to over $2 billion that was spent in a little over two years and as of now hhs has her ordered 7.1 million people have enrolled in private coverage and these are enormous sums of money to be paying for such a small fraction of the population cometh actually considering that estimates show that well over half of these already had health insurance before the law went into effect in that most of them will obtain advanced premium tax credits which further drives up the cost. given that you propose to spend more than this enrollment, let me ask two questions of you today and can you tell us today how many enrollees the president and for the affordable care act went into effect and how many were worse to give up their insurance under the law.

>> 1.7 million enrollees the president mentioned have health insurance, before the affordable care act went into effect. many were forced to give up their insurance mandates under the law. are there any? >> there were a lot of plans that were adjusted to come into compliance with the law and people that were transition and given options with no plans. and i do not have data to give you right now in terms of who exactly was previously uninsured. we are collecting that. the reason that the study just came out this week says that before even the final surge at

the end of march that by mid-march they say that there are additional 9.3 million people with health insurance thanks to the affordable care act. i can tell you that those numbers are going to be much more significant by the time we tally newcomers. >> several people have signed up since the 15th of march and we are getting that information from intruders or if we don't have individual names and numbers of who exactly was insured prior and who is not. so we will be feeding you information as soon as we get from the company. >> all right. thank you. >> thank you, senator hatch. senator stabenow will talk and

i'm going to run and vote and senator rockefeller is on his way. we can go back and forth for the five-minute or left red. >> thank you very much, mr. chairman. and welcome, madame secretary. the ongoing debate on health care reminds me very much of the old saying that it's a lot easier to tear down the house than to build one. and i remember under medicare part d i voted no because of the structure. and i didn't shut him down the government afterwards because i didn't get the approach on medicare than i wanted. so we are at a point now where we need to be talking about how we move forward and make better something that as than as you have indicated, 7.5 million people are now using to get their health insurance for the first time for themselves and their families. doesn't account for the 3 million young people under age 26 and the millions under medicaid. i have a question but then a

common concern and differences in values between this and the ryan budget that the house will be voted on. i think it is stark when we look at this under medicare alone in addition to costs going down area and we have seen is with that in their pocket because they close this gap in medicare. one of the things that we needed to fix after he passed out and we did fix it. the budget by chairman brian will tell folks to go back and figured out private insurance companies. a big difference. the affordable care act, we are looking at this upwards of 400,000 people who have never had insurance before. forty hours per week, minimum wage jobs are it's still in poverty. this was getting health

insurance in the house but they will be voting on medicaid and cutting it by $732 billion over 10 years and a big difference in value and views and finally i would just say that the affordable care act, 7.5 million people being able to get health care for themselves and their children, many for the first time. the ryan budget repeals that basically takes affect to zero with the health insurance companies in charge of the pre-existing conditions. so a big difference. so i hope that we will really debate how to move forward rather than move backwards to that system. so a couple of questions. one includes two different topics. i talked to you a little bit before about a victory or community mental health that we

were able to achieve on a bipartisan basis in medicare with a fixed hell. we now have a demonstration project that will be taking place and rules that need to be written and others want to make sure that hhs and others will be charged with drafting the regulations will work with us and others that care deeply about moving forward as quickly as possible so that the states and we can strengthen community mental health care and i'd like to have you comment on that. >> senator, i would like to thank you for your leadership in this area. you and i have worked on this for a while and i think this is a big step forward to find out how we can structure programs and actually develop best practices that can be used to take it to scale. so we look forward to working with you and senator roy blunt and others to fashion rules and

regulations to get the other he out the door quickly and to actually get those as practices from states around the country to be able to figure out how to make sure that the mental health system, which is in definite need of assistance really is grown and fostered in various regions of the country's thank you. sirach another area we want to talk about costs as well as saving lives and supporting families that is critically important, is the area of alzheimer's. i'm wondering if you might speak for a moment about the president's budget. we had the alzheimer's association in town and we are all touched by this issue. and as we have a chance to live longer becomes more and more of an issue. one in five medicare dollars is spent on someone with alzheimer's and doesn't count

