis leading to heart attacks and strokes. some have high cholesterol is not being a lot of fun, not taking their meds, part of becoming a meaningful user is that a provider not only has to collect data but then demonstrate that there are actual changes being made in patients being monitored, which i think can be enormous effective to those quality outcomes, which will be

enormously effective at less than a third of the people in the country diagnosed with high blood pressure are on any kind of strategy to reduce blood pressure. many say they can collect data, focus on the abc's and abcs and make sure that a piece of that is management of chronic conditions. >> thank you. senator menendez? >> adam secretary, thank you for your service and performing this extraordinary job under landmark laws. one of the main goals of the portal track is to provide access to health care coverage to all americans with the expansion of medicaid eligibility which is a step towards achieving that goal.

i'm pleased that new jersey is among the date and i am also concerned by some reports including this morning's national journal about how medicaid applications are being processed in several states including new jersey. specifically i'm hearing about since the backlogs caused by the medicaid departments need to input applicants information by hand in the 21st century. and despite the no longer a policy that allows medicaid enrollees in the marketplace website, the online applications are currently just imprinted a out. and in camden county, new jersey, thursday reported backlog of 10,000 medicaid application and what steps will

be taken to address the current backlog and to prevent war from happening in future applications? >> senator, we sure can turn or raid frankly it is not a state like new jersey expanding medicaid. but those across the country got been on notice and the law was passed four years ago and we are working closely with dates around the country and so we have a additional problem in terms of the automated system

and the federal system is ready to send automated report and receive automated reports and as we tried to seamlessly do this we are actually ramping up the pressure on states and will look at potentially some administrative reductions in payment people don't pick up the pace. and it's just keeping too many people from the health care they are entitled to. >> so they have their own lack of performance? >> at this point, yes trade the federal system to take a while. what we have is a system that is back-and-forth between the states. if someone who is marketplace eligible, and most of it is the

new that new jersey system not being able to give over the number of people. >> we are trying to be aggressive and there's a lot of people. finally laster ms devising new rule to determine whether or not a medicare beneficiary would be heard in inpatient or outpatient during their hospital stay soli based on whether this spans more than two nights. although it helps clarify some issues, we have all heard about beneficiary spending a week or more than the rule fails to of knowledge and instance or a beneficiary needs a high level of inpatient care for a shorter amount of time even if they determine if it is necessary or appropriate by a physician. the cms individual sub arctic knowledge this on a number of occasions and congress just

stepped in and prohibited enforcement until march 31 of 2015. i have a bill of several members of this committee who have cosponsored to call the two improvement acts and what is more important is that cms has the existing authority to implement the provisions of this bill which is to have them consult with outside experts like hospitals and physicians to develop the criteria methodologies that ensure beneficiaries in need of a short stay inpatient care that they are able to receive and to make sure that we don't have these long stays and they are not necessary. so can you give us some sense of whether we can make progress here without necessarily doing legislatively with a? >> think the fact that congress, as you say, has chosen to delay the implementation, we will certainly be looking for

strategies. another with a lot of consultation earlier, but i would love our back to circle back with you and your staff to see what the elements are in the bill that we could perhaps move forward on an immense rate of basis. >> senator fisher, it's a bipartisan bill, so i hope we can do that. >> thank you, mr. chairman. madame secretary, thank you for all your hard work and washington state is the sixth highest place of marketplace and woman in the country. we have always had a lot of success in getting people coverage. so my colleagues may have brought this up earlier. there's a lot of discussion discussion in "the new york times" about small segments of the physician community in payment and reimbursement as one has said. it a tiny fraction of doctors

getting something like 25%. so as you know i have been very good in the implementation of vat from the portal track so that we can focus on healthy outcomes instead of the number uppers teachers performed. so getting an update from you on how we can get that implemented. to also know if some of this other information, which is part of the midst mix of reimbursement that we don't have data on things like the diagnosis of whether their carelessness is area, a procedure performed, particularly on those with durable medical equipment, whether we can make that information more transparent as well to help us in this effort of focusing on how comes instead of procedures.

>> senator, i know you're interested in this area and i certainly share it. the data release earlier this week was a big breakthrough that data has been under federal injunction since 1979 when it was attempted to be put out once and have them blocked and that injunction has been updated ever since. at the department we have joined with "the wall street journal" and others asking the judge to lift the injunction. i'm pleased to say that the data is now available. we have also discussed this with senator grassley earlier. and it will be collected and we are on track to have this available because it is helpful to consumers to make a choice and it's also helpful to look at what providers are actually collecting. we would love to work with you

going forward on what other data that and the determination initially about the 10 or more procedures with a sometimes collecting one at a time is a scattershot look at a scenario and doesn't give you comprehensive data. we want them to know if you can go under the knife on the we want to know who does the most hip replacements, knee replacements, who is the most familiar with that. so it's great consumer empowerment at all though information that we think should be transparent. >> and the value-based modifier? >> again, that is part of the initiatives going forward. certainly one of the looks that the medicare team is making with how you can allocate adjustments to payments based upon this

