in congress we repeal all or part of the affordable care act? 55 sound about right? if you get how many times those were signed into law? none. are you aware of how many times we put on some sort of replacement bill to the affordable care act that we voted to repeal 55 times to provide americans with quality, affordable access and financial assistance to access to health care that they deserve? spent i think the number is none. >> i would agree with you. ..

like to mention we have a proposal improve the small business provisions of the affordable care act to try to both simplify and make the tax credits better for small businesses. that is feedback we've received. about that, and that is something that is included in our budget. >> now turning to a couple i think, hopefully more substantive questions that i could get to with you, madam secretary, i was pleased to see the democratic chip reauthorization bill included in the president's budget extended medicaid primary care increase. rate of increase was initially included in the aca is absolutely critical. for the last two years boosted payments to doctors treating

most vulnerable populations making access achievable goal not just a tar get. the payment at end of last year will result in medicare provider payments cut on average of 43%. over 50% in some states. impact on wait times could be drastic and immediate. i was hoping madam secretary you could comment on importance of parity to medicare and medicaid payment to our primary care providers, when they have to choose seeing some of our most vulnerable population seniors, pregnant women and children, why would there be possibly a discrepancy? >> you're indicating why we have proposed contain wages of these payments because we believe it is a making a difference and making a difference to access and coverage people are getting in the system. so we proposed it as continue wages and we hope that ising the

congress will consider and support. >> thank you. the second topic i want to touch on today actually, my colleague, mr. murphy, touched on quite extensively in his comments is about substance abuse and mental health. back in massachusetts madam secretary i see communities on the front lines of a growing extraordinarily opiate abuse crisis. we're looking to the federal government in support for prescription drug abuse and heroin overdoses continue to amount. when i was running for office i saw impact on this on daily basis, not in terms of addiction, people needing treatment, property crimes personal crimes folks looking to find a way to get help but treatment options just aren't there. there are not enough doctors and beds as mr. murphy indicated. there is not enough wraparound service, there is not enough care. i was hoping you touch on importance of creating incentives through medicaid largely which is our largest mental health provider make sure just not another grant

program, to make sure incentives are in place to allow that marketplace to provide care. >> the bad news as you indicate there were it 59 million prescriptions for -- 259 million prescriptions for painkillers opioids, more than one per adult in the nation. good news i believe there is bipartisan support for us to do something. that is both in the executive and legislative branch in washington and as well as with the governor i met with this weekend on issue. payment is important place. there are three fundamental things we need to work with congress and positives to do. one in terms of prescribing. that is root of much of the problem. we've seen progress in states like florida where they are watching the prescribing. the plans that states can put in place to oversee that is important part. but we have part two. second issue of things like milxone and access to those and things like payment issues. third was medical treatment.

that is the third part what you're mentioning. basic agreed upon. whether senator portman or senator widen or mr. rogers or it is across the board. there is bipartisan support, states from massachusetts to kentucky west virginia, my own home state are suffering in devastating ways. one piece you didn't mention is economic impact having come from a large employer like walmart what it means in terms of employee base that can pass a drug test. >> thank you, madam secretary. >> thank you. >> chair, thanks the gentleman. chair will note we've just been joined by a group of students from the houston area. ranking member informed me. >> mr. chairman, like to recognize a number of chiropractic students from the houston area and the doctor who retired is president of our chiropractic college in pasadena texas. i invited them last night because i wanted to show how health care policy is made in the health care subcommittee.

thank you, mr. chairman. >> thank you. you're certainly welcome to be here. the chair recognizes gentleman from virginia mr. griffith, five minutes for questions. >> appreciate that. students being here and we may have disagreements but i will tell you ranking member mr. green and i worked very hard on health care bill signed into law last year. no matter what you may see today, we do get along more often than the press lets you know. all right, that being said madam secretary, in response to a previous question you indicated you weren't aware of any laws being signed in. i'm sitting here with crs report congressional reserve service, indicating 12 bills that repealed parts of obamacare were in fact signed into law. you're not aware of that, is that correct in relationship to your previous answer? >> with regard to the specifics of the answer, those were repeal questions i thought, full repeal. >> full or part. so you were mistaken weren't aware of these 12 that were

partially repeals? >> i was referring to the issue of full repeal. >> but you are aware of these? >> with regard i would have to look and see. >> i could have it entered into the record. >> so ordered. >> thank you mr. chair. also, are you familiar with my hr 130? >> apologize, don't know what the bill. maybe if described. >> bill deals with the black lung provisions of obamacare? >> i'm not familiar with that. >> i appreciate that. are you familiar with my hr 790 the compassionate freedom of choice act. >> not familiar with the specific names of legislation. >> i appreciate that. and are you familiar with hr 793 which deals with referred pharmacy networks, part-d. >> another one it. >> the reason i ask those questions, very well-orchestrated from a political standpoint the other side of the aisle asked you repeatedly are you aware of republican legislation that deals with issues we're dealing with related to obamacare.

i would submit to you, that in some way or another, three points that you pointed out each one of those bills. you're not intimately familiar with them. around i understand that i'm not blaming you. because you've been put into that unenviable position sometimes happens difference between negative evidence and a lack evidence. what you presented today is lack of evidence. i appreciate that. that doesn't mean these bills don't exist. just as i gave you numbers on those three. it doesn't mean there aren't other bills that other members have that are out there that are republican proposals to take care of the american citizen while we are in the process of repealing obamacare. so you're just submitting that you are not aware of it but there are in fact bills out there may be doing that and also further discussions behind the scenes that may be doing that, that you're unaware, isn't that correct? >> would welcome there was a veterans bill we all agreed on. the firefighters -- >> i'm say though in the answer to any number of members on other side of the aisle you

aren't aware, that doesn't mean they don't exist. it just means you're not aware, am i correct? yes. all right. we'll move on. the president's fiscal year 2016 budget calls for 92 million for the office of national coordinator, onc for purposes including transition to governance approach for health information exchange. in 2012 an hhs request for information noted that congressional authorities granted to the onc in the 2009 high-tech act would support this governance mechanism. madam secretary i hold in my hand a copy after congressional research report dated january 7th, 2015, that suggests onc does not have the authority to support the onc governance structure outlined in the president's budget. don't you agree that when agencies take action they should be supported by congressional authorization? >> not familiar with the report. would welcome seeing it. with regard to the office of the national coordinator i think ou know we just came out with the

plan to continue moving us towards electronic medical records. we back that up with specific things. we continue to work on something that cuts across many of the issues. but whether -- >> you would agree with the principle there ought to be congressional heart for an agency to take action, yes or not. >> i would agree we need authority. >> mr. chairman, if i could have that congressional research service report placed into the record. >> without objection so ordered. >> as a part of its governance push onc awarded a contract to rti to develop the i.t. safety center. rti said at time of award it would focus on governance and relevant i.t. content. i'm concerned as i point ought minute ago, when you have these comments being made, we haven't seen it yet, the report that just had entered into the record shows we haven't seen the final analysis what they're going to do but when you have comments they're planning to work on governance and they don't have

that authority, i am concerned when the experts are telling me, both legal and otherwise this agency is going beyond its scope of authority, that this is a problem in this administration and that we should be careful that we have any agency moving forward without congressional authority. i'm going to ask you to work with me as we move forward on this i will follow up with some questions and some other things. ask that you work with me to make sure the onc does not overstep its authority granted to it in legislation by this congress? >> would want to work with you to understand and understand what these concerns on governance are. this is new to me would like to understand further what the concern is. >> i appreciate tiat. i yield back, thank you mr. chairman. >> chair thanks the gentleman. recognize the gentlelady from california, miss capps, five minutes of questions. >> i thank my colleague yielding time. i do have a different topic to discuss with you, secretary burrwell but my colleague from texas asked for 10 seconds.

>> i do my 10 seconds. i want to thank the congressman from virginia. i think the clarification up until congressman kennedy all our statements were repeal the affordable care act without an alternative. now, there were bills that were passed. none of us, at least up until congressman kennedy but you know there is no repeal and replace. there is only repeal for 56 times. thank you. >> that is why i responded to full repeal. >> thank you. you know, i want to go back to the president's budget this year, i think on the whole strikessance important balance between controlling spending and promoting public health. these public health topics what i want to bring to your attention. i was pleased to see there was continued support for nursing workforce development. i believe, i know you do too, a strong nursing workforce improves health of our communities as well as quality of the health care system. we now have significant challenge in our nation of

caring for a growing patient population with limited resource. i'm a nurse. so i know that we can't reach our health care goals without a strong, health care workforce made up of a range of health care professionals. and these are the development programs such as title eight that are proven to be a solution that can help address this challenge. so would you please discuss briefly, because i have two more topics, what this budget request does to make sure we have diverse health care workforce well-quipped and large enough to meet our needs. >> i will just be very brief. >> sure. >> which is i think one of the core anchor place west do that is making sure we are funding our national health service corps. and the increases we asked for are a very important part of that across and it is especially important because we serve that group of people 30% are diverse. >> yes.