the caregiver responsibilities and challenges to the families so despite the shocking cost of health care system, only .25% is spent on research. so i wondered if you'd speak to this and how we might work together to really open on research and caregiving support for those with alzheimer's. >> well, senator. the alzheimer's action plan, which was put together with a lot of stakeholder input, and has a number of features in it. research is at the heart of it. and we are trying to figure out what is going on and what stages helping to identify people who may be prone to diagnosed with

alzheimer's and whether or not there any effective strategies for dealing with as much lest your thing. and so i think that is an increase in a variety of ways. not only in the brain mapping strategy but nih is proposing to spend an additional $63 million to continue to implement components to address alzheimer's disease and has a scheduled spending plan up until 2025 and a total of $2.8 billion is in our budget for 2015 on alzheimer's disease, which is an increase and that is under the umbrella of the administration for community living. some of it is with nih and there

are other strategies employed as well. so we share the concern that this is a growing issue and as seniors live longer we are going to have mr. kelly moore diagnosis is along the way. so certainly nih has identified that the is a key concern moving into the future. >> thank you very much. and i turn now to the editors thank you, madam chairman area secretary, i appreciate you being here today. i see in a new health care is program is promoted in your budget like expansion of the national health service and the new targeted to work for graduate medical education and they are included under the purview of the health resources administration. however, according to recent jail analyses of federal health care program, they are already having over 90 programs in the

federal government, including more than 50 in hhs dedicated to improving the health care workforce are you to the department assess whether the proposals for new programs would be duplicate of existing efforts before the budget and if not, why not? and are there programs that should be reduced or eliminated as a result of the expansion of the health services or the new funding for the graduate medical education? >> senator, we definitely did an analysis and worked across the department. frankie the bulk of the work force training effort are in the health resources administration which is why we are proposing that additional effort also be designed and promoted and they are the umbrella agency over the community health centers or a lot of them end up practicing.

so it was a logical combination and what we are doing, i would say we are not decreasing funds and certainly targeting those funds. the focus is more physicians to work in primary care. >> i appreciate that what they are aimed at doing. you've done anything duplicate you eliminate that would help us out in this budget situation? >> again, i don't think that is necessarily duplicate the. it's shifting so that we have been doing this were a couple of years, for instance changing some of the residency slots to focus on primary care and collecting them from institutions were not doing that and refocusing on. so it's not that they have been illuminated. i think everyone would agree with the population and the

health needs that we have. we will need more providers not fewer providers. and i would say that we are much more strategic about the way monies being spent. >> so we have 92 programs. the administration announced that it was going to begin open enrollment of exchanges for the 2015 plan on november 15 at 2014. conveniently that date falls after the election day this year and over month later than the traditional beginning of the open enrollment season for health insurance when, including the exchange. can you explain why the admin is ration would like to begin the enrollment so late in 2014? and you can you assure the committee that this is based on other stakeholders and not simply made to provide political cover for hormonal members? >> yes, sir. i think that the date was very much in collaboration with the

insurers looking at their calendar and frankly you cannot bid on the new plants until you know who is in that pool. given the fact that that pool is currently being tallied, this is a multi-month process where they will then be able to access who is in and what their pool looks like and to be able to compete and offer bids for the following year. there is no traditional open enrollment. this will be the second year. we had a six-month open roman the first time. we always knew that the second time around in subsequent years, we have a shorter open enrollment and so choosing a portion of that window to ordered is exactly what we have done. >> thank you. a number of my colleagues and i express significant concerns with the administration treatment of certain plans and

the rules for the insurance program and specifically we were concerned that the administration would exempt certain insurance lands from paying the reinsurance be, many were un-sponsored plans which would create the appearance of political favoritism. sure enough the admin is ration has done just that. can you please line why they believed it was necessary to exempt those plans and not others? >> a policy decision was that for plans and those that administer their own insurance going forward and do not rely on an insurer and are not covered by the reinsurance see it, there are some union plans in and not in there are others that are a policy decision that ari possible under the law. we have a lot of input from the

holders then make that call. >> thank you, my time has expired. >> who is up? >> is your chairman, i am going to yield my time to mr. grassley the president commitment to. >> did he tell you that specifically? >> something about ethanol. [laughter] >> ethanol and for producers were the two top things. we have an important commitment and could i yield, i would be more than happy to do so. so i hope you will recognize me later. >> and my five minutes start over again? [laughter] >> okay. >> the two things i would like to discuss with you is one of sunshine and the other is an