series of criteria and what the outcomes are. we are testing a lot of different models including accountable care administration's and it is probably the most promising set of test are not only cost is being watched closely but certainly the quality outcomes for patients. and we have some very promising early results in a better thing that could be taken to scale in terms of what works very well. but the innovation center is probably testing 15 different models right now which would lend scientific data to the value-based modifier and give us way that we can build change payments based on what works to increase quality and lower cost. >> i appreciate that. for the record i am for more information being released. we feel like we have art event experiment in so we have provided better care at lower cost and get lower reimbursement

rates and i would not say that we all finally back, but we certainly would be more amenable to that continuing with the rest of the country would follow suit. >> and you don't want to be punished for that. >> exactly. we would rather be rewarded. transparency will help us on the outcome. >> thank you. >> well said. senator bennet? two thank you, mr. chairman. adam secretary, it's good to see you again. i'm glad you're here under circumstances other than what those who have predicted before. i do think that what we saw in the fall as a reminder that we may not be up to the task when it comes to certain things like

i.t. and procurement and customer service. my hope is that the politics around this, as they subside, which i deeply hope they will. because at home health care is the farthest thing from a political issue for some people. it is a day-to-day way that people live their lives. and i think that any wisdom that has been wired that could benefit other agencies or other levels of government, even a senator menendez was talking about, i ink you could provide a huge service at some are not on whether it's leading a discussion or having an interagency initiative or that this is the work that no one ever gets two. and you know that. at this level, the local level, no one ever gets to it. what it means is the velocity of

the world we are living in the we run the risk of finding ourselves and you don't need to react to that today. but you can certainly if you want to, but that is just a thought. i think it would be a shame to let that as it was just disappear and forced not to learn what we need to learn from it area than the other topic i just wanted to raise at the end here is that when we passed the law the cbo had projections about what premiums would look like and i think that the actual premiums came in 50% of what the cbo projected and if you look at the last two years it has been the slowest rate of health care inflation in the last 50 years which is saying something. and the medicare growth rate, i think we just learned it as my 3.4%. i'm wondering if you could help

us understand what is going on out there. for years and years we have talked about doing things in congress that might bend the cost curve and are we beginning to see that, and are we seeing the beginning of this. and we have name calling and all the rest. have we actually done something here? or is it too early to tell remapped. >> i think that the early couple of days of the affordable care act, a lot of that cost reduction for contributed to the sessions. two people not using health care as much, although i would argue that you have a guarantee of benefits and it really didn't very alive with a recession. but having said that now, now that we have crossed this and we

are seeing a fundamental shift and i think some of it is due to the framework with not only directions to reduce costs and increase quality and medicare and medicare advantage, but also deliver a very strong signal that we need to look at ways to lower the overall cost and what i find to be intriguing and very encouraging is that it's not just medicare spending which is down. but it's overall health expenditures so that in the eight years, the roads at just about 6% a year and the gdp per capita was rising at 2.9% year and health care was dramatic lee

over. 2012 gdp per capita of about 2.8% and health expenditures, and this is everything, not just the public programs was at 3%. so we have come from twice as high to underneath and medicare is significantly underneath and that was updated going down and medicaid is on a trendline going down as well as private health insurance is also going down. so i think that the news is good and what we are trying to do is capture exactly where those expenditures are. some are hot will in some of the work done around this, some has to do it the efforts on the preventatives i area but capturing that in figuring out how we doubled down on it, what you have done in the affordable care act is at least on the public riverside to give us an

indication that if you find things that work you can take it to scale without running a demo project for coming back and doing it. so there is an opportunity to accelerate as we learn more. >> mr. chairman, as we think about this going forward, these trends all as read and the real question is whether they are such a noble and we ought to be watching for that. but i think that the committee, i hope, is interested in getting that data from you in real-time because we need to understand what is working well and what is not we can help people at home that are trying to deliver care a low-cost to bring that to scale and not just wait. the next discussion that we will have with health care and we have a billing place and we need to transmit that data and we should be surging ahead with the stuff that is actually out there and a lot of it is in my state

and i know the other states agree as well. >> determine and i have had some conversations about the possibilities of reading this committee and others about the reading of the innovation center which is part of this what is being tested and tried on what we know about and what those results are. some of it is at this deep level, some of it is dual eligible, some of it is a direct delivery system. but it's very promising information we would like to do that. >> ultimately like that to inform our reimbursement and that is what we need to do. >> exactly. >> a very good point to quit on. leaving you with one thought as we get you out the door. i have been struck over the last couple of hours at how often the conversation focused on the nuts and bolts of improving health care policy. we look at critical access

hospitals, value purchasing, children's health care, these are all areas where democrats and republicans can work together and work together in a constructive kind of way. this is about the opportunity for democrats and republicans worked together we will have a lot more conversations like that in the days ahead. >> thank you senate finance committee is adjourned. [inaudible conversations]