>> in the nation as a whole the number is 10%. we're overindexing for that in that, we think that is important place. i will stop there. >> right. because this one i'm going to mention is near and dear to my heart. maternal infant and early childhood home visiting programs. such bang for the buck you get with this group. if you have ever seen it as i have, been part of one it is such a proactive and preventative service. and there is increase in commitment in this home visiting program in the budget for 2016. these are evidence-based as you know bipartisan programs epthis -- helping to insure all children across the board get an opportunity to be healthy and successful. they're so critical improving health outcomes for both women and children and families. so my question is, how increased funding for these programs is going to address disparities and

improve the health? how can we make it better? so with regard to -- >> because i'm a mother of five and seven-year-old i lived importance of that information very recently in terms giving your children what they need. so the program that you're describing, why we think it is important to continue on the pace it is evidence-based program. we've seen the results in terms of reading and other analytical skills up to 12 years old in terms of benefits. that is as far as been tested. we see what's happening. when we give mothers and parents opportunity to give information they need in the home. when you go to them, it is making a difference. we believe this is important part and continuum in the budget. home visiting next comes to the early child care. making sure we fund child care so working americans can be part of that issues of improving head start in terms of lent of day, time of year and quality that we require. so it is continuum in terms of making sure we're taking care of those children along the way for

working families and pressing ourselves to improve quality. >> right. to build on that in the focus on children and family this question was asked about graduate medical education. but i want to focus on childrens' hospital, gme. because childrens' hospitals programs are so critical for training pediatricians pediatric specialists and pediatric researchers. it is, less than 1% of hospitals. they train 51% of all pediatric specialists and the childrens' hospital graduate medical education programs reserve much less funding than other -- children don't lobby. we have to do this on their behalf and would you explain the proposed changes to funding for childrens' hospital graduate medical education programs and what steps are, taken to insure that we are meeting demand for pediatric care. >> we want to meet that demand and want to meet the demand for primary care and specialties where we don't necessarily have number of practicing physicians

that we need. so the proposal that we have tries to respond criticisms that we received last year with our proposal. there is $100 million dedicated firmly to the children's programs. in addition to that, they are able to compete. right now what we do is we cover the direct costs but we don't continue to cover the indirect costs. >> thank you very much. >> the chair thanks. thanks the gentlelady now recognize the gentleman from texas, dr. burgess, for five minutes. >> thank you mr. chairman. my apologize for being in another hearing. i also apologize for not having the president's budget here this morning but the president outline ad number of savings in the medicare space in the presidential budget is that correct? do i understand that correctly? >> that is correct. >> and in general as the head of hhs, are you supportive of those proposals by, in the president's budget? >> yes.

>> let me ask you a question then. you know that one of the things i mean am just pounding my head against the wall for 12 years on the sustainable growth rate formula. we were very close last year. we almost cracked the nut but we didn't quite get there. but i thought we had a good proposal and very close to introducing the same policy language again in this congress. steps have been difficult as everyone would expect. let me ask you those savings that the president identified, those medicare savings that the president identified in the presidential budget, do you think it would be a good idea to apply those savings toward the permanent repeal of the sustainable growth rate formula? >> with regard to how we pay for it in the president's budget we pay for it within the baseline. we include it that way. with regard the specific question just using our approach to the medicare, those savings are part of a broader context. it is a budget and we put the budget together in its entirety. we view those savings need to be

pair with other elements of the budget. >> but to the extent those savers are identified and those offsets are identified in the budget seems to me that would perhaps be a reasonable place to begin the discussion of what are the offsets that are used to put in place for the permanent, universal, complete, forever repeal of the sustainable growth rate formula? >> first i want to agree with the, concept we're talking about. in my opening remarks i specifically said we support the bipartisan bicameral concepts put forward. on that we agree. with regard to the question of offsets. why i started how we do it building it into the baseline because that is the way we believe it should be done. that uses the balance of things that we use to pay for things in our entire budget. so in terms of where we start and what we believe, we believe that it needs to be a range of things and not simply focused on those. >> yeah but at the same time as you know the difficulty with

the sustainable growth rate formula the budget baseline, the fact it was built in years ago, accumulates over time, never corrected even though a number of patches passed by congress. we paid for this damn thing at least 1.4 times over the past 12 years. again, i just want you to know, i like the fact that the president put forward cost savers in his budget. fair warning to you that these are where i am going to go. lack of participation in people who are willing to come forward and talk seriously offsets leads me to go president's budget only place i can go for democratic ideas for an offset, that is one of the critical missing pieces in getting this sgr settled. >> i think our colleague actually mentioned, your colleague mr. pallone, actually mentioned his specific idea when he spoke for this issue. you may disagree with that but that was in terms of contributing to the debate. >> my door is always open to

mr. pallone. i await his invitation. i would glad to go to his office. i know you're tired about hearing about king versus burwell. i bring it up one more time. since i haven't been here it is not exhausted to me. the hope around contingency plans and american academy of actuaries is concerned insurance companies are suppose toddies close that data upon which they're basing their rates in may but there could be something that changes the equation in june. so to the extent that the insurance companies are having to deal with unsettled future. they will have to deal with contingency plans are they not? why should the department not have contingency plan as recommended by american academy by actuaries? >> with things i have the authority to plan for i will plan for the current budget you see before you unaccompanied

children issue, one i know there is difficult issue and controversy around we put in moneys to plan up to 60,000. asked for a contingency fund in case, we don't believe it will -- where there are places i can plan we will. with regard to this issue that's why, while the letter was simple, it actually gets to the core and fundamental. we do not believe we have administrative authorities. if the court makes a decision and i want to always repeat we don't believe the court will decide this way but if the court makes a decision that says and rules for the plaintiff and says that those subsidies are not available the question of, we don't believe we have an authority to undo the damage that would then occur which is subsidies go away individuals can no longer pay, they go off of their insurance. they become uninsured. it drives premiums up in that marketplace. they become uninsured. there is indigent care, it goes

up. we don't believe we have authority if the court makes that decision, at that level that we have an authority to do it. and therefore that is why you're not hearing a plan we don't have authority. >> i think you have to agree it will strange structure of risk pools for insurance companies. mr. chairman, for that reason i would like to submit the letter from a caddie of actuaries. >> without objection. >> i see those companies filing their briefs they have filed in the case, that are articulate the point you're making. >> gentleman yields back. chair recognizes gentleman from maryland mr. sarbanes five minutes for questions. >> thank you, mr. chairman. thank you madam secretary. first, thank you for stepping into public service as you've done. your tenure at omb and hhs is i think a real service to the country. i wanted to talk about this concept of full repeal which has been a drum beat for years it

seems from the other side of the aisle to understand the implications of a full repeal. so i wanted to go through some of the things that were part of the aca. and ask you it may not be that everyone of them is jeopardized by a full repeal. but i think certainly some of them are. so, the aca include ad measure that would allow young people to stay on their parents healthcare up to age 26 and i think upwards of three million younger adults have benefited from that. if there was a full repeal of the aca would that benefit and provision be in jeopardy? >> it was part of the original act, so yes. >> then there was an effort to begin closing the doughnut hole on prescription drugs under the part-d program. which, has bedeviled many of our

seniors who kind of fall into that doughnut hole. often at a critical stage in terms of being, needing to access prescription drugs and the aca reform included an effort that's begun, it underway to close that doughnut hole. would that be in dep did i if there was -- jeopardy if there was full repeal? >> it would and $15 billion of savings seniors received to date would stop. >> right. then there was terrific provisions in terms of reimbursement that benefits and benefits and reimbursement. on the benefit side for medicare beneficiaries, you had more preventative care being covered fully, eliminating co-payments for certain kinds of preventative care screening for annual wellness visits et cetera. that was part of the aca, full repeal i imagine would jeopardize that reform as well?