obscure part of obamacare and i welcome you and i'm glad to have you here because i wish we could see you more often. yesterday the department again process of releasing medicare payment data and this is something that the chairman has spoken about. something that we have been working on for years. no one should be afraid of this data coming out and no one should be afraid of explaining the existing payment structure. the benefit of asking this as we consider the policy changes as needed i believe trent currency works and with us you have accountability and i hope people will now at that work to improve this is some instead of fighting it. context is critical. and i want to bring up about the

position payment sunshine act and that kind of thing. it is also a form of payment transparent the and i remain concerned and many providers have raised concerned with me about a journal article being reportable. i want to know if the database will make clear to the readers what specifically a provider accepts and so i would like to have you tell me the providers can have confidence that the data made publicly available through the sunshine act will have a with the contacts providing details about items excepted and not just dollar amounts. >> senator, i'm not sure that i can answer that.

physically i will check on that. and as you know, we are doing the data lection and we are on track. we are doing this the first aggregate data and with more granularity. and i will double check on exactly what will be part of the display without. i agree that people should be able to get in contact. >> i wonder if you could have someone talk to my staff so we get some idea of where you're headed. not saying you are responsible to us, but we want to make sure that this sunshine ask work i know you're leadership along with the senator and others on this was critical. and so we would be happy to come in and do a briefing on what is exactly being collected and what mks looks like and what that way it is.

because the data out there is an interpreted inaccurately. and so now to this issue. i think i have tested the war or maybe written a letter or something. and i would like to turn to the statute and the application to qualify that affordable care act area and i have three questions and i hope you can give me a short answer to. they are kind of hypothetical. a hospital or other third-party be allowed to pay insurance premiums without payment being considered a kick? >> all, let me ask two other hypotheticals area is a hypothetical, it seems to me that these are things that actually happen. what a hospital or other be

allowed to pay co-pays and deductibles without the payment in considered were can a drug party provide this for a patient to use in purchasing prescriptions. >> senator, i don't want to try to give illegal answer because i am not a lawyer and i can tell you that we have made some guidance available. not-for-profit plans that could help insurance coverage. that has gone on for years and would continue to go on. in terms of the hospital situation we have weighed in and said that they would not be able to do that. at the kick that determination is really it just is determination. the reason, i would tell you,

the federal health care program applicability is not able to be applied to the qualified health plans. these are private insurance plans operating with customers paying their premiums. not connected to the trust fund like medicare advantage and not connected to a government program. so it was a determination that we wanted to make it clear that this is a private market. having a back, we know that it is important that we look at the entire fraud statute. they are not immune from not in any way shape or form area and in fact we have asked her inspector general and others to look at the false claims act and other applicable statutes and we make sure that we hold them accountable. >> mr. chairman, can i have just 10 seconds for a summation and

the question? remixers. >> undersecretary for my want to a that with the release of qualified health care plans of the etiquette edge, it's unclear what the federal policy is regarding this and whether we prevent false claims and so this is something that probably i hope i can continue to have a discussion with you on. >> i think that we have clear sailing on a tour and what we need to do is give every senator here and senator thune is next thank you, mr. chairman and madam secretary, not too long ago aged just finalized a rule and i think the senator touched on this a little bit. but i wanted to just get you on the record on this. something certain self-administered plans from paying the reinsurance tax in 2015 and 2016.

which means that there are going to be a number of union groups who will have to pay the tax and will appear on the service to sort of be a political favor. as you know, that tax designed to raise a billion dollars in 2015 and 5 billion in 2016. there is a question posed of an hhs official in which that person when asked for clarification or affect other plans, rates, and fees, she said it is true that the these will be higher because some plans are exempt and so i'm wondering if you agree with that statement but those plans that didn't get an exemption will have a higher the because the white house is favoring groups. >> i would say that what we did is look at the statutory language and make a determination of the best interpretation and anyone who

has this insurance component should be exempted. our legal counsel eldon was wifi the best interpretation of the attitude and this is not a union issue. it was a broad-based issue especially ordered to put out the rules in this includes who is applicable and would not be applicable under the rule of. >> the question is a very straightforward one. >> there is a dollar amount in the vacuum. >> there were no fees, it was just a definition of who the pool is and who is obligated to pay the fees. >> you distribute that a number of people have shrunk because of the exemption, is it not true that those who are left and will have to pay more?