[inaudible conversations] >> interface with page, we are asking you to share her thoughts of the resignation of secretary kathleen sebelius. join the conversation on c-span. >> coming up on c-span2, a senate foreign relations committee hearing in 2015. and then president of americans

for tax reform in later testimony from health and human services secretary kathleen sebelius whose resignation was announced on thursday. >> there is an interview in 1942 on the question of integration and in baseball. and he says it's very interesting. because i have read all of the accounts of what he is actually dead and it is clear to me that he had serious doubts about the integration of baseball. and so what'll happen is, i think what they want is they want a fan base. we are packing them in and we think they want our fans. and he says if you want to integrate, kinkel team. take wac all-star teams into the

majors. and if they were interested in increasing the talent of their teams, we have bunches of players are good enough to play in major league baseball. >> integrating professional baseball saturday night at 8:00 p.m. and on american history tv this weekend on c-span3. >> the tears on july 2, 1964, president lyndon johnson signed the civil rights act. there's a president obama spoke at the lbj library in austin, texas at the double right summit commemorating the day. you can do this event in its entirety at c-span.org. here are some of the president's remarks. >> this was true 50 years ago, there are those that dismiss the great society is a failed

experiment and an encroachment on liberty, who argued the government has become the true source of all that ails us in poverty is due to the feelings of those who suffer from it. there are also those who argue that nothing has changed. but racism is so embedded in our dna there is no use trying politics. the game is rigged. but such theories ignore history yes, it is true that despite laws like the civil rights act and the voting rights act and medicare, our society is wracked with division in poverty and

yes, still colors our political debates and there have been government programs that have run short. in a time when we have to often passed off as wisdom, there are limits to change and we are trapped by our own history and politics is a fools errand and we would be better off if we rule the chunks of the legacy of lbj or at lease if we don't be put to much of our hope and invest too much of a hope in our government. and i reject such thinking. not just because medicare -- [applause]

not just because medicare and medicaid have lifted millions of suffering. not just because the poverty rate in the nation would be far worse without food stamps and all the great society programs that survived to this day. i reject the cynicism because i have lived out the promise of the efforts of lbj or if but because the shell has lived out the legacy because my daughters have lived out the legacy of those because millions in the generation were of the position to take the baton that he handed to us. because of the civil rights movement and because of the wall that president johnson time, new doors of opportunity and education swung open for

everyone. not all at once, but they did swing open. not just blacks and whites but also women and latinos and asians and native americans and gay americans and americans with disabilities. they swung open for you and they swung open for me. [applause] and that is why i am standing here today. because of those efforts and because of that legacy. >> first lady michele michelle obama and joe biden host an event on friday and port of military and veteran caregivers. former senator elizabeth dole and rosalee carter will also be at the event. you can see it live at noon eastern on c-span. >> a senate foreign relations committee thursday looked at the president's budget request for usaid, the u.s. the of international development.

the administrator testified about several topics including global poverty and the social media platform in cuba. this is one hour and 20 minutes. >> this meeting will come to order. we welcome you back to the committee. you come at a time when we are making headlines for doing nothing more than the job you were appointed to do. so let me say for the record that when it comes to the issue of work in any society, i do not believe that usaid's action to promote resilience and democratic societies are able to realize their potential are in any way a cockamamie idea.

i believe it is in that we want the people of cuba and iran, burma, north korea and other authoritarian nations need to help them communicate with each other. to help them achieve the stated mission of a free and peaceful and self-reliant society with an effective and legitimate government. so i commend you for helping people having less control platform to talk to each other and for helping them to find a way to connect to share their views. global internet freedom programs in u.s. international broadcasting as well as support for human rights accidents are of fundamental components of our country's long-standing effort to promote democracy overseas. for more than 50 years the united states has had an unwavering commitment to promote freedom of information in the

world. and our work in cuba is no different than our efforts to promote remote expression and uncensored access to information in the ukraine, russia, china, or north korea. it should be noted that in fiscal year 2014, there is $76 million set aside to promote global internet freedom and democracy in societies like cuba where the regime allows no independent press and limits access to the internet. it also is they that with respect to democracy and human rights and governance activities, that these programs shall not be subject to the prior approval of any foreign country. it is common sense that we

shouldn't ask the government of iran or egypt or china for permission to promote advocates of free speech and human rights or political pluralism or to provide uncensored access to the internet or social media. at the end of the day just giving people the opportunity to communicate with the outside world and with each other is, in my mind, a fundamental responsibility of any democracy program. as bill gates said, the internet is becoming the town square for the global village of tomorrow. but to go one step further, the town square will become more free and inclusive thanks to the democracy efforts of organizations like usaid. so i think that it is dumb and even dumber to go ahead and suggest that there can be freedom and that we should seek freedom of internet access and

freedom of expression globally or that somehow the people of cuba don't deserve the same freedom. and i will finally say on this topic there is only one entity responsible for the imprisonment of alan gross and that is the cuban regime. it is not this government but it is not usaid but the cuban regime. and i am tired of blaming ourselves when the entity that should be blamed is the regime that unlawfully holds an american in prison for doing nothing but having the jewish community be able to communicate with each other. it's pretty outrageous. with reference to the letter, we look forward to how we can make certain that u.s. development

assistance alliance with u.s. foreign policy and i look forward to hearing about your priorities for the budget. i know i speak for the members when i say i am impressed by your nativity and management, which is essential to usaid reform into your agency's pursuit of an national development priorities in ways that focus on best practices and result. and so as we have discussed on numerous occasions before i do as i have said to the secretary when he was here, i remain deeply concerned about the resources for the western hemisphere and they are insufficient to meet the challenges of the region and it is an important factor to our props dirty and shared interest in health and development. and so that is something that we look forward to continuing to engage iran. so while this poses a strategy