>> yes and we actually were just able to have the numbers and we have seen an increase a number of seniors using that preventative care and percentage of seniors using at least one preventative service continues to go up. >> excellent. we put in some enhanced payment and reimbursement for primary care physicians recognizing that we need to make sure we're incentivizing that part of the profession, in terms of getting into the pipeline. and also having opportunity to spend more time with their patients and have their be some economic reward for that which the patients themselves also want. i presume that would be a in peril with a full repeal as well? >> a full repeal would imperil. >> what about the provisions that have eliminated discrimination based on preexisting conditions? of course we started right out of the gate eliminating that discrimination in the case of children. now that has been expanded.

more broadly but i imagine that also would be undermined by full repeal? >> it would and having had a chance to meet a young woman who had cancer when she was 12 years old, first had colon cancer and then had thyroid cancer later. now in her 20s, was engaged but not continuing graduate education or getting married because her focus was paying for her health care. now the opportunity to have affordable care is, because she had a preexisting condition obviously is now allowing her to go on with her life. the issues of health security are very important but for many individuals the financial security is as well. >> thank you for those comments. the medical loss ratio requirement, that requires insurance plans to direct more of the insurance premium dollar to care as opposed to overhead costs, and so forth that was part of the aca, adhering to particular standard.

that would be eliminated, i would expect in a full repeal? >> in full repeal. >> subsidies and tax credits for small businesses who, want to do the right thing and provide health care coverage for their employees was part of the aca. so small businesses would be impacted by a full repeal in terms of their ability to offer that benefit to their workers, isn't that correct? >> it would take away the tax credit if it were a full repeal. >> so even before we get to a discussion of the pros and cons of the health exchanges which have now offered coverage to millions of americans there are so many other reasons in addition to that we wouldn't want to repeal, the affordable care act. thank you very much for being here. i appreciate your testimony. >> the chair thanks the gentleman. recognize the gentleman from florida, mr. bilirakis for

questions. >> [inaudible]. thank you very much for your testimony. thanks for your appearance welcome. i want to talk about medicare advantage. according to 2012 data there were 145,000 seniors in my direct, 45% are on medicare advantage, a little higher than the national average. they want their plans and want to keep their plans. they love their benefits and choices. unfortunately this administration may not love medicare advantage as much as my seniors of the actuarial firm of oliver wyman, did analysis of proposed 2016 medicare advantage rate reading the report i'm troubled to learn the estimated combined impact of cuts from 2014 to 2016 will cost seniors average of 60 to $160 a month or as much as $18,920 a year. -- $1920 lars a year. many of my seniors, live on

fixed income. why is administration forcing seniors to pay more than $120 a month to keep the plan they like. >> we think medicare advantage is good program. during the changes enacted we've seen the program expand by well over 40%. we've seen a number of medicare advantage plans that have, the top two ratings go from 17% to 67%. . .

>> thank you, madam secretary. many seniors who like the medicare advantage program, they have or are going to lose it in the following years. in fact, a recent milliman report details a nearly fourfold increase in the number of u.s. counties that no longer have medicare advantage as an option going from 55 counties in 2012 to 211 counties in 2015. isn't it concerning to you that seniors are losing the ability to choose a medicare plan that provides high quality and coordinated care? this is a very successful program, and again, this is extremely important to my constituents. >> agree that it is a very important program, and we want to make sure that it continues. want to see the studies and the underpinning of that. the most recent numbers i have seen are that 99% of beneficiaries have access, so those numbers may not align with the most recent study and want to understand what the difference in that is. >> thank you madam secretary. one more question.

the impact of seniors' medicare advantage could result in seniors losing access to their current coverage or facing higher premiums, reduced benefits and changing again changes to the network as a result of the cuts. the proposed cuts. when i talk with seniors in my district about medicare advantage, again they believe medicare advantage the model offers high quality coordinated care. yet further cuts will disrupt the benefits upon which millions of seniors rely. your agency likes to tout the so-called affordable premiums and better consumer choices under the affordable care act but when it comes to medicare advantage, why is the administration pursuing policies that would increase premiums and reduce choices for seniors? and again, it's very concerning. >> i think the response is with regard to the issue that what we have seen with the changes we have done to date have not had the premium pressure that's

described. we want to continue to watch and monitor and also that we have seen more people enter in and the quality improve. and so that's what we've seen to date. we want to continue to work and monitor. we want the program to succeed, we want to support it, and we want to try and do it in the way that's the most fiscally responsible. >> thank you madam secretary, i appreciate it. i yield pack. >> chair thanks the gentleman chair now recognizes the gentleman from california for five minutes. >> thank you very much, mr. chairman. appreciate the opportunity to have this public dialogue for the benefit not only of the members, but for the public as well. preserving access to prescription drugs that work for every senior is important i think, to everybody on this dais and i think every person that cares about a senior in this country which probably makes everybody. so my question has to do with what proposals in the president's budget would increase access for seniors? >> with regard to the specific access for seniors across the

board on prescription drugs i think in terms of the programs whether that's the way we use some of the programs we've just been discussing, but i also think one of the most important things that has happened is that seniors have access to preventive services, that they historically may not have. and just announced on tuesday that what we are seeing is because the seniors have that access to those preventive services they're increasing that -- the use of that. i think throughout our budget one of the things we're attempting to do is work very hard to do a system, delivery system reform which which means getting better quality at a better price for the nation. and i recently announced about three weeks ago that in the medicare space we're going to try and move to 30% of all medicare payments will be in new payment models payment models that are about improving that quality and reducing that cost. and so those are some of the areas that i think the budget focuses on this. >> now, that effort, is it

likely to create an environment individual by individual that's likely to increase their quality of extended life versus -- because when we're talking about access to preventive care, that means if you catch something, it's early stages. we all know with today's modern medicine and opportunities you can actually thwart it or actually overcome it versus finding something in latent stages it might even take your life correct? >> and across the department there are a number of investments to get to that, and whether that's in the nih investments in research, one of the things we have a proposal that we're getting response to has to do with hospice and curative care and how to combine those two in a way that will maximize for the quality of the patient. so it's throughout the budget these issues of cost and quality are things that we focus on. >> thank you. on that note i'd also like to for the record if you would allow me unanimous consent, mr.

chairman to submit a letter for the record from my office that lays out the issues that we're discussing at the moment. >> without objection so ordered. >> thank you. >> i i keep hearing a lot from some of my colleagues about their constituents losing choices. but then again, one of the things it's it's my understanding, please clarify -- when people are talking about losing choices, they may be describing policies that were in fact, more expensive on the front end and perhaps didn't have minimum benefits standards to the person paying. is that in many cases what people are tribing what people -- describing what people are losing choices? >> it can be, i'd want to ex-- >> that's why i say maybe. >> there are 25% more issuers which means more choice. they do important things and they get to some of the issues that mr. murphy and ms. met suey

on mental health and having those benefits be clear and incorporated is extremely important. without understanding the specific case, i think it's a little hard to know. >> but there are, in fact, in some areas where certain kinds of policies are not allowed but that was -- that is based on a new minimum standard correct? >> that is correct. >> and one of the things that i've discussed with some of my constituents, my staff and some of the providers and experts that we pulled together we registered at least over a thousand families, and i personally tried to speak to as many of those individuals as possible. and what was sad is many of them were even scared to be there. they were thinking about this big obamacare dragon that was going to obliterate either their finances or their health care. but what almost to a person every person that got up from once they sat down and figured out what was available to them or what have you had a big smile on their face and they were very

pleased and relieved and glad they came. and in one instance i was talking to a gentleman who was paying $60 a month, he was making $9 an hour, single income family, he had a wife and a daughter, and i met all three of them. and when he was done, he had a big smile on his face -- he almost got up and left when he met me, but when he was done, he actually realized that he now was able to provide for his family without having to spend $60 a month and now his entire family has coverage. so i think that's a perfect example of what this -- what's good. thank you, mr. chairman. i yield back my time. >> chair thanks the gentleman now recognize the gentleman from indiana for fife minutes. >> first of all, i want to thank you for working with governor mike pence on indiana on the healthy indiana plan 2.0 which will help to cover 350,000 low income hoosiers, and in a state-based program that i think has been shown historically to not only save money, but is very