.. and to that and be the consolidated appropriations act provide an additional $6 million in funding to implement new program integrity efforts in that program. i'm wondering if -- how these funds are being used. can you provide information about verses intentions to use the additional appropriations on

the. an example of that, i guess, hhs has already undertaken on its to extend those to manufacturers as well. >> well, senator, i would say that dr. wakefield to his head of her son and did the umbrella agency over the 340 is very much engaged in making sure that the program operates in on more stringent fashion to a year to the rules. there are artists, as you say, already under way images and a couple of briefings for me, and she looks toward to working with congress to make sure that we are not allocating funds inappropriately and that the pro grams and entitled to receive the discounts are the ones, and fried, receiving discounts. that landscape is being reviewed

right now. i can tell you specifically about manufacturers, but i would be glad to follow up and come back to you on that. the opportunity to make sure that we're following rules. a highly important program. >> really quickly, cms 96 greuel regarding inflation reimbursement and critical excess hospitals. can you comment on that? there are a lot of positions that we deal with. a lot of critical access hospitals to don't think it's fair. there's this -- >> i would say, senator, this is one that while getting a lot of feedback, i do, of our rules the absolutely faith that people

have and how important it is to have critical alexis appeared in a profitable manner and stay in the community. so i think the rule was put in place in terms of trying to define inappropriate but. well whether or not that may be too stringent or too rigid. we would appreciate your input and feedback. as we look toward the future i don't think the intent from anybody is to damage the opportunity for critical access hospitals to remain in place. but in trying to define what is appropriate in terms of a patient's stay i think was the attempt. >> thank you. >> but i just want to let you know, and sympathetic to where you're talking about an interest in working with you and your administration. next in order of appearance would be senator isaacson.

he his juggling. would you like to go next? >> i'm going to need a chain saw to get the arms of these chairs of. i apologize. >> thank you. >> secretary, thank you very. as former governor of kansas i'm a question for you, a loaded question of great concern around the country in various states. the affordable character, an opportunity for states to expand medicaid eligibility. and in that there is a promise for the fence to make a harmless the states for a time. 1978, the current and ministers and we passed, there is a 40 percent federal mandate of increase money or underprivileged and disabled children. the problem is the fed's would run their fair share. they have not.

the cost of education is in on higher. do you fear at the end of the hold harmless. states that have taken it will be burdened with an amount of money they cannot afford to pay? >> i certainly was the recipient of the ida promise. >> i can tell you that the decade. the funds are there to extend medicaid. when the law was passed, don't know when go beyond that. i can tell you that the funding is there. it's part of the law. so unless pieces of the from the europeans along the way for congress decides to change the law that will be done. >> second question, i was one of the republicans in the first

series. on two occasions with the president in an ad hoc fashion, if you will, to try and find some common -- coming ground. and this was last year, dealing with last year's recommendations in his recommendations for significant cuts in terms of medicare to out reduce the growth rate of the debt and deficit. one of those was change cpi which of the time of the budget last year was included but has not been this year. does that indicate a reduction in the interest of the administration to find ways to reform entitlements? without cutting people's ability to get those entitlements we manage them on the basis that makes sense for the future. >> senator, i would say that the president is interested in the possibility of some global approach to deficit reduction. by some recent it inside.

where you were that he feels a balanced approach is very important. i think air of a whole series of ideas as part of that cost approach where in some cases captain made in another case is revenues raised. but in that context would to not go forward, i don't think it's a light of interest. >> well, the debt and deficit call people and both parties, very difficult discussion. one of those will have to be the forest and tournament. i personally think social security and medicare payments a little bit wrong. my income for medicare. people should expect in.