for the region, the law is fundamental. i believe we can do better in the mr. and i think that we can do better in meeting within that context or international development priorities within the hemisphere. i look forward to an ongoing conversation with you about how to get the best results. .. for the taxpayers and now i would like to recognize senator corker. >> thank you, mr. chairman and those passionate comments. we appreciate you being here and all of the work you do around the world. my comments are going to be brief. but we look forward to your testimony. we appreciate you being here to go over the budget request for 2015 and appreciate the reforms you are trying to put in place around the world and within the

usaid itself. i think foreign aid one of the most misconcepts american have. we spend 1% on foreign aid in the budget. and i would like for you to herald the successs. i know you will do that today. but it is our responsibility to have healthy talks about the specticism. i like what you are doing with the food programs to make them more efficient and other programs that deal 30% with local enities and one way that is appreciated and on the other hand i want to make sure there are results. thank you for being here and we look forward it to your questions and testimony. and we look forward to your

work. >> the floor is yours. we ask you to summarize your record and we will add the full to the record. dr. shah: thank you, secretary hagel, and thank you for your generosity in inviting usaid and our many partners from around the world to be part of this important discussion, and for your vision of using this forum to help us build greater cooperation across all of the range of issues that bring us together as a common community. it's an honor to be here. this resource and investment is a core part of keeping our country safe and security over the long term and improving our own domestic prosparty as the world grows with us. our mission is to end poverty

and promote demcrotic societies. our efforts have constituted a serious rebuilding. we have added to staff, managed budgets and projected priorities in food, water and health. and expanded our base to include companies, universities, scientist, faith-based organization in addition to the val valued g ngp -- ngo's. our efforts have constituted a

new model that involves many partnerrelationsh partnerrelationship. president obamas feed the people program now reaches 7 million small scale farmers in 19 countries. this year 12.5 million children will no longer be hungry because they are in families that are beneficiaries of feed the future. our invest. -- investment and matched and exceeded sometimes and i want to thank the commit for supporting food aid reforms that will help us reach an additional 800,000 children in the context of disasters around the world. or our effort to save children's

lives are supports with a 2.7 billion budget request. every year we save more than 5 million children from dying under the age of five. similar foal of 6 million by 2030. education, water, energy and many other sectors of the economy we work in a result way and i look forward to that discussion. i was in the philippines last week with secretary hagel working to build the capacity to be great partners in dealing with disasters. this includes more than $3 billion for disasters in places like syria and south sudan.

this past weekend, we noted with initial success an election in afghanistan that saw 60% voter turnout and a large proportion of women. those efforts were supported by the united states and other international partners and led by afghan institutions themselves. budget have been tight and this budget does make tradeoffs. we have now launched a u.s. global development lab that is bringing businesses, scientist, te technologist together. we are seeing interesting results. we will spend $5.7 to get banks

to $133 to farmers in columbia, peru and guatemala. that kind of leverage and scale is what is possible if we do things in a more creative and effective way. let me close by saying thank you. i had the opportunity to deliver the speech at the national prayer breakfast. it reminded me when we come together to serve the world's most vulnerable people this cuts across party lines and brings us together and allows us to continue our proud heritage as humanitarian and global effort aid giver. >> let me start off with the one concern i had in the western

hemhe hemisphere will be cut. venezula 14%, haiti, columbia, guatemala, all cut by 20%. i don't underestimate the problems we face in the world, but i think we underestimate the problems we face in our hems sphere. we have problems in south america with the highest homicide rate in the world and challenged governments in terms of rule of law issues and meeting the challenges. in mexico, some states that are lawless still, near the frontier border with the united states. we have the challenge of venezuela and a growing set of circumstances there where civil

society is under siege and ec ecuador and i see a wide range of issues. i understand that some of the countries have graduated. but instead of looking for other investment opportunities, the money is sent to other parts of the world. and we have now seen year over year, double digit cuts that from my perspective are not sustainable. so, can you commit to me you will work with us, as the secretary said he would, to see how we change the dynamic. because in our own front yard there are challenges that are both in our national interest on so many different questions from security to drug addiction to

economic opportunities to health care issues that no borders when it comes to diseases. can you talk a little bit about that? >> yes, thank you center. i agree where the nature and importance of the region. while we have made tough tradeoffs, as secretary kerry noted and president obama this region is important to the future from a trade rperspectiv and partnership. we are trying to possession so as countries get wealthier, we shift to public-partnerships. in particular, i am proud of the fact that our development credit

authority team has expanded the number of loan guarantees we provide to local banks. whether it is el salvadore where $25 million has been opened or in mexico where i will be next week to meet with partners. we are unlocking local guarantees. and similary we have a >> hoshost of improved partnerships. one i would note is one with starbreaks to help them reach 25,000 small scale farmers in columbia so they can bring better prices to the farm gate, economic value and build supply

chance that enhance economic opportunity. i think the region can be a model especially for countries moving up the scale. >> i appreciate the innovative thought and welcome it but we are looking at other challenges as well. in the ukraine, the language passed by this committee and in the senate and house and signed by the president, asked for reprogram assistance to the ukraine. $50 million for the improvement of democratic law and $100 million for security spread over the next three fiscal years. where were you in the process of reprogramming this assistance and when would you expect it to

get to ukraine and when did you believe the usaid mission director signing the agreement with the ukrainian government that transfers the billion in loan guarantees will take place? any sense of the timeframes there? >> i appreciate to come back to you on the bilateral agreement and loan guarantee because our acting deputy and assistant administrator are in the ukraine right now working with civil society groups and groups supporting the election process. some of the partners there were critical to documents the human right situations that took place during the protest. our economic portfolio is being aligned to move forward with the imf agreements so they can get tens of billions of help from

there. we are working with the future of their energy security and in a number of other areas. we have a proud and significant history of working in the ukraine and we have delivered significant results and look forward to do that at a higher level given the resource and the strong support of the committee. >> i understand it will incentvise unfunded money and i think that is is an important initiative that deserves highlighting in a time of constrained budget. what hard deliverables will we discuss with the incoming afghan government? what are some of the goals?