popular with the enrollees. so thank you very much for that, for that work. before i came to congress, i was a cardiothoracic surgeon, and i treated many of my patients for many week withs after their surgery, and as you probably know, that falls under a global payment, a 90-day global surgical payment by cms. now cms wants to repeal that rule and eliminate global payments for surgical services. why? >> with regard to our understanding of how the global payments are used the reason that we want to do this is make sure that while we are promoting quality care, that we do it in a way that is most cost effective for the taxpayer. most of the changes that we do in the medicare space are focused on those two things and trying to balance those two things. >> okay. has hhs or cms looked into the administrative cost that the new system will have on doctors and cms? the reason i ask is because in my practice i'll give you some

examples of how this would work or won't work if you do it. we would bill a global payment for anything including follow-up visits and now doctors will be billing for their surgery, every hospital round that they make every follow-up appointment all separate tally -- let me finish -- and not only would the medical practice have to pay employees to submit all these what i consider excessive claims, but then cms will have to process each claim and how can that not cost cms more none not less? that's my first question. >> with regard to the global payment issue, and one of the things dr. patrick conway we try and have physicians who are practicing at the table as we have these conversations. want to understand the point that you're making and how we believe -- i want to look into this one in terms of the specific answer to -- >> it will be a dramatic increase. let me tell you why. if i did an open heart surgery on a patient, i would see them in the icu anywhere from 3-5

days every day and then probably 2-3 follow-up appointments. that's all under global. >> uh-huh. >> and so now that -- those numbers will be submitted as individual bills. from a surgeon's perspective i see this as -- and i think seniors should be paying attention to these comments. this is going to be a dramatic pay cut for surgeons across this country, and that's in my view, that's where any potential savings will be coming from. so as you as you look at this you better -- you should really, i'd encourage you to pay attention to that. because what will happen is you're going to have to reevaluate every code evaluation of every follow-up appointment, you're going to have to discern whether there's duplicative billing. for example, if i see a patient postop in the icu and a critical care physician is also seeing my patient that day who gets paid who doesn't get paid? there'll be increased denials. my point is this, global

payments were put in place to save money administratively and also simplify and i think, improve quality health care. and i think going backwards away from that is regressive, regressing backwards with. yes, it will save money this will save money by dramatically cutting provider reimbursement and if that's the intelligent that's unfortunate -- if that's the intent that's unfortunate because what will also result is access issues for seniors for health care services and, i would argue less quality health care. and so, you know, most of these bundles are re-examined every few years by ruck and so, you know, the argument that overbilling so occurring, if that were to be true then, you know, these bundles are looked at every couple of years and reevaluated. on that subject i would encourage you to take a really hard look at global payments. they save money they don't cost money. the savings will be at the, on the backs of seniors' access to health care and quality, in my

opinion. the other thing is the president's budget would seek to save $20.9 billion in savings over the next ten years by strengthening the ipab board, a board of unelected members selected by the president to cut, in my view, to cut medicare payments to providers. i understand the president's not yet nominated anyone to sit on the board so it could not recommend medicaid cuts this year, so in what year will they begin to make recommendations on medicare costs? >> in the current president's budgets, ipab would not kick in until 2019. >> 2019. >> that's correct. >> okay. thank you, mr. chairman, i yield back. >> chair thanks the gentleman, now recognize the gentleman from new york mr. collins, five minutes for questions. >> thank you, mr. chairman and thank you, madam secretary for being here today. i'm from western new york which is a very rural community. we have one of the highest enrollment of medicare advantage. i know prior to the affordable care act i would say that

without a doubt one of the bright spots in the delivery of health care in the united states was medicare advantage. dealt with the doughnut hole, it was a lot of comfort for the seniors, to be able to go in much like we do with hmos and -- great program. and yet as was brought out earlier, and i want to get into this, it seems as though the president and the administration and hhs views medicare advantage with some level of disdain in that it's the piece that keeps getting cut. and as i look through some of the data and i'm kind of a day-driven guy, the interesting thing i found about medicare advantage, there's over seven million enrollees, represents almost 30% of the medicare population which would indicate it works. number two, when you look at who uses it lower income beneficiaries have a higher

enrollment in medicare advantage than do wealthier individuals which means it's serving best some of the lower income populations. we've also seen that when i look at the rural plans, again, in rural america which i represent a higher percentage of folks from rural america are using it. so i'm just asking the question -- and the interesting thing, too, the bad information we got today was from ahab. they said the current .9%, the .9% cut that's coming now in the subsidy to insurance companies for mode caravaning is going -- medicare advantage is going to add another $20 a month to beneficiaries either in higher premiums or reduced benefits. so could you speak to just the opinion of older americans on medicare that they are being used as the funding source for the expansion in medicaid and

all of those increased costs on the back of our seniors who depended on this great program for all these years? that frustration level exists within that population. >> appreciate that, and as i responded to your colleague with regard to the issues of medicare advantage, i would say we support the program believe the program is a good program but also believe that our responsibility where we think there are things that are happening whether that's upcoding or other things that we try and take care of that. the changes that we've done we've tried to transition those changes, we tried to do those changes slowly so that we watch and monitor. we've seen an increase in the number of people in medicare advantage. we have seen premiums hold steady. we've seen an increase in quality. so the negative impacts that were articulated at the beginning of those proposals we have not seen. we want to continue to monitor and make sure that we don't see some of the negative impacts that you're talking about. we value the program. we think the changes -- they've been recommended by medpac and

others. we you understand the concerns but trying to operate in a world -- and with regard to the oh issue you mentioned across the board with regard to providers or the $780 million we do in discretionary cuts, we try to spread these things across the entire parts of our budget. >> but are you aware that there are now over 200 counties in the united states that don't have a medicare advantage plan at all to offer their seniors as a direct result of the cuts you've made? so when you say it hasn't had this impact, there's seniors in over 200 counties in the united states that can't even buy the coverage. >> so 99% of the nation has coverage in terms of the beneficiaries' accessibility. >> but yet the number who don't has increased. from 55 counties before the aca to over 200 today. so there's a direct impact. i mean, the numbers finish the data is the data. you can't make it go away.

>> with regard to those numbers, as i said, i have the number of the current coverage and would want to understand the change -- >> yeah. what i'm trying to point out is it had had the -- the reason you're looking for this funding is to pay for the expansion of medicaid. i mean whether it's the health insurance tax or the individual mandate or whatever, the big cost driver has been this huge expansion in medicaid would be my observation. >> what i would observe is some of the comments that have been stated about the question of overall entitlements in the growth, we have a bulge a poplation. we have a large group of elderly in medicare. the medicare costs even though we've controlled per capita costs over the period of what we're seeing, because more people from the baby boom are retiring and older, that's an issue that we as a nation are going to have to look at and deal with. medicare costs are going to continue to increase because of volume even if we can control per capita costs. and so with regard to the questions of what will be costing the nation money over

periods of time, the issue of medicare is one on a -- because we're going to have the baby boom and the echo come through we're going to continue to have to make good on the commitments we've made. and that will cost us. because even if you control it per capita, volume is greater. >> thank you for the answer. my time's expired. yield back. >> chair recognizes the gentleman from new mexico fife minutes for questions. >> thank you very much, mr. chairman. and i would yield to our ranking member mr. green, for a quick response. >> thank you, mr. chairman. e want to respond to my colleague from new york. i've not had any of my seniors question the expansion of medicaid based on what's happening with medicare. the affordable care act was totally paid for and, in fact medicare was improved under the affordable care act. and, madam secretary, if you'd just -- this is the first i've heard that seniors are complaining that the medicaid expansion's being paid out of medicare. that's just not in fact that i hear about.