the american people will been a. and your department has probably more to do with the way up because of a thing you're doing but because of the demand of health care, medicare, and medicaid. so i would mccourt to working together with you and the of ministration in the years ahead trying to find somewhere to find common ground. >> i would very much look forward to that opportunity. i think circling back to the chairman's. and the beginning of this discussion, no one is about entitlement reform in the affordable care actor and medicare, and it's working. it is working in a way that was difficult to predict at that point but is happening. i think it is continuing on into the future, and i think the

recent prediction of the actuary, and we could just keep medicare spending at the rate that we have seen the last couple of years we would have an enormous change in the overall cost. i think there are some futures in place, some ways to shift from of value payment to a different for as the chairman referred to, the delivery system reform is beginning to show promising results. i think that we bled very much look forward to talking about a structural change that is on the delivery system payment side and keeps benefits in place for seniors. >> i agree with that comment. adjust to what -- we can read the part where you cut too far and is not reform. thank you very much. >> thank you, sir. >> madam secretary, we talked about crime and disease earlier. senator isaacson and senator to me on that side of the aisle

have a great interest to have interests in calling of. center card and his next. >> thank you, mr. chairman, secretary sibelius. let me make one comment about the affordable care act. millions of people who have directly benefited from the affordable care act from the medicaid expansion the talked about which is been a great success to my state, to the insurance reforms and a protected families, to medicare filling in a lot of the coverage gaps that we had for preventive care and prescription drugs to numb people of affordable options the the exchange to equal the insurance products. i just want to make one observation. it would be, i think, a lot easier for you and we in congress took a look at the wall as to how we can help you in dealing with many of the challenges they have had in implementing the law. instead, we are stuck in this repeal-non repeal mode particularly in the house and representatives which is not doing a service to the people of

this country. we should be working together to be the budget support you need an to us take the law as to what we need to do to improve it to make a stronger and easier for the american people. as we talk about a bipartisan budget we'll also talk about working together to make our health care system work in this country. i think the framework of the affordable care act has proven to millions of americans, and i can give you many, many letters i have received from people whose lives had been changed because and out of the insurance coverage. on the budget -- and we're here on the budget. start with a thank-you. that is to holocaust survivor assistance that is in this budget. for the first time it will provide direct help to holocaust survivors, americans are vulnerable to my real fear of institutional causation. thank you for including and in the budget. on the other side the realities

of the budget at home, i think, with the national institutes of health. the budget there to me is entirely too low. i am extremely disappointed that several of the institute's get no increase in their budget and all, including the national institute of minority health and out disparities. you and i have talked about it in the past. i know your commitment to that institute and to the department's agencies who are directly responsible. i just encourage you to do everything that you can within the budget restraints to continue to make that a top priority. let me ask a question as it relates to the therapy caps and the sdr. i am strongly in support of german wines and senator hatch's efforts that we can get a permanent fix to the replacement to the sgr and at their peak

gaps in the other issues. to me that makes the most sense. i hope that we can continue to work on it. in the meantime we are still in that mode dealing with the temporary extension through march of next year. and in that there be caps which makes absolutely no sense whatsoever for a point of view of health policy, we now have the manual medical reviewers you , those that hit the cap at 3700 which could prevent access and timely payment. it's my understanding that you are considering some payment review rather than looking at it and holding of those two are in need of care wondering whether their services will be covered and not. can you just tell us, give us an update as to how the implementation of the therapy cap under the existing law, how you envision that during this time? >> senator, what i would like to do on that is come back to you

with a much more descriptive answer what are folks are looking at for, as you say, what may be his interim time. another is been a lot of discussion. i don't want to give you incorrect information about the direction that is likely the go, but i do know it's of great concern in terms of patient care and how it is interpreted. i will circle right back and give you kind of an updated answer from my nicotine on how they anticipate calling for. >> thank you. i yield back. >> senator robertses next. >> well, thank you, mr. chairman, madam secretary, have a couple of news articles year. maybe you could help us clarify exactly what's going on. rather than meet trying to explain this and just going to read it. americans thinking about buying health insurance on their own later this year may be switching to a different insurer are probably out of luck.

policies are going out of the market as a loan of consequence. limited exceptions insurance companies have stopped selling until next year that sorts of individual plans the use to be available all year round. that locks out many of the young and healthy as well as the sick and injured, even those that can afford to buy without the government's subsidy. now they are stuck according to an independent insurance broker in los angeles is as she wonder customers last year of the change coming. it closes everything down. the next wide-open chance to sign up arms in november when enrollment for 215 begins. companies are following and schedule, even for the plans they sell off some of the federal-state exchanges. there are other news articles that say the same thing, and i will take the committee's time to read them. could you clarify that? i think there has been some misunderstanding or, perhaps, you can shed some light on that. >> certainly, it.