what are some of the challenges there? >> thank you for your leadership in supports our programs in afghanistan. for 2-3% of the total cost of the war we think we have delivered important results that create the bases of a more secure society in the future. we were part of an effort in tokyo to bring together international partners and create a set of conditions that the afghanistan government would have to meet to receive the full mount of development assistance and not just from the united states but all of the int international partners. anti-corruption activities, the conduct of free and fair election, collecting more custom

revenue to replace development assistance over the long-term and there is a 360% increase on that bench mark and several with protecting girl's rights and access to schools for girls. our committee meets twice a year to assess their performance and we make suggestions after that. >> senator corker. >> thank you, mr. chairman. and thank you were for being here. we talked about the food for peace program and it has been delivered somewhat but we are failing on it. i wonder if you would-like to

talk about that and what you would like to see happen relative to your food programs >> tank you, senator. america has for food for peace served more than three billion people and providing them food assistance when they need it. because of nearly every other country that provides food assi assistance made a shift to purchasing food locally and providing cash resources to institutions like the world food program so they can by and deliver. >> that empowers that local countries to be more self-sufficient and raises the standard of living, right? >> yes >> how many more people could be served if he moved fully to this kind of program and i think anybody would say from the stand point of what we are trying to do makes more sense than shipping united states products

overseas to places and never building up that independence we would like to see. how many more would be served? >> it correlates to 2 million additional children who would receive food and that is women and men and children in syria, south sudan, afghanistan and other areas. >> and if we did it fully how many more people would be served >> i have not made a 100%. >> we did an estimate and we think it is 7-9 million more people would be served if he we move away from this and build up the economy which is what this is about. we have preferred shippers, i guess. would you tell us about that?

>> the way the shipping/contracting system works relies on a handful of core partners. they have been important partners over the course of the program. and the president's proposal maintains on important role for farmers and shippers and we are asking for additional flexibility so we can meet the needs of beneficiary at a time the most need with the lowest budget. >> we asked for a goa study and this is along the lines. your goal is contract 30% of your activities at the local level. one of the concerns we have, though, is that right now, the way you are tracking that is you are tracking how much money you are spending but not tracking outcomes to see that even though

the money maybe 30% going there, are we getting the same results? this is a different effort than the food aid. this is contracting to work with people to care out the work that usaid is doing. do you have concerns we are original measuring money out and not results? >> i think united states forward allows us to be more efficient and better to report on core results. so that is a pack of forms to move us in a direction and i would say we have been able to do that. i believe the review is focused on the shift of including more local ngo's and local

institutions. i would hope they broad n the analysis because if you do, you would find, unlike a few years ago where we said we are reaching seven million farmers and helping 12 million kids and why saving millions of lives a year. and that ability to quantify and report on those results is also a part of usa forward. our progress against our goals in moving to local institutions has been as designed incrimental and we are doing this at a pace that is responsible. the ultimate goal is to build assi assistance locally so that we don't have to be there forever. >> one of the important things that we do as a nation is trade capacity building. and these are along the lines that i think most people here

would like to see and that is making sure that we are doing on a daily bases everything we can to empower countries that we are working with to be sustainable on their own and not depend on aid forever for the united states. we looked on the website for who is in charge of capacity building and there is 24 agencies involved and which one is ultimately responsible tr building trade capacity in countries that we are dealing with? >> well, sir, first i think this is critical and important and we commit nearly $200 a million to trade capacity building more more than that if you look at agriculture trade support in regions in africa and elsewhere. michael and i are co >> hoscohosting a discussion so we can figure out

to implement the new agreement and president obama launched trade africa in africa based on resulted that showed for every dollar we invested generated $40 in value. so the united states trade representative, myself and the state department work in close coordination >> i think the concern is, and you are one of the most reformed minded leaders of this administration we have had and i think we applaud the efforts, but i think the concern is there is not a small group of people, and there is so much to do without much money to empower these countries to be involved

in trade that go on. is there a way that i cannot answer this in the setting but there is a way you would work with us to help figure out who is in charge and responsible for accountable for these activities so it has a focus that gets us to place that we would like to go? >> we would absolutely like to work with you. i would say the way it currently works is united states takes responsibility for the implementing of the programs and reporting on the results and ensuring they are designed appropriately and the trade uses the programs to deploy them where they are needed. it is critical we work together and i can report to you with confidence that relationship has never been closer. >> thank you.

