. >> thank you. they will try to have an additional hearing in july. as a window. hopefully they will be significant. it's the hope they will revisit japan. japan absolutely has to be on the list. i would like to yield to the ranking member of the full committee. >> thank you, mr. chairman. i want to make a brief statement and then i think we are being called for votes. i want to thank you for scheduling today's hearing and thank you for your tireless advocacy through all the years we serve in congress together. i no of no one who fight harder than you for causes in which you believe and are

effective in fighting for. everyone here should understand how much of this is driven by you i'm here because i want to show my support which affects more americans than you know. parents of an internationally abducted american child. i no that you have been a champion of returning abducted children back to their home and join you in recalling for the system. a system. a few crimes that are more heart-wrenching and child abduction. wwor

>> it is an often overlooked

crime which can impact the lives of the children and parents involved and we need to send a message that we take compliance and returning abducted children back seriously. i want to thank my constituents for being here. we are there with you. you are not alone we are going to do everything we can tell. again, i would like to thank my colleagues in mr. smith for the tireless effort in this important issue. >> thank you very much for your excellent statement. your leadership, and the american people need to know more and more as we work across the aisle. it's always a privilege. we would like to thank the ranking democrat on the committee. we thank you. so let's go to our next guest. >> i thank you for being here. and i look forward to your

testimony. >> good afternoon. i am honored for the privilege to provide my testimony before you. and i commend you for holding this important hearing. and i'm here today because i am inspired, traveling on a train in 1893 with a paid ticket. one individual was thrown off the train because of the color of his skin. the sense of injustice and outrage within him inspired a struggle for civil rights in south africa, which he later transformed into a fight for national independence from colonial power. that resulted in this and i'm not comparing myself to mahatma gandhi, but i'm compelled to write with the cause that transcends cultures and nations. and i'm here today because my little boy whom i love dearly,

is with me and he had been robbed of his father's love for over three years. this is not perpetrated by a stranger but by his own situation. it was a calculated and malicious act inflicted without any regard of rights. [inaudible] and dozens of parents whose children have been abducted are hoping that i have encouraged to give this not only to the abducting parents but by civilized nations who have shown a blind eye to the immense woman suffering that we have experienced here for years. it is about our children. these are precious human lives and they matter to me and to

others [inaudible] [inaudible] [inaudible] and the list goes on and on. the government has failed to rise above the economic security cultural and other geopolitical interests to solve what is a solvable problem. if one of the objectives is to scrutinize the record indonesia and other countries, then i humbly request that we add one more name and that of the united states. why the u.s.? simply put, cases like mine have been lingering for years without any final progress.

and we don't need to know the inner workings of our government in this way. the department of state's website, which is included in this testimony items listed include exchange visitors programs and youth exchange programs. how much does that give them an on one hand they state that they care about our children and are doing everything to bring our children home, yet the facts show a different picture. how long do we have to wait even for a glimmer of hope. let's look at this in our government. the department of justice who defends the in interests of the united states to ensure public safety against foreign and

domestic and provide federal leadership in preventing and controlling crime and to seek just punishment for those guilty of unlawful behavior and to ensure fair and impartial administration of justice for all americans. has the department of justice lived up to its mission. how many parental child protection cases have been prosecuted in the last decade, how many cases have a close without children returning. how many have been successfully prosecuted. the answers are hard to find. and so here i am today presenting a victim's report card. to talk about how we have acted to protect children's rights and cooperate in this, using a ratings bill that my son would understand. not good okay, good, and awesome.