as a recovering insurance commissioner, would tell you that rules that you just describe there release said that the state level. you quoted an article from los angeles, and they have decided in california that they will not allow off market plans to be sold. they want to encourage people to buy during open enrollment. this is a state-by-state decision. kansases made a very different decision. those determinations about the up market plans will be and how robust the market will be are made by individual insurance companies -- commissioners throughout the country. >> we have an expert at the kaiser family foundation that says it is highly unlikely, talking about nationwide, not to state-by-state. companies will offer such coverage after the deadline closes. some still offer temporary plans lesson from a month to year, but they don't cover pre-existing

conditions committed buyers of the a. and they're is a window for life-threatening communal, a life-threatening situations. i know you are setting them. they're all different, but i think that this is a national concern. am i wrong on this? >> again, it is my understanding that it is very different state to state. a lot of states will have a robust off market plan and will actually have a number of consumer protections and features that are in the market, but it is a state-by-state decision. that reference may be too the excepted plans, the kind of mini coverage. those will be less available. the companies are making that determination, not the law. >> well, i think the companies are making that decision due to the law. we will get past that. i want to go back to the 96 hour

rule because it gets to the president's budget. the same question that i asked last year about proposals included in the budget a cause disruption to the critical access hospital liver. you are extremely familiar with that. you designated some of these novels. some accountants and the proposals are once again in the presence budget. is that the mileage limits and reduced the reimbursement for critical of metals. we all know we and 803 in kansas. i would like to know who can get some regulatory relief. in that regard one of the more problematic decisions is based on : and then i wrote, if i can find it. at any rate, it was to a cms and indicated it -- here it is.

in the reply was that there are statutory of begin to enforce the new requirements. i don't know where we come up with 96. hundred 20, 72, 48. and then if you have a patient coming to the hospital, they can keep them for those number of hours and it seems to me that it it was not statutory designated to be when i asked if they could waive that and certain conditions may be of help they said, well, no. that's just once again something that we can do. can we get one years relief from that? you said that maybe mr. bloom could be of help on this. what happens is the patient comes in. they're monitoring that patient. the doctor doesn't give any medicare reimbursement. and so you have to go to another hospital which could be miles and miles away or just out of

hospital. you know about hostelry admissions. help me on that. >> well, senator, one of my to do is get a copy of the letter that you're referring to. i will personally follow. i don't know exactly what the questions were, and i don't know exactly what statute they're referring to, but i will defend his circle back and get your response. i agree that we don't want to make it more difficult for patients to access care or for doctors to be reimbursed. >> i appreciate that. i will provide a letter as soon as possible. >> thank you, senator robert some. >> thank you, mr. chairman, madam secretary, thank you for your testimony in service. i was not here when -- during your testimony regarding the number of folks that have taken advantage of the exchanges. i guess were up to seven and a half million. that's could news.

no one to ask you about two questions. on the one hand i can't say enough about the commitment the of ministers and is made to our children on a host of fronts. very substantial commitment on programs and prioritization. i commend you for that, and i commend the president. where have a fundamental disagreement with the administration and where i think we will be probably continue to be on -- unalterably opposed, we fortunately past and the president signed into law reauthorization. i was happy about that. the board cart on that, but none of going for a debt the position of the administration is to eliminate that funding for the program. i don't agree with that, and i want to ask you about it. we've got right now about 1% of

all hospitals trained. about half, 49 percent of all pediatricians. a program of works. pediatric care or the shortage of and if we didn't have a trained specialist. it's bipartisan. it's not expensive, and i don't understand the opposition to it. i would ask you about the position he administration is taking, wine and is, and whether or not there was in some way that we can reconcile a differences. >> well, senator, and knowing your commitment to this area. as you say, i think the administration also as a command to not only children but to training providers in needed

aryans. the budget proposes that there is a hundred million dollars in new targeted support for the hospital programs. additionally with the bigger ball, and a competitive opportunity where are would suggest that i think it's possible the edge of and hospitals receive even a larger amount than was then the directed program of the past because there's a floor kind of set automatically and then an opportunity. we estimate that the new power in support will be about 13,000 new residencies between 2015 and 2024. i would tell you that the discretionary program in the past, about 26 percent of those slots or non pediatric residents

so even though it was an a director program, is nine least a fourth of the slots were filled. so we would love to work with you on ways than we make sure at the financing is going, really directed and training more pediatricians, charles specialists. i think looking at this there's an opportunity to really then target the funding. >> i hope he can. we have got in our's to. i think we can say this without contradiction. there are very in tune with the program they are concerned that it will give three authorized. so this begin do for the record by where response.