do you have any information on that? >> that is the first that i've heard that anyone felt that was an issue with regard to the federal budget because i assume that's what they're referring to -- >> if the gentleman would yield one minute? >> thank you reclaiming my time. thank you madam secretary for testimony today. i want to reiterate what many of my colleagues have said, that we must repeal the sgr but not on the back of seniors and a strong chip extension must be included in march as well. also that the affordable care act is working despite an attempt of over 50 republican repeal attempts. the aca has had a positive impact on new mexico in my home state and in my home district, 25,000 people now have quality affordable health coverage because of the affordable care act that didn't before and overall the number of uninsured has declined by 17%. americans can never be discriminated against because of pre-existing conditions, women can never be charged more for coverage because of their gender and americans will never

be sold health insurance policies that disappear when they need coverage most, when they hit those lifetime caps and suddenly coverage goes away. i think that it's time that we come together and work to strengthen the law and stop playing political grahams that will strip -- games that will strip millions of americans of the health coverage they depend on. as my father would say enough is enough. madam secretary, in your opinion has the affordable care act had a positive impact on places around the country including my home state of new mexico? >> yes. and i think it has in three areas; affordability, access and quality. with regard to the issues of quality, you touched upon a number of the areas where i believe there's been an improvement in quality, and those are the fact that people can have their children covered up to 26, the quality that you don't -- if you have a pre-existing condition you can't be kept out or thrown off of your health care. the fact if you take your child in for their wellness visited there isn't co-insurance so you

don't have to pay. in terms of that preventive care. so increases in quality, we've also seen increases in quality through partnerships we're doing with physicians and we've seen a 17% reduction in harms. those are things like infections and falls in hospitals. that's also about saving lives, but it's also about money. with regard to the issue of affordability and the progress that we've made on affordability, well, we can all still continue to make more. we have in that space and what we've seen is that in the years 2011 '12 and '13 we have seen a record in terms of per capita health care cost growth. it's one of the lowest that we have seen on record, and we've seen that. that's in the broader marketplace. with regard to the individual market, what we've seen is that people the vast majority -- over eight in ten folks in the marketplace -- can find coverage using a subsidy that is $100 or less than a month. that's affordability in that marketplace. with regard to affordability and the taxpayer ceo estimates

pre-the affordable care act would have estimated spending in medicare would have been $116 billion greater. lastly access. the question of access and the fact that 11.4 million people have come through the marketplace this time but let's even use last year's number where we saw a ten million person drop in the number of uninsured. against the three fundamental measures, that's how i would think about it. >> thank you for your response there, and i do want to raise an issue that has great concern to my constituents and to myself back in new mexico. it's now been over 18 months, and the state of new mexico claimed credible allegations of fraud or their allegations of fraud against 15 behavioral health providers resulting in the eventual closure or replacement by five arizona behavioral health providers. this transition and turmoil has raised significant concerns across access to care especially in light of recent reports that the new providers are financially unstable. in fact, one provider's already pulling out of new mexico. the recent elected new mexico

attorney general has also released the audit that led to the suspension, and it shows a lack of underlying basis for many of the allegations of fraud. my staff has had several meetings with cms and i am very concerned we are not making progress. when payment suspensions are put into place, what can cms do to make sure states are acting in good faith and what is cms doing to stop the reoccurrence of this happening both in new mexico and other states, and can i have your commitment that we can meet with the dell base? >> do want to work with you on this issue. know it is one in terms of making sure people have access to those benefits. >> i appreciate that. yield back the balance of my time. >> recognize the gentlelady from california. >> thank you. and thank you, madam secretary i'm sorry do you have some water there? we should get you some water. i do want to address as i have three different, um, very different questions to ask you. but i do want to address the

issue of medicare and our seniors who are concerned. it is my recollection and, you know, there again i'm just going back to history that over $700 billion was taken out of medicare in order to pay for obamacare, about 300 billion of that was medicare advantage. so to the question of whether or not our seniors are concerned about that, i would say yes. they are concerned about that. and they want to make sure that they will be able to continue to get the good care that they deserve. i do want to start off by talking about medicare reill burstment -- reimbursement in relation to the 2% sequester cuts that were put in place a number of years ago dramatically affecting our chemotherapy drugs and our other part b drugs. as you know, this has, this has affected our industry back in january 14th of 2013, office of management and bum put out a -- budget put out a letter

basically asking federal agencies to, quote use any available flexibility to reduce operational risks and minimize impacts of the agency's core mission in service of the american people. and it goes on. some of the adverse things that have happened as a result of of the 2% cut over 16 months after cms started applying the 2% cut we basically ended up with 25 oncology clinics closing one of which a very large clinic in my own district and 75 others merged with hospitals. cms' own numbers show that it costs $6500 more per year per patient on oncology services if they become part of the hospital system versus the clinic setting or outpatient setting and about $650 more out of pocket. how can -- you know, why hasn't

cms taken the recommendation of omb and addressed that situation? >> congresswoman, we agree with you about sequester, and in this budget we fully get rid of sequester both on the mandatory side and on the discretionary side. we believe there are other choices that are better choices and so agree with you this is not an approach. when you use an approach like this, you end up doing things like the types of things you're talking about. so what we want to do is fully replace it and that's what our budget does. we are willing to make other choices in terms of how we get those savings. >> thank you. and i'll just go on. and there again a very important question having to do essentially with our tobacco product. and i, my question for you is do you agree with the director of fda's center for tobacco products that if the smokers -- and i'm going to quote him -- who are otherwise unable or unwilling to quit were to completely switch to smokeless tobacco products, it would be good for the public health? do you agree with this

statement? >> i, i would have to to understand the context in which he made that statement. with regard to the question, i think, you know, we want to promote the public health, we want to make sure we're doing the right research to understand that and put in place the right guidelines and regulations to do it. >> with well, thank you for that. i do want to add there that there are no government remember sites that help promote or, you know, address this issue including cdc, fda hin. -- n be ih. it would be helpful again, for the public to understand that there are the non-tobacco products available and that this is an approach that we need to make. and i would welcome the ability to continue to work with you and your office on any way that we can, you know, better help to get that information out and address the needs from a scientific basis and using the scientific research that's out there. i do want to switch gears a little bit to our vaccines and

to barta. right now barta maintains a stockpile of roughly 1.7 billion dollar ares' worth of pandemic influenza vaccine. this year's budget i believe, was about $20 million in order to take care of that stockpile and main tape it -- maintain it. does the 2016 budget increase that amount, and into the future how does barta plan on dealing with those issues, especially when we know that we are in our situation where this is, this is a very timely issue? >> across the board our budget has worked to do a couple of things with regard to the preparedness, making sure that that vaccine stockpile and that the issues that barta handles which are making sure that we have what we have on hand in stockpile and that we have the ability to work with manufacturers to bring new products online where that's appropriate for different types of issues that we as a nation may face either manmade or otherwise, but we also have paired that with things in our budget which are about the

preparedness in our communities and we've seen that front and center certainly in our time period. we are implementing the dollars we appreciate from congress as part of that in terms of ebola but also broader preparedness where we have been given that authority by the congress. >> thank you, secretary burwell for being here today. i truly appreciate your input. thank you. >> thank you. >> chair thanks the gentlelady. that concludes the questions of the members who are present. i'm sure we'll have lots of follow-up and written questions from some of the members, so we'll get those to you promptly. we ask that you please respond to the questions promptly. i remind members that they have ten business days to submit questions for the record, and that means they should submit their questions by the close of business on thursday march the 12th. thank you very much, madam secretary, for your attendance today and your answers. without objection, subcommittee's adjourned.

[inaudible conversations] [inaudible conversations]

[inaudible conversations] >> israeli prime minister benjamin netanyahu speaks before a joint meeting of congress today. mr. netanyahu will not meet with president obama on this visit and several democratic members of congress have announced they'll not attend the speech. we'll have live coverage of his remarks starting at is 1 a.m -- at 11 a.m. eastern on c-span. >> 2016 budge hearings continue today with defense secretary ashton carter and joint chiefs chair general martin dempsey. they'll testify before the senate armed services committee about their department's budget request and challenges abroad. live coverage starts at 2:30 p.m. eastern on c-span3.

>> the c-span cities tour takes booktv and more than history tv on the road -- and american history tv on the road traveling to u.s. cities and this weekend we partner with comcast for a visit to galveston, texas. >> people throng to the beach, and the rising tide, the rising wind certainly drew them. they watched in amazement as both of these factors batteredded the beachfront -- battered the beachfront structures. at that time we had wooden bathhouses out over the gulf of mexico, and we also had piers and we even had a huge pavilion called olympia by the sea. as the storm increased this intensity, these beach structures turned into matchsticks. the 1900 storm struck galveston saturday september 8th, 1900.

the storm began before noon increased in dramatic intensity and then finally tapered off toward midnight that evening. this hurricane was and still is the deadliest recorded natural event in the history of the united states. >> watch all of our events from galveston saturday at noon eastern on c-span2's booktv and sunday afternoon at two on american history tv on c-span3. >> president obama was among the speakers friday for outgoing attorney general eric holder's portrait unveiling. the justice department event also included a surprise appearance and singing by aretha franklin. this is 5 minutes. this is 35 minutes. ♪ ♪