>> thank you for your leadership, development assistance is a critical part of our national security interest and the obama administration made it clear the national security budget included the development assistance programs and you are less than 1% of the federal budge & small fraction of the total national security budget. it is very important. i particularly want to acknowledge the budget support f fore east asia pacific. as i said, you are work on a tough budget. the overall budget growth is very much reduced. and you had to make very touch decisions so i appreciate the priority that has been given to east asia and the pacific from

the philippines to burma and i might say to senator corker your trade capacity improvements, there is many countries benefiting directly from what you are doing in that area. secretary clinton initiated this on environment, health and also on infrastructure and it is a major initiative that i think we can be proud of. >> having said what i did, we want to make sure the aid is done in the most efficient way. and i agree with senator corker, we need improvement and reach more people and leverage our dollars more than today. you started the global development lab and i want to talk about using this to

leverage the money we make available at a our academic centers that have expertise in this area. if we work in a coordinated way we could get more effective results and achieve the objectives in a more efficient and hopefully shorter time period. can you share with the committee how this program where you are using this program with existing resource and how you will continue to operate as you lunched the development lab? >> thank you for your help on the issues related to work and for your personal commitment. we are excited to have launched

the u.s. global lab. in our time in this role we are increased had spending on science, technology, research and development from $130 to just over $600 million and done that through tradeoffs where we make the tough choices to move money in this area. this allowed us to create developmental laboratories on college campus across the country. and groups of staffer and technology are creating new ways for babies to breathe through low-cost devices coming from rice university and the device from duke that allows us to save drugs so that women can they can that and take one dose before

and for the child after and prevent the transmission of aids from the mother to a child without being in an assisted medical environment. those kind of breakthroughs reduce the cost of saving kids' lives, saving mother's lives -- >> it reduces the cost we would do in direct health services to deal with babies that are infected. >> that is exactly right. and we have also found that big companies around the world have been eager to partner with us. walmart joined the lab and they are working with us to reach farmers in africa and procter and gamble joined in giving us packet that allow us to filter patter in burma. and they are donating that to

help countries where too many children die from too many organisms in their water. this will allow u.s. aid to have a technology we can employ and allow young people that want to create businesses on their own whether it is making and selling solar power flashlights in parts of rural africa where there is no energy access or commercializing this positive airway device which they do for $20-$30 a device and we are deployi deploying. to use that business savvy and skill to actually solve some of the world's most challenging problems is exciting >> you are leverage the strength of america in our science and

technology and what we have been able to discover and share with the world as well as our private companies. leverages these -- these are american values and where are the challenges and where congress? >> we have requested new authorities from congress to help us be more flexible in how he we carry out the work like hiring people with science and business backgrounds, the ability to provide prizes. we see a lot that come out of prized competitions and you spend money on those winning and you can motivate thousands of partners that you would never be able to find to compete for winning prizes on the awards and

some flexibility in how we use the resources in the development assistance account which is critical to funding this effort and fullly funding the budget. those would be the request and i want to thank the members of the committee for the ways you have done to support this >> it is using existing resources in a more efficient way to accomplish greater results? >> that is correct, sir. >> senator rubio? >> thank you for being here. this isn't a charity right? they promote humane aid around the world and furthering our national in the right? >> that is correct. >> as you get involved in each country, you look at the spi

specific needs. some have lack of access to water, some women need to be treated better, and you aim to go into the countries, determine the needs and promote those causes but also in a way that promotes america. >> our mission is to end poverty and promote democrat cities. >> so you have programs on the island of cuba and as i believe it is to break the information block aid in cuba and promote information sharing among other goals. those are stated goal of our program there. >> we have notified congress in every year on the goals of those

programs and we run internet access and freedom of information programs in many parts of the world including cuba. >> the reason i bring this up and rightfull y so you focus on this because cuba has the second most oppressive government in terms of denying access to the internet. people in cuba can't go online. the average person on the street can't go on the internet. it isn't a capacity issue. it is prohibited. i will send out a tweet right now. if i sent this right now i would be put in jail. and i will send it as an example of what people in cuba can't do. and as a result of that, usaid, as it has been revealed over the last days, usaid had a program

that cause designed to provide the people of cuba access to information and to break the information blockaid allowing people to share information. there has been talk this program was illegal. but i think this program was within the stated mandate and purpose of your program in cuba. that is accurate, right? that is within the goal? >> we have publically notified these programs are designed to enable open communication. >> and the other argument i have heard was this was a covert program. but this was reviewed by the general counting office, right? >> correct >> and they made no suggestions for changes? >> they complimented the usaid. >> this wasn't an intelligence

program. >> no. >> we were not selling weapons or arming people on the ground in cuba. >> no. >> this program was allowing cubans to be able to communicate with others because their government doesn't let them do that. people should be able to do that in an advanced society but in cuba they are not. so this program chose to fulfill the mandate and break the block aid. at the peek, 40,000 users were on the program and that is not true. at the peek it had 68,000. when was the last time we stopped a program because it too successful? this program in my mind is successful and not only am i glad we did the program but i am upset we stopped.

i believe we should do everything we can to provide the people of cuba, and other repressed cites, full access to internet. if they want to read the communist rag they can, or the cnn or drudge or whatever they should be able to do that. for everyone who is outraged by this program, when was the last time undermining a tyranny is counter to the purposes of the united states? when was the last time we were outraged and lost the ability to talk to each other? i read the quotes in the paper of people setting themselves on fire. we have radio broadcast to europe during the cold war and to cuba right now. all we wanted was people to do was to talk to each other.