many carry vantage, was grateful for the ministrations recent determination. when an premiums are down 10% and an ominous of. but there's still some concern about the near-term and long-term. and abcafive and writing what steps it planned to take. >> secretary, you can do that briefly and then get to a senator casey in writing. if we spread the canyon everybody in the four secretaries of believes has the leverage is michael. >> that's a good bill. >> is that our right? great. >> thank you, mr. chairman. great to see you. let me first of all say that the numbers you report today of seven half million my hope this will start to change the nature of the debate and of and not

here, but i want to commend senator hatch and senator byrd. it and agree with the friend in went out, but they have laid out alternatives. as a group was that of let out a series of targeted changes that i think will improve delivery. ton to touch on one of them's. one of the areas and a year where of, the treasury report recently finalized reporting rules a lot and force the employer and individual mandates in this challenge by treasury as the reporting in the two just provide the subsidies. trying to make sure there the correct amount. continue from a number of employers and the concern of some of their workers who are offered employer plans might erroneously still apply through the exchange to try to get individual tax credits.

with this is setting a potentially it the end of the year a contentious dispute between the business of the irs and the being the referee. nothing this could be prevented if there was more up front accountability on the front in between treasury and hhs. when a personal. you will, there's. we're basically allowing employers who would be willing to provide information up front some ability to be full word meaning when'd in having this monthly reporting requirement. for small enterprises colombians enormous burden to give them not completely a safe haven but by having this kind of collaboration between hhs and treasury. we might be able to remove one of the administrative burdens. quite honestly we would be in a system that doesn't and his

senate bill 2176, one of six or seven different pieces of specific legislation that we would like to advance as we hopefully will move the debate to how do we keep what's good and fix what's wrong. ..

>> 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]

all took the oath. and i welcome everybody here, i'm going to be the chair and

ranking member of the committee with jurisdiction, senator owner shire and senator lee will be taking over the hearing at some point during the morning and i appreciate the work both of them have done in getting us here. the original business of the cable industry delivering television programming as we all know migrated to internet and the industry's been changing in response. consumers can now watch what they want and when they want. if any of us have any question about it ask our children or grandchildren and they'll explain it to us. when companies like comcast and time warner cable were founded the term binge watching was unheard of. now it describes how many americans watch their favorite shows.

cable companies have moved beyond delivering televisions after the networks provide broadband. they're now the sole source of service for millions of americans, resulting in playing a dominant role in how many people in the country get their information. and consumers deserve to know how the combination of the two largest companies in the industry will impact them. every senator has heard from their constituents saying what is this going to do to me? so we're going to cover the current state of the video and broadband markets. hear discussions of vertical integration, relevant markets, public interest standards, importance issues to consider when analyzing the mergers. co consumers don't want to hear complex legal jargon, they just want to know why their cable bills keep going up. they want to know why they do not have more choice of

providers, and consumers want to know, is this merger good for them or not. frankly every one of us want to find out the same things. in 1996 i voted against the telecommunications act, in part because of concerns i have for look of competition in the cable tv market. i'm still concerned. similar questions are now being raised about the broadband industry where consumers feel they get large bills, inadequate choices. in vermont, we are deeply concerned about net neutrality but we don't want just lip service, on meaningful rules of the road to protect an open internet so anyone with an idea can have a chance to succeed in the online marketplace. and vermonters aren't alone in this. thousands of americans have flooded the fcc in recent weeks with comments supporting the restoration of open internet rules. and their voices have to be heard. i appreciate that comcast agreed