>> please be seated. good afternoon everyone. i'm sally yates, the acting deputy attorney general, and i want to thank you for joining us here this amp for this special ceremony celebrating our attorney general, eric holder. first, please join me in thanking the joint armed forces color guard and the president's own marine corps brass band for the music and the presentation of the colors. [applause] i want to welcome all of you here today; senior administration officials, including one person whom we hope will soon be a senior administration official, loretta lynch. [applause]

members of congress members of the judiciary friends, colleagues and most importantly attorney general holder's family his wife, dr. sharon malone -- [applause] his daughters, maya and brooke -- [applause] his son, eric -- [applause] his brother, william holder -- [applause] his sister-in-law, deborah holder -- [applause] nieces ashley and amanda holder -- [applause]

and his sister and brother-in-law margie and reid tuckson. [applause] welcome, everyone, to this place that has been attorney general holder's home for much of his professional life. this place where as a line attorney, as united states attorney as deputy attorney general and now as attorney general of the united states, he has dedicated himself to seeking justice, to keeping our country safe and insuring that the law is enforced equally and fairly for all. now, all of you here today know our attorney general, so it probably won't be a surprise to you to hear that he didn't really want to have a big farewell to-do. and he, in fact be, resisted having this event. we knew that the only way we were going to be able to strongarm him into this was to go to a higher authority.

but given that he's the attorney general of the united states, um, that's pretty much limited to the president and dr. malone. [laughter] mr. attorney general, we are glad that you relented because we couldn't let you walk out the doors of this department without recognizing and thanking you for all that you have given to the department of justice and all that you have given to our country. [applause] the attorney general's commitment to our mission our singular mission to seek justice, has guided his entire tenure at department of justice. as attorney general he has had the courage and resolve not just to manage the department but to lead it.

he has chosen what's right over what's popular what's just over what's easy and others over himself. he has said what needs to be said even when some didn't want to hear it, and he has stood his ground when needed. eric holder loves the department of justice. and on behalf of the career men and women of this department, i want to tell you we love you back. [laughter] [applause]

>> thank you for devoting your life to the cause of justice that we all hold so dear. history can sometimes be hard to grasp as we're living it, but i have no doubt that for the years to come young lawyers will walk by your portrait in the halls of the department of justice and feel a special pride for this chapter of history that you have you have written for this great institution. and speaking of your portrait, i would hike to now invite -- like to now invite dr. malone and the artist who painted the attorney general's portrait to the stage to join the attorney general at the portrait for the unveiling. simi knox has been repeatedly called upon to capture the essence of our nation's leaders. his work includes the official portrait of president bill clinton and first lady hillary clinton, governor mario cuomo and supreme court justice thurgood marshall. dr. malone and mr. knox will

you do the honors? [laughter] [applause] [inaudible conversations] >> it's not often that i get to boss the attorney general around. [laughter] it's a tradition at the department that when an attorney general steps down he or she is presented with the actual cabinet chair in which they sat during cabinet meetings at the white house. and so on behalf of your friends and colleague here at the department, we are presenting

you now with your very own cabinet chair. it may be a little worn around the edges after six years of use, but we hope that you won't mind. [applause] and now it is my privilege to welcome to the stage the president of the united states. [applause] [cheers and applause]

>> hello everybody. thank you. please please, everybody have a seat. i think it's important to point out, first of all that eric has more gray hair than that. [laughter] clearly, he posed early in his tenure. [laughter] but it's a remarkable likeness a wonderful portrait. i am thrilled to be here despite the fact that eric is really just milking this departure thing -- [laughter] for everything that it's worth. [laughter] i mean golly. [laughter] i'm thrilled to be at doj with all of you today to celebrate a great friend and a great public servant. somebody who's led this

department with integrity and along with all of you made our nation more free and more just. our attorney general eric holder. [applause] now, in september when eric and i stood together at the white house and announced that he'd be leaving the justice department, he thanked all of you for joining him on a journey that, in his words, will always be guided by the pursuit of justice and aimed at the north star. and that sums up erik's career. eric's career. a life guided by justice, aimed at his forth star. north star. his bedrock belief in the fundamental rights and equality of all people. it's a principle that shaped his

career from his early days as a federal prosecutor through his years on the bench his previous terms at the justice department as a deputy attorney general and acting attorney general and finally, his exemplary service as 82nd attorney general of the united states. eric is america's third longest-serving attorney general. [applause] i know it felt even longer. [laughter] and i'll just come out and say it, he has been one of our finest. [applause] hundreds of terrorism convictions, the largest mafia takedown in history, billion

dollar financial fraud cases long overdue reforms to our criminal justice system. thanks in part to eric's leadership, the overall crime rate and overall incarceration rate declined together for the first time in 40 years last year. and then there's all that eric's done to restore what he calls the conscience of the nation, our civil rights division. and as many of you know eric has a personal connection to that office. when nicholas katzenbach was deputy attorney general during the kennedy administration, he escorted two african-american students through the doors of the university of alabama after the courts ordered that school to be desession regated, and one of those -- desegregated and one of those students happened to be a young woman named vivian malone. her younger sister, sharon,

eventually became an accomplished and renowned doctor and married a promising young lawyer somewhat below her standards -- [laughter] named eric holder. so if you ever wondered why eric has katzenbach's portrait hanging in his office, that's why. under eric's watch this department has relentlessly defended the voting rights act and the right to vote, pushed back against attempts to undermine that right. he's challenged state immigration laws that not only risked harassment of citizens and legal immigrants but actually made it harder for law enforcement to do their job. he's brought record number of prosecutions for human trafficking and hate crimes and resolution to legal disputes

with native americans that had languished for years. several years ago eric recommended that our government stop defending the defense of marriage act because he wants our country to be a place where love is love and where same-sex marriage is recognized on the federal level and same-sex couples can receive the same federal benefits as anybody else. [applause] with eric holder as its lawyer america has become a better country. which means that saying good-bye is bittersweet. you have done a remarkable job. it's hard to let you go. i tried to talk him out of it. [laughter] but he's earned a break. and sharon and brooke and maya and buddy, they've waited a pretty long time to get you

back. eric promised to stay on until the senate confirms his successor, and just yesterday the senate judiciary committee approved loretta lynch to be the next attorney general -- [applause] once the entire senate confirms her and she's finally allowed to get to work, i know that she is going to do a superb job. and, eric that means that you're leaving the justice department in outstanding hands. let me close by saying that you don't have to take my word that eric has made a difference in the life of this country. we collected just a few samples of the letters that were written during the course of the presidency or after the

announcement that eric was leaving. never in my lifetime read one let or from an older american in michigan, can i remember any attorney general of the united states that has done so much for our country and all its citizens. a woman in california wrote: eric holder was the best u.s. attorney general ever. when people complain about you, that means you're doing something right. [laughter] he will truly be missed. a kentucky man wrote to say: we thank you, mr. holder, for your unwavering passion in pursuit of your honorable vision. you made a difference. you are much more than simply a public official, you are a servant possessing a heart with the audacity to care. and i'll provide one last testimony from today, not in written form. working with eric in the wake of

the trayvon martin case, we initiated something called my brother's keeper. and we're trying to reach out to young people all across the country who may not have all the advantages, may sometimes be subject to stereotypes, trying to give them pathways for success. and as part of this we had a group of young men african-american and latino, who are white house mentees drawn from this local area. and today we had dinner -- or lunch. roderick was there, and we sat down and i explained to them that they don't have to be that tense about which which fork to use, you kind of work your way in -- [laughter] that when i had dinner with the queen of england, i seemed to do

okay with just that basic rule and not eating with my mouth open. [laughter] and we went around the room, and they talked about their hopes and their aspirations and what colleges they'd gone to and what they were doing, and there were a couple of outstanding football players in the group, a track star, a number of future neurobiologists and several who were planning to join our armed forces. and this one young man who had a, at the moment disqualifying haircut -- [laughter] said said i want to be the attorney general of the united states. didn't say he wanted to be governor or senator or a congressman, even president. he said i want to be the attorney general of the united

states. and i think about all the young people out there who have seen you work and have been able to get just an innate sense without knowing you personally that you're a good man. and, you know having good men in positions of power and authority who are handgun to fight for what's right -- who are willing to fight for what's right, that's a rare thing. that's a powerful thing. it's something that shapes our future in ways we don't even understand. we don't always imagine. it made me very proud. so eric, your country thanks you for your honorable vision and your unwavering passion and as the gentleman from kentucky said your audacity to care. michelle and i thank you for being a friend and partner throughout this incredible journey and to all the men and

women of the department of justice, thank you for your extraordinary service on behalf of the american people. with that, it's my pleasure to introduce my friend attorney general eric holder. [applause] >> thank you. [applause] thank you. thank you.