those had contact them them. i want to know when it was against the united states and goal of america to under monopoundermine a tyran tyranny. a tyranny that votes against us in every international form and consistently on the side of every madman and tyrant on the plant. if there was a vote on syria, they are against us. russia, they are against us. human right violations in china, they are with china. when was the last time cuba lined up on the form of decency and right. they are trying to undermine our foreign policy aims and the foreign policy aims of the world. when do we start the program

again? and what do we need to do to expand it so people can do in cuba what i just did and that is speak to the world about cuba live and anything they want including the latest record from beyonce or jay-z or what someone wore to the oscars. >> senator, i want to clarify. usaid programs are designed to promote open access to information and facilitate information. any programs that have further purposes are not implemented by usaid but rather by other parts of the state department or the national endowment for democracy. in terms of restarting these types of things, we have the fy 14 fiscal guidance clears as to which agencies will pursue this into the future. >> senator? >> thank you, mr. chairman.

i guess i want to follow my colleague and friend senator rubio. i don't coral with the premise, whether it is china or cuba, opening up free exchange of information is fundamental to our country and the basic values of a democracy. so the critics of this effort, ought to come up with a better idea. but the notion and premise is sound behind it. i may go further than my colleaguee colleagues on the committee when i say after 50 years of what has been a dubious foreign policy in cuba by the united states, i have been in favor of opening up cuba and the people of the world and the united states that is how communist and the soviet union came to an end.

cuba is isolated from reality. if we had more social media level and beyond i don't think the current regime could survive like in europe. i visited alan gross, i think two years ago. what a heartbreaking situation. this poor man is being held because he may have brought in equipment that would have brought in more information into cuba. i don't know specifically whether he did or not. and what they have done to this man is heartbreaking. when you visit and see what his life is like today or meet his wife and family as i have. i said to the cuban officials i have leaned your way opening up, but you have lost me on gross. what you did to this man and closing out his small effort to

bring in equipment to me is just outrageous and this poor guy is still in prison, hospital prison and is going on a hunger strike. i don't know how he keeps his mind when he faces this every day. but i don't agree with the premise. open it up. the more ideas we poor into the that island the better chance they will move toward values we share. so those who are critical of the approach give me something else that will achieve this goal. two things i focused on, one was with a legacy for my predecessor, paul simon, about w water for the world. we have been appropriating money and the other is child marriage. i know there is a program underway in usaid to try to

discourage child marriage and the awful things that come as a result of it and i would like you to comment on those two areas, if you would. >> thank you, senator, on your leadership for water and water for the poor. >> -- we have given people access to waters and girls who are usually sent into dangerous environments to fetch water avoid being abused and raped and hurt as they are going about those tasks and they can do things like go to school. it an extrodinary thing the congress should be proud of. our spending on water went up from 1.4 million to 1.2 billion.

as we focus on the cost effective results that save the most lives and produce the most students for girls around the world, investments in water were at the top of the list and that is why you have seen that transition and shift. i want to thank you for your lead leadership. with respect to child marriage and gender-based violence, we have new programs that focus on these issues, in particularly high-risk places. but it is amazing the challenges people face. i was in eastern congo and saw the un report showing 15,000

girls that have been raped and that is a part of how war has been conducted. i am proud of the fact that thanks to your support and other members of the committee the united states leads the world in supporting health services for helping girls get back on their feed and finding economic opportunity and going back to school. the range of the program have gone up since secretary clinton went to that region five years ago. it is something america could be very proud of. >> thank you very much. i might add. i am promote ing a product maden chicago. it is called port-a-pure. this man made a six gallon thermos and whatever you poor in

the top comes out clean drinking water in two minutes. no chemicals. they use nano fibers filters. it sells for $60. if we can take this into a micro credit situation in haiti they can buy a jug that would provide safe drinking water for family. that is one idea. you mentioned others and i hope your committee takes a look at it. portapure. one word. you will be very impressed with this. >> we set-up the u.s. global development lab to help commercialize and distribute those items. we will take a look at it.

>> senator johnston. >> thank you. we have good water filtration center in milwaukee and probably helped out with that company. welcome. i really enjoyed your key note at the national prayer breakfast where you made a strong case for foreign aid. unfortunately, not ever american got to hear that case and it is also unfortunate situation. most americans look at the foreign aid and that is the first place they want to cut. so can you speak in terms of making the case for foreign aid. >> thank you, senator. what i learned at being at the prayer breakfast was that when

we come together, republicans, democrats, house and senate, and very importantly faith community members who carry out the mission of serving those who are among us. we present a picture of a world of america that cares about vulnerable people and cares about countries and societies that have been left out over the centries. 860 million people go to bed hungry. 6.6 million children die under the age of five almost all from diseases that could be prevented with pennies-per-dose treatments. people see the opportunity and

ask us to do more in foreign assi assistance and developments. our priority is to demonstrate the resources congress entrust in us are deployed efficiently as possible. congress has helped us rebuilding the agency to do that. but we evaluate every major program. i can describe programs that work and those that don't. >> and i am going to ask senator mccain to preside. i am going to vote and come back and we will maximize your time. >> you mentioned a word that is dear to my heart: priorization. i think something that hurts is when we good give foreign aid to a country that is corrupt and the converse of what senator