>> it doesn't give me any joy to see this, but after several decades of collective hardships, the dial on international parental child abduction just hasn't moved. >> from a parent's point of view there is the leadership, there is the urgency. left behind parents have been kicked around from one quarter to the next, one government agency to another, one elected representatives office to another. by chance if the stars align they may get the support and justice they deserve great otherwise we hit the repeat button and do this all over again. one individual was adopted in

1990 from california and his autosomes the console. the abducting parents did everything they could to alienate from his father and he spent his entire life savings to fight a legal battle to the justice which continues to elude him. and this must change. the time to act was yesterday. many were outraged by the reality and the mediocre response. at best, the voices of children have been left behind and they have been ignored or silenced. if i don't stand up today and speak about injustice we will have one less role model to look up after.

it is based on the foundation of shared values, including family values. the enhanced situation is more and more people are are crossing national marriages for all practical purposes. and it includes considering alternatives like bilateral agreements an executive order. and can lead to a human rights disaster that can jeopardize your children's future.

family and custody matters to align them to international standards. i respectfully urge all members of congress, especially those to use this opportunity to bridge the divide. it is time to take individual and collective ownership and bring accountability wherever it is lacking. and this includes upholding core values and protections of human rights without taking stock on its own reality, it will not lead to this. i wish i could say that the only challenge that we face is systemic [inaudible] so that we could consistently get this justice in india.

this includes instances of custody battles the fact of the matter is that those decisions are too far and far between. indian courts are using outdated laws or no laws. to address the processes of modernized actions. in a recent case the court ordered a return of two british children abducted from the uk and the parents need to meet a slew of criteria. and it's clear that even when the abducted children in rare instances a return to returned to their home countries, often with significant conditions on the left hind parents which penalizes the victims and

rewards the abductor. based on direct experiences and the ground realities in india even in 2015 and not because america is demanding or asking for any favors by because the citizens deserve better. the lack of policy is a crime both civil and significant ramifications have some sort of an association. and in this decision that they are competent to decide on

individual cases based on existing law. and it's leading to confusion and inconsistency, decision-making for a country that has over 31 million cases as of september 2014. this includes the incorrect application of criteria with an indian divorce law such as foreign seller sends and others resulting in wrongful assertion of jurisdiction raising heated questions of these applications and u.s. constitutional right guaranteed to each of us living in the united states. there's a cocktail of issues combined with joint custody

provisions and domestic violence laws [inaudible] giving abundant incentives for parents across the united states and the world for india to become their preferred destination for child adduction. >> if you could just continue briefly. we have two votes on the floor and i will be back. in about 10 minutes if you could pick up where you are now, we will go to this and i apologize. we have a brief recess and then we can be back.

>> the head at the department of health and human services told lawmakers that if the supreme court nullifies health insurance subsidies that are part of the health care law, it will be up to congress and state officials to come up with a solution. she also testified her department's budget at this two hours house ways and means committee. congressman paul ryan chairs the committee. [inaudible conversations]

>> the committee will come to order. we know the secretary is on a tight timeline today with a hard deadline at noon so that's why ranking member and i just discussed we will limit members questions to four minutes to accommodate as many members as possible into question. but first let me start by thanking our witness secretary burwell. i understand that you've got to get going so we are going to move this as quickly as we can we were supposed to this hearing earlier in the year but events overtook us. so here we are today. i understand the majority of your remarks of the about the budget, that's all well and good but it shouldn't surprise you that we're more interested in talking about obamacare, especially given the president's remarks this week.

i hope they give you a medal for this job because defending this health care law is no easy task. i think any objective observer would say this law is on the fritz, by the law's own standards. the whole point of obamacare was to make health care more affordable. but premiums aren't going down they're going up, way up. all over the country, insurers are proposing double-digit premium hikes. in maryland, it's close to 30%. tennessee, 36%. south dakota, 42%. tax season was like a bad dream before. now it's a total nightmare. people could never afford these plans on their own, so the law gave them subsidies. to some people. well, now, two-thirds of the people who got them had to pay the irs back, on average over $700. that's not the kind of money most people have lying around.

and for all of this hassle, what are we getting for it? the argument was if people had insurance, they'd go to the doctor instead of the emergency room. but now even more people are going to the emergency room. so, whatever the supreme court decides this month, i think the lesson is clear, obamacare is just flat busted. it just doesn't work. and no quick fix can change this fact. we're not talking about a fender bender or a flat tire. the whole law's a lemon. its very linchpin its central principle, is government control. that means higher prices, fewer choices, and lower quality. so the answer isn't just tighten a few screws and everything will be fine.