before i begin my remarks, i want to do something that's pretty risky which is to recognize somebody -- at the risk of not recognizing a whole bunch of other people to who i owe so much. senate patrick leahy is here -- [applause] and in tough times both professional and personal, this is a man who has been there are for me -- there for me. he is a patriot in the truest sense of the word. this country is better for the work that you have done as a senator generally and more specifically, when you chaired the judiciary committee. i learned a lot from you.

the relationship that we have will continue beyond my time here at the justice department. and at least for today -- and he'll understand what i mean by this -- at least for today you are the real patrick. [laughter] ask him about that. i came to this department as an unformed 25-year-old graduate from law school. i will leave grayer and wiser but still struck by the wonder of all that this great organization and its people have exposed me to. i have made friends during my time here and lost some of them to the vagaries of life, but each of those people has left an indelible mark on who i am and who i still aspire to be. the beauty of this department is that at its best, it is like our country. at its best, always growing always changing, always being

vigilant in the defense of those values that have distinguished this nation and made it truly exceptional. this quality is derived from the ideals that serve as the foundation for all that we love about america. great as it is, our nation is not yet perfect. the fact that we can acknowledge this is what truly distinguishes us as a people. we have always examined ourselves and determined that which needs to be improved that which needs to be maintained and that to which we should aspire. this is the essence of and the beauty of the united states of america. unlike other countries complacent in an older system, we are still young, dynamic and unafraid to question ourselves. this spirit initially led to revolution and then to the removal of the sin of slavery the right of women to vote a great civil rights movement that

truly transformed our nation and now a recognition of the rights of all americans regardless of their sexual orientation. make no mistake we still have unfinished business and work to do. reform of our criminal justice system must continue. and under loretta and sally i'm sure that will be the case. the historic wrong withs visited upon our native people must be righted. the widening gap of income inequality must be reversed. and in the defense of our nation we must always adhere, always adhere to the values that define us. and at all costs all costs the right to vote must be protected. [applause] now, that list may seem

daunting but if we are true to who we are as americans no problem is too big no issue insurmountable and beware those who would take us back to a past that has really never existed or that was imbued with a forgotten inequity. our destiny as americans is always ahead of us. our gaze is always focused on the horizon. those who have loved this nation most have dared greatly and have sought to change the status quo for the better. the founding fathers who never let it, never let it be forgotten. they chose revolution rather than sent an unjust -- than accept an unjust status quo. lincoln, frederick douglass, teddy roosevelt garvey, susan b. anthony margaret sanger, jackie robinson john lewis and dr. king jfk and lbj, vivian malone. harvey milk.

barack obama. [applause] we should not fear change. it is part of who we are as americans. it is what distinguishes us. it is what makes us unique. now, i leave this place proud of what we have accomplished over the last six years and grateful for all that doj has given me these past 39 years. this has been my home, and you will always be my family. i thank the parents who raised me and the west indian sensibility that they instilled in me. ..

you know who you are. and my crew on 24th avenue and 21st street. and more recently a president and colleagues in this administration who stuck by me when i didn't always make it the easiest thing to do. i'm grateful to this great nation who gave a black kid from

east amherst queens, new york city, more support and opportunities in any individual could have hoped for. thank you, america. to the wonderful, dedicated, accomplish men and women of this great department i realized i have asked a lot for each of you in the last six shoes but let me make one final request. keep going. keep fighting. keep believing in your ability to improve our country and our world, and know this. know this. no attorney general, no ag has ever loved this institution or you more. not one. now, i lack the words to fully convey what this place and all of you mean to me, so let me and this way. and their phrase duke ellington. i will miss you as i have loved you all, madly.

i love you madly. thank you, and goodbye. [applause] [applause]

>> mr. attorney general i know that we promised you that there would only be one speaker for today's event, and there's only going to be one speaker. but we do have a special musical guest for you today. it's someone who has the utmost respect for you, and when i say respect -- [laughter] -- i mean r-e-s-p-e-c-t. ladies and gentlemen ms. aretha franklin. [cheers and applause]

>> hold on. >> okay. [laughter] >> thank you. >> there you go. [applause] ♪ ♪ ♪

♪ o beautiful for spacious skies, for amber waves of grain ♪ ♪ for purple mountain majesties ♪ ♪ above the fruited plain! ♪ ♪ america! america! ♪ ♪ god shed his grace on thee ♪

♪ and crown thy good with brotherhood ♪ ♪ from sea to shining sea! ♪ ♪ ♪ ♪ ♪ ♪ ♪

♪ ♪ ♪ ♪ america! america! ♪ ♪ may god thy gold refine ♪ ♪ and specialness ♪ ♪ and nobleness ♪

♪ and every every divine ♪ ♪ mr. attorney general, mr. eric holder, speaking for we we the people, we appreciate you, and god bless and keep you as you go forward and in all of your endeavors. ♪ is courageous ♪ ♪ integrity ♪ ♪ a hero ♪ ♪ yes he is these champion a note he is a warrior ♪ ♪ yes he is ♪ ♪ yeah yeah.

everybody say yeah. >> yeah. >> thank you. [applause] [cheers and applause]

>> wow. >> a man. >> thank you, ms. franklin for that wonderful word vision of america the beautiful. thank you for joining us today as we celebrate our attorney general, eric holder. since there's really no way to top having president obama speak, and aretha franklin saying, i think it's going to conclude our ceremony here today. [laughter] but we would like to invite everyone up to the fifth floor to join the attorney general and his family. thank you again for coming today. if you could wait and let the attorney general's family exit this room first so that they can take some pictures, please come on up to the faithful and have an opportunity to see the attorney general and his family than. thank you for coming today.

[applause] [inaudible conversations] >> israeli prime minister benjamin netanyahu speaks before a joint meeting of congress today. mr. netanyahu will not meet with president obama on this visit, and several democratic members of congress have announced they will not attend the speech. we will have live coverage of his remarks starting at 11 a.m. eastern on c-span. >> twenty '16 budget hearings continued today with defense secretary ashton carter and

joint chiefs chair general martin dempsey. they will testify before the senate armed services committee about their department's budget request and challenges abroad. live coverage starts at 2:30 p.m. eastern on c-span3. >> you would see what is to colonize a kid a mutt and jeff combination, or a stickball set. washington was a large man six-foot very robust terrific natural athlete. and madison is a skinny little guy. >> this sunday on q&a, historian david o. stewart on founding father james madison and the partnership he made that aid in the success of our fledgling nation. >> is get that i write most about is his ability to form remarkable partnerships with really the great people of his

era. but it also alludes to his gift to the country of his talents and what is able to do to help create the first self-sustaining constitutional republic. >> sunday night at eight eastern and pacific on c-span's q&a. >> c-span2 providing live coverage of u.s. senate floor proceedings and key public policy fans. and every weekend booktv number 15 years the only television network devoted to nonfiction books and authors. c-span2 created by the cable tv industry and brought to you as a public service by your local cable or satellite provider. watch us in hd like us on facebook and follow us on twitter. >> the u.s. senate is about to meet for a brief session before recessing to go over to the house for a joint meeting to hear from israeli prime minister benjamin netanyahu today. senators are using this time before the address for general

speeches on any topic. legislative work will start this afternoon at 2:15 p.m. eastern when we'll debate whether to proceed to vote to override president obama's veto of the keystone xl oil pipeline. the actual veto override vote is planned for tomorrow. a couple of issues awaiting action in the senate. the nomination of loretta lynch for attorney general and mitch mcconnell suggested wants to bring up bills dealing with human trafficking labor relations board rules on union elections. live now to the senate floor. the chaplain: let us pray. eternal god let the moments and hours of this day reverberate with the sounds of your unfolding providence. may our senators hear you working throughout their deliberations transforming the discordant

into the harmonious. may your unseen presence enable them to discern the direction that they should take, as they seek to heed your instructions and follow your commands. as they fellowship with you, give them discomfort with easy answers, half-truths and superficial relationships. inspire them to believe that they can make a difference in this world. we pray in your holy name. amen. the president pro tempore: please join me in reciting the pledge of allegiance

to the flag. i pledge allegiance to the flag of the united states of america and to the republic for which it stands, one nation under god, indivisible, with liberty and justice for all. mr. mcconnell: mr. president. the presiding officer: the senator from kentucky. mr. mcconnell: i ask unanimous consent that the president of the senate be authorized to appoint a committee on the part of the senate to join with a like committee on the part of the house of representatives to escort his excellency benjamin netanyahu into the house chamber for the joint meeting at 11:00 a.m. on tuesday march 3