rubio asked, can you name a program and give me ininformation -- information -- or argument where we ended a program that wasn't successful and we haven't been able to influence a country into better behavior? >> over my tenor we have shutdown 34% of areas around the world and that is what we needed to do to free up the resources to invest in feed the future that is in 19 countries and delivers incredible and outstanding results. specifically, i went out with my team a couple years agree to afghanistan and did a review of everything planned and called it a sustainability review. we removed a number of projects we didn't think would be financely sustainable and i am glad we did as i sit here >> provide my office with that

list. that gives me information where i can say we have a good administrator and he ended these 34 appropriately so. let's keep going on priorization. you have have half a billion toward global climate change. when you were before the appropriate and subcommittee we talked about lombard and i respect this bright writing because he is looking at where you get the most bang for your book. he wrote a book, "cool it" saying saying we are better at addressing aids and providing fresh water as opposed to spending money on global warming

and climate change initiatives. that is 3% of your budget being allocated to something they some are scratching their heads saying you are far better off spending money else where. >> just so i am clear, the largest area of of investment ad usaid is health. when you include the hiv program it is $8 million a year. food is 2.5 billion dollar is that includes the food to feature program so the food aid is no longer needed >> so another half billon for climate change that could be put toward the food initiative. >> and $800 million for education and $600 million for water. ...

people actually pay a huge amount of money for diesel generation for power and energy in places where there is no systemic access. in that context small-scale

solutions, off-chrysalises that rely on solar, wind, and other sources our extraordinarily cost-effective. a zedekiah the math, investing in things that because we want to invest in things that have the highest return on investment , but ultimately we're making an initial investment. companies themselves have to sustain these systems. like we did in afghanistan, we want to be sustainable and how we carry out this work. bringing that kind of sophisticated analysis and our allied thinking san how we do this work. in particular, carrying out the cost-effective analysis on these major programs. >> again, thank you where answers. >> thank you. good to be with you today. just three comments. a set of questions around syria. humanitarian relief. senator harkin and others talked about the development.

i was in the palestine recently and met with technology, japan yours to work with usaid when not only create economic opportunities. you are a good ambassador. senator menendez concerned allow the american budget. the line items going down on the sea there are ten ambassadorial positions unfilled. some of that is on the white house, but some of it is on people languishing on the floor of the senate. the south, region of our defense has been hit very hard by the politics and having to reduce there drag interdictions as a result. the combined message that we seem to be sending, their own explanation, let america is

really a place of importance to us. just because it's not a place of points to us doesn't mean it's not to china, ron, russia, russia is doing military exercises in the caribbean. i really worry about this. a just want to echo what the chair said. the committee two weeks ago and the full senate last week passed a resolution, as are to be a four dealing with the largest provider of humanitarian human refugees outside syria. much of the aid has been delivered through ngos and the u.n. the best resolution last picking upon the u.n. security council resolution. now is the time for cross border delivery of humanitarian aid.

they're refugees outside, but there's 9 million. the un has indicated unimpeded access cross border is now something that is supported by the united nations security council, and our resolution last week, then the administration to bring back a plan for how we will be more aggressive. the more aggressive humanitarian strategy to deal with the suffering. >> thank you, senator. thank you for really no such a broad range of issues. on syria in particular i hope more americans can see that the money be provided is making a huge difference, reaching over 4 million people inside assyria courage in a two and a half million refugees, as you point out, that are tremendous.

and within syria, three and a half million of the nine you referenced are essentially not reachable. the constraints placed on how 80's provided. in that context u.s. aid has been a world leader in providing cross border assistance. they win council resolution calls for you and agencies to do the same and was agreed to by all security council. per valerie's report presented at the end of march it essentially shows that the syrian regime has not allowed for the security council to put men and a reasonable scale. there have been have you convoys across the border done in coordination with the syrians, but a small and very incremental steps, three and half million people that could be reached

that are not being reached because the terms of that resolution are not being implemented as aggressively as necessary by the regime. so we are currently non main provider of cross border assistance. you know, that assistance as allow us to provide surgery's and medical support to 250,000 injured syrians in the north in the south and in places that others are not reaching. i want to recognize syrian american ambassador's and other humanitarian actors who have risked their lives to do some extra repair work in that context. we need the u.n. agencies to do more and ultimately the syrian regime to abide by what some of the un security council resolution calls for. >> i was at a meeting with save the children, one of the many ngos that does work inside syria talking about the effect that the regime does not allow access in accord with the security council resolution. as important thing for the

administration to understand in terms of congress. while there are complicated feelings here in congress about syria and particularly that was demonstrated in a vote about authorization of military force in august the feelings but humanitarian assistance, humanitarian resolution came out of this committee unanimously, pass out of the senate unanimously. it would not be providing the aid if it was controversial and congress. so as the administration wrestles with what is the next at to try to make a serious policy more effective, take advantage of the fact you have a congress that is unanimous about the aggressive delivery of humanitarian aid. that is something we are with you in there is not controversy about. i think there is much more of can be done. >> thank you. that is wonderful to hear because just tomorrow i am convening my counterparts from other donor countries to basically ask them to do more of this type of cross border work. and that is good to know that ther