to be bound by the fcc's open internet rules as part of the nbc universal transaction. it's an important commitment. especially now that core elements of the open internet order have been struck down. the commission that currently apply to comcast should not be seen as the end point but rather the minimum level, minimum level of protection. should apply to promote competition online. and regardless of the outcome of this latest merger i hope that comcast will accept the extension of these rules beyond 2018. but still i urge them to support stronger rules that protect consumers and drive innovation. and the recent interconnection between comcast and netflix also raises important questions for advocates of net neutrality. when ipss can charge tolls and block access to networks, net neutrality policies may no longer be enough to protect consumers, or promote open

internet. companies have to enter special agreements to ensure adequate quality of their streaming video service. i worry about the potential impact on other band width intensive services. one i think of that worked on for years is telemedicine. and especially tying together medical centers, and rural areas. it is an annoyance for consumers when they cannot stream the most recent season of "house of cards" due to internet connection dispute. but where it is really serious, if it becomes a life or death for patients who can't reach health care for the same reasons. so the proposed transaction touches on a range of critical policy issues. going beyond just broad band strength. supporting diverse, independent video programming, and vibrant

marketplace for online video. so we have to ask how it's going to impact consumers. i urge the fcc and justice department to consider just as carefully, so i thank everybody for being here, going to yield to senator grassley, and then i understand you have a brief statement. >> good morning. thanks for the witnesses being here. our judiciary committee's role is not to decide whether or not what conditions comcast and time warner will be permitted to merge. the federal communications commission and the justice department are responsible for determining whether there are any issues with this transaction, but no doubt, a hearing like this as we've had in this committee on other merge ers is a very important part of the process because it does give

the committee an opportunity to hear and to conduct proper oversight not only of this specific merger but to make sure that we understand the issues, and that the federal communications commission, and the justice department, is carrying out the law. every year we're seeing a new and exciting innovations in technology and communicationses. when i first came to congress, i didn't carry a phone around in my pocket like we do now. i never knew that one day there would even be such a thing as twitter and have 75,000 followers. innovations like these have addically changed how we communicate and how we interact with each other how we learn, how we get news, how we conduct business and access entertainment. access to the internet is quickly becoming an absolute necessity. americans need to compete in this fast-paced, and more

importantly, the globalized economy that has developed over the last 50 years and is going to be more important in the future. they need the internet to stay in touch not only with family and friends, but probably very much a part of their economic lifeline. and particularly when they have access to their choice and what a wide range of choice now. right now we're experiencing a bit of revolution in internet technology. just examples, product like verizon fios and google fiber. are changing the internet's infrastructure by delivering faster access through fiber optic cables. and on the content site companies like netflix and hulu are allowing people to cut the cord. and access their media through

internet and their handheld devices. comcast and time warner control a significant amount of cable infrastructure that americans use to access high speed internet. they control the cable lines that go directly into the people's homes. so there's a lot of interest in what will happen if the two companies merge and quite frankly, probably just stated a little bit different but i have the same interests that chairman leahy has expressed. consumers want to know whether a combined comcast-time warner will be in a better position to expand high speed internet access. will consumers have higher cable bills? will they have more or less content choices? will the merger inhibit growth and deployment of broad band services. will it enhance competition with other companies? and what are the downstream effects of the merger.

another question is whether a combined comcast-time warner will impact television or internet content in a detrimental way. will the company be able to block consumers' access to content or will the merger allow the company to negotiate for better licensing arrangements from popular broadcasters like espn and disney? because comcast creates some of its own programming some have suggested that this will put independent programmers at a disadvantage well all of those things are what this hearing is all about. today we have an opportunity then to learn how these markets actually work and what a comcast-time warner merger could mean to competition and consumers. there's no doubt that a combined comcast-time warner could significantly affect the markets for television programming, high speed internet access, and

program access. and there's been no shortage of opinions expressed in the media since the company's announced the planned merger. so i look forward to a very important hearing. and also following up with high doj and fcc's going to respond. thank you mr. chairman. >> thank you senator. senator klobuchar? >> thank you, very much mr. chairman. thank you to you and senator grassley for holding this very important hearing. competition in the cable industry is one of the most critical issues that this committee faces for a very simple reason. cable is the primary way americans get pay tv and broadband internet access. this issue literally touches people's lives every day, and it touches their wallets every month. as senator lee, the ranking member of our subcommittee, and i have said from the day the merger was announced, the proposed merger between comcast