2015. the presiding officer: without objection. mr. mcconnell: mr. president later this morning israeli prime minister benjamin netanyahu will deliver an important address to congress. members of both parties extend a warm welcome to him. this leader is a great friend of our country and his visit comes at a critical moment in the relations between our countries. the prime minister's address coincides with an increasingly aggressive iranian campaign to expand its sphere of influence across the middle east. it represents a threat to both of our countries. it represents a threat to moderate sunni allies, and it represents a threat to the international community at large. that's why prime minister netanyahu is here today. he is ideally suited to explain the multitude of challenges this presents including the threat of an iran with nuclear weapons capability and how our countries can address them jointly.

so we're glad the prime minister is here with us today. we'll be listening closely to what he has to say. i hope the obama administration will be listening too because this visit isn't about personalities. it's about doing what's best for both of our countries. and here some context is important. as it has been since its founding israel is a constant state -- is in a constant state of existential crisis. it continually is threatened by terrorists like hezbollah and palestinian islamic jihad to work every day to see a democratic israel destroyed. israel's leaders wake every morning knowing that with just one wrong decision, it could be their last in an open and tolerant democracy. that's the frame through which the israelis approach their national security policy. and here's the frame the obama administration uses. it formulates policy with two

objectives in mind -- fulfilling political campaign promises made back in 2008 and pursuing politically expedient solutions to whatever stands in the way of the first objective. you can see the basis for tension right there. for me, there are two book ends that really define president obama's foreign policy. the executive orders that attempted to close guantanamo without a credible plan for what to do with its detainees and to essentially end our ability to capture, detain and interrogate terrorists regardless of the threats that remain for our country represent one book end. the president's push to withdraw all combat forces from iraq and afghanistan by the end of his term regardless of the threats posed by the taliban or the senior leadership of al qaeda represents the other book end. the politics about policy approach mystifies allies like israel. israel knows that it may well be

the first to suffer if the obama white house makes another flawed political decision, but americans should understand that it's not just israel that needs to worry. we should be concerned by a nuclear iran. the whole world should be concerned about a nuclear iran. and the prime minister is going to help explain just why that is. for israel's sake and ours, i for one am very glad he is. the presiding officer: the senator from nevada. mr. reid: today marks the 115th day since president obama announced he was nominating loretta lynch to be attorney general of the united states. that makes her the longest pending attorney general nominee in more than four decades. the judiciary committee reported nominations favorably last week. so what's the wait? why can't we get this woman

approved? it appears we're not going to do it this week. she has a spotless record, credentials that are above reproach. there is absolutely no reason she should have to wait any longer for a confirmation. our nation needs an attorney general. each day that passes without miss lynch's nomination being confirmed is yet another testament to republicans' inability to govern. mr. president, last december, rightfully the national labor relations board voted to make important changes to union election procedures. their rule changes are good for workers and businesses. they modernize the election process and help prevent delays and frivolous litigation. i am sure there are some businesses who oppose this but i haven't found them. this is simply a problem that's been engendered by the republicans here in the senate. they're trying to roll back these reforms instead of supporting the rights of

workers. the reforms they made are so basic, like using email and using other processes such as a fax machine and using the employers' records not the unions' records. later this afternoon the senate will consider a republican resolution of disapproval to seeks to undo the nlrb rules changes. this is yet another sad reminder of how little regard the republicans have for the american worker. last year we saw republicans vote against an increase in the minimum wage as well as legislation that would ensure american women getting the same way for doing the same work as men. republicans in the congress, i don't think mr. president they just don't get it. we're here in this building, in this chamber to help the american people, and we're willing -- we want to work -- make sure that businesses are prosperous but we also can't lose sight of the fact that the workers are what makes those businesses profitable. so if you are for the american workers and the families they

support approve the vote on this resolution. the presiding officer: under the previous order the leadership time is reserved. the senate will be in morning business until 10:30 a.m. with senators permitted to speak for up to ten minutes each with the time equally divided, with the majority controlling the first half. the senator from north dakota. mr. hoeven: mr. president at this point i would ask consent to engage in a colloquy for up to 20 minutes. the presiding officer: without objection. i'm sorry. is there objection? mr. durbin: mr. president i understood the time was equally divided between now and 10:30. is there sufficient time for the republican side to use 20 minutes? the presiding officer: the time would be 18 minutes on each side. mr. durbin: thank you mr. president. i have no objection to the use of that time if that's how the senators choose to use it. the presiding officer: without objection. mr. hoeven: i would like to thank the senator from illinois. mr. president, i am here this morning to engage in a colloquy with the good senator from south

carolina. we will be joined by the senator from new hampshire the senator from kentucky and perhaps the senator from arizona. the purpose of the colloquy is to welcome prime minister netanyahu this morning, who is to be speaking in front of congress and to talk about why it is so important that he is joining us today. in a few moments, we are going to hear remarks from the israeli prime minister benjamin netanyahu in the house chamber. we welcome him to congress to affirm the friendship between the people of the united states and the people of israel and to assess the threats facing our two democracies. actually today's speech is not unusual. this is the 115th time that a foreign leader has addressed a joint session of congress. this is the seventh time an israeli prime minister will address a joint session of congress. it is prime minister netanyahu's third address to congress.

and it's not surprising that we are hearing from the leader of our -- from the leader of our ally israel. israel is a democracy in a neighborhood of authoritarian governments. prime minister netanyahu speaks the language of freedom with us today. there can be no doubt of his passion on behalf of the people he represents, and that makes us take his message very seriously. so this joint session is not unusual or surprising, but that does not mean that it's unimportant. in fact, today's speech is profoundly important. the partnership between the united states and israel is critical for the security of the middle east and the world. we need a strong u.s.-israeli partnership to stop iran from developing a nuclear weapon. we need a strong u.s.-israeli partnership to stand against the extremism that is ripping apart nations across the middle east.

we need a strong u.s.-israeli partnership to demonstrate the value of democracy human rights and the rule of law for societies that are no longer satisfied with dictatorships. so for all of these reasons it is good to have prime minister netanyahu here today. it is good to reaffirm the bond between israelis and americans and it is good to join hands again with an ally to stand against tyranny and extremism. i look forward to hearing from the prime minister because views directly from israel are extremely important. since its birth in 1948, israel has faced one security threat after another. israel's strength and vitality in the face of these threats are a testament to the ability of its people and its leaders to head off threats to its security before they become impossible to overcome. there is no substitute for the

israeli view of security in the middle east, and the iranian threat in particular. so today represents an important moment to learn how israel sees its own security and understand the next steps for the u.s.-israeli partnership. and now mr. president i would like to turn to my colleague from south carolina and ask for his comments about this important speech from the prime minister of israel today. mr. graham: thank you. i appreciate being on the floor with the senator from north dakota who has been very involved in trying to secure america against threats. i will get to the heart of the matter. some people feel the prime minister should not be here at this time because in a couple of weeks there will be an election in israel. they have a parliament system. they do things differently. they vote for parties not people. they're having a real contest over there about who should be

in charge and what coalitions will lead israel. i have got a very simple comment. that's not for israelis to decide. you decide who you want to run your country. you vote for the party or the groups of people that you think best represents your view of israel. that is your business, not mine. my business is to try to find out what's best for america when it comes to defending our nation. that's why all of us are here on the floor today. i don't think i can adequately do my job if i don't hear from the prime minister of israel if he's willing to talk to me. now, some people may be able to do that. god bless you. if you feel like now is the time to boycott this speech, if you want to send a political message about politics in israel, be my guest. i'm going to be a the speech to try to learn as to what to do regarding american-israel concerning the iranian nuclear threat. why do i think it's important for me to be there? i can't think of a better voice

to tell me what would happen in the region if we get a bad deal with the iranians. israel is in the crosshairs of the iranian. ayatollahs have been for decades. they threatened to destroy the state of israel. so i want to hear from the people on the grouped israel in particular as to what a good deal would look like and what a bad deal would look like. i want to hear from the prime minister of israel the consequences of a bad deal. i do not trust this administration to negotiate a good deal but maybe i'm wrong with and the best way to find out is for congress to look at the deal and if it is a good deal believing vote for it because the arabs and israelis will tell us this is something we can live with. at the end of the day a good feel diehl is a blessing for the world, a bad deal is a nightmare. i not only welcome the prime minister of israel to speak to congress, i am looking forward to it because i hope to learn something that would make