the answer is to tweak it here and we get there and we will all be okay. the answer is to repeal and replace this law with real patient-centered reforms. and the truth is i don't have to convince this administration the law is broken. i know that you know it's broken because you keep trying to fix it. for several years now, hhs has delayed parts of the law, and in some cases rewritten it, on the fly. we know the most egregious example: the subsidies. the law says people who buy plans on state exchanges can get subsidies. it doesn't say anything about the federal exchanges. and yet, hhs has sent millions of subsidies out the door putting millions of people at risk. more and more it seems the administration isn't so much implementing the law as improvising it. we already have evidence of the administration using one account to pay for multiple programs, programs that congress has never funded. that's one of the main reasons we're holding this hearing today. it is congress that wields the power of the purse.

and more and more the administration is acting like a purse-snatcher. so again my kudos to you for taking a tough assignment. but the american people deserve better. they deserve a health care system that puts the patient first. they deserve lower prices, more choices, and higher quality. and this committee is going to do all it can to make those things happen. and with that i will yield to the ranking member. >> welcome. the republicans want to focus on aca, and i think it's a good idea. because what's busted is not aca but your attacks on it, endless attacks. never coming up with a single comprehensive alternative all

these years. so we sit as armchair critics while millions of people have insurance who never had it before. millions of kids have insurance would not otherwise would have had a. people who have preexisting conditions no longer are canceled or can no longer get insurance. doughnut hole is gone. millions of people in lower income categories are not insured through medicare. millions and millions and millions. cost containment is beginning to work. is beginning to work. the increase in costs, that rate is going down. and so you are livid because

it's getting better. that's why you are livid. and i'm not surprised at your fervor. we will be glad to take it on. we will be glad to take it on. and i think you just need to understand what this experiment is all about. it was combining increased access to medicare medicaid with an increased reliance on the private insurance sector. that's really what this is all about. and experiment. and you talk about government control? more and more people are getting insurance through the private sector.

and estates that are denying their citizens further coverage under medicaid are essentially telling people, well it lost when it comes to health coverage. get lost. and you have a governor, mr. chairman, who is running around this country talking about the evils of health care when millions of people are benefiting from what happened. so you decided to turn this from budget to aca. welcome. welcome. your frustration is millions and millions and millions of people are benefiting, have health care when they did not before. so madam secretary i think they have thrown down the gauntlet. i don't think you just i don't feel sorry for you. i think you love this job and

you like being the person who is administering this experiment in greater health coverage after 70, 80 years of nothing being done in this town or throughout this country. so i happily welcome you because i think you're a very happy warrior. i yield back. >> i like to recognize a happy warrior now for your opening statements. the floor is yours secretary burwell. >> thank you, chairman ryan ranking member levin and members of the committee. thank you for the opportunity to discuss the president's budget for the department of health and human services. i believe firmly that we all share common interests and, therefore, we have a number of opportunities to find common ground. and we saw the power of common ground in the recent bipartisan sgr fix come and i appreciate

all of you all's effort to get that work done. the president's budget proposes to end of sequestration, fully reversing a for domestic priorities in 2016, matched by equal dollar increases for defense funding. without further congressional action to sequestration will return in full in 2016 bringing discretionary funding to its lowest level in a decade, adjusted for inflation. we need a whole of government solution about both parties can work together to achieve a balanced and commonsense agreement. the budget before you makes critical investments in health care science, innovation and human services. it maintains our responsible stewardship of the taxpayers dollar. it strengthens our work, together with congress to prepare our nation for key challenges both at home and abroad. for hhs the budget proposes $83.8 billion in discretionary budget authority this is a

$4.8 billion increase which will allow our department to deliver impact today and let a strong foundation for tomorrow. it is fiscally responsible with a company legislative proposals would save taxpayers and net $250 billion over 10 years. in addition it is projected to continue slowing the growth of medicare i securing 400 -- [inaudible] in savings as we build a better, smarter, healthier delivery system. in terms of providing all americans with access to quality, affordable health care it builds upon our historic progress in reducing the number of uninsured, and improving coverage for families who already had insurance. the recent example of this progress is a 10.2 million americans who are currently enrolled in health insurance through the marketplaces in 2015. the budget covers newly eligible adults in 28 states thus d.c.

were expected medicaid and it improves access to health care for native americans. to support communities throughout the country the budget makes critical investments in health centers and our nation's health workforce, particularly in high need areas. to advance our common interest in building a smarter, better, healthier delivery system it supports improvements to the way care is delivered, providers are paid and information is used. to advance our shared vision for leading the world in science and innovation, the budget increases funding for nih by $1 billion to advance biomedical and behavioral research, among other priority for it invest $250 million for the precision medicine initiative which will focus on developing treatments diagnostics and prevention strategies tailored to the individual genetic characteristics of individual patients. to further our common interest in providing americans with the

building blocks of healthy and productive lives this budget outlines ambitious plan to make affordable quality child care available for working families. to keep americans healthy the budget strengthens our public health infrastructure with $975 million for domestic and international preparedness including critical funds to cover but the global health security agenda. it also invest in behavioral health services, including more than 99 million in new funding to combat prescription opioid and heroin abuse. dependence an overdose. finally, as we look to lead our department stronger the budget invest in our shared priorities of addressing waste fraud and abuse. initiatives that are projected to yield $22 billion in gross savings for medicare over the next decade. we are also addressing our medicare appeals backlog with a coordinated approach. we are pleased that the senate finance committee last week

passed bipartisan legislation, and we look forward to working with this committee honor. i also want to assure you i am personally committed to responding promptly and thoroughly to the concerns of members of the committee. i want to close by taking a moment to say about him of the hhs employees from the work combating ebola, to assisting unaccompanied children at the border. the commitment they should take a day, day in and day out as they work to help their fellow americans have those building blocks of healthy and productive lives. i look forward to working closely with you to advance our common interests on behalf of the american people. thank you. >> thank you. let me first off i sang where we agree with the administration, we work with the administration. this week's action on trade is a perfect example. but on this health care law we could not be more opposed to what the administration is doing. we really think this is doing great harm to the health care

system and to the people we all represent. so let me start by just addressing the big elephant in the room. any day now the supreme court as you will because your name as is burwell, in king v. burwell, is about to roll if the court rules against the administration, and millions of people will be stuck with a government design health insurance that they cannot afford. so the question is then want? what about the people who are going to lose their subsidies and possibly their coverage? is the president going to dictate to us how to fix this flawed law? or is the president come is the of michigan going to be willing to work with us to give families greater freedom in choosing a health care that works best for them? >> so with regard to the question of the court, i think you know we believe that we're implementing the law as it was written, as the statute is written, as was intended, as cbo

escort for all these years, as recent articles have reflected that those were part of writing to indicate that it should be. the idea that citizens in the state of new york should receive federal subsidies that taxpayers contribute to and citizens and the state of texas should not come is not what we think the law -- >> i understand your opinion on what the court ought to do but it stands to reason there's a pretty decent chance they may not go your way. so the question then is what? >> so if the court does decide come into the court court would decide for the plaintiffs in the idea that the court would say that subsidies in the federal marketplace are not eligible, though states are part of the federal marketplace, that those citizens cannot have those subsidies, if the court makes that decision, we are going to do everything we can and we're working to make sure we are ready to communicate to work with states and everything we can, but the critical decisions, if the court says that we do not have the authority to give

subsidies, the critical decisions will sit with the congress, and states and governors, to determine if those subsidies are available spent so here's the question is the president going to stand up and say i have a once in sticks taken by what are the highway? is that going to be the decision or will the administration be willing to work with congress to find a way to give more people health care freedom act. >> with regard to the question of health care freedom, i think it is important reflect the marketplace is a market. it uses private insurers. april a sign up in the marketplace are not on active many choices. as the medevac in the marketplace this year number 25% more plans. that's more choice, more competition. that is why the -- >> let me ask you this because i want to be kind of everybody's time. let me ask it this way. if the plaintiffs prevail if

the king side wins and in the exchanges are deemed unconstitutional not legal in the federal exchanges states, then individual mandate is effectively struck down for those taxpayers in those states. is the president going to say reinstate the individual mandate? i got to tell you it's not real popular come and we hear a lease on the side of the aisle are not eager to reinstate the individual mandate. i would say the administration has kind of in a little to side on this particular issue band-aids were you delayed the employer mandate twice. that goes away as well. so is the administration going to take the position congress must reinstate this thing all these 37 states reinstate individual mandate, the employer mandate, my way or the highway? or is the president going to be willing and flexible to work with congress to fix this mess and negotiate with congress? that's what i'm going to get it. >> so i think it's october important though with regard to

the decision before the court, the decision before the court is who receives subsidies and whether or not those subsidies can be given in states that have a federal marketplace versus a state marketplace. that is the decision that is the only decision before the court right now. with regard to what happens if the decision occurs, two things occur. the first thing that occurs is for the people of -- >> secretary burwell, we know what will occur. we all know this. the question is what will the administration to? will they stand up with one piece of paper and say my way or the highway or what to work with congress to address this situation? >> the problem that occurs if the court decides against us that they've made a decision that the subsidy speed you are not going to answer the question, are you? >> no, the issue. know, the answer is the problem to get screwed if subsidies are not available for millions of americans. they lose their interest. it drives up costs and individual market.

to solve that problem the critical decision are going to say whether congress or state spent for a bill to become a law, house senate, and the person at the other end of pennsylvania avenue, the president signed the law. is the president going to come out with a one pager fix or is that president of the united states will be thinking less about digging in and defending as long as exactly written or is he going to be willing to actually deal with the issue which is affordable health care for millions of people who are losing their health insurance? will work with congress to address the situation or is he going to put concrete around his ankles and say it's a mile or nothing? that's the question. >> the president and we've said, the administration has said all along with regard improvements and we believe there are improvements that can be made, we look at three things at the fourth underlying. affordability, access, quality and issue of how it affects the deficit and our economy.

we will look at anything and have a conversation. with regard to the specific that you raised, i do think it is important. the issue of the individual mandate, that is related to a very fundamental part of the system, which is preexisting conditions. and it is our experience am at least in my conversations across the country most americans believe that you shouldn't be kept out of insurance or band. if a child that has a condition that's one with a particular condition, that i shouldn't spend my time worrying that the child whenever to insurance once they go off mine. >> you are kind of going off-topic or i'm going to cut you off there. we both know that their ways of dealing with those problems without having to impose individual mandate. in the interest of everybody's time mr. levin. >> well, i'm not surprised at the tone but i really think it is so counterproductive.

chairman, you talk about to sightedness. the two sides, when you say you were about the millions who will lose their insurance when it's your allies who brought the suit that would deprive them of insurance. you talk about about concrete having feet in concrete. that's exactly where you've been in terms of aca. your feet have been in concrete block you have brought up bill after bill to try to destroy aca. and when you say will be president be my way or the highway, that's precisely what has been your approach to aca. concisely.

you've never sat down with us to say how could we make some changes? instead, you have been out to destroy aca. and you say where's the president's plan? when the president leaves the court will and should uphold the law. all you've done is issue op-ed's. >> and bills spent and bills, contrary, contradictory bills. so you don't have any plan, like you haven't had a plan for 60 years. so you can keep going after the secretary, and she will keep trying to spell out i will ask you and i will finish. how many people have been receiving subsidies, madam

secretary? >> so 7.3 noting people have received subsidies that are in the marketplace right now. >> so when you shed tears about 7.3 million, remember, or about the law it's 7.3 million. what's been the average subsidy? >> $272 per month is the average subsidy. and in terms of those that are in the market place that are subsidized, that's the 7.3. so tim pawlenty million people are currently overall but 85% received subsidies. the average subsidy is $272 per month, which is what results in the affordability. >> and just quickly tell us, how many people have received additional care through expansion of medicaid? >> the question of the total number, because of the our people in terms of the expansion itself about 10 million people

are the estimates in terms of those states that have expanded. >> so add those two together and we're talking about individuals with families, and the republicans come here and castigate you and this president. this you should really be on the other foot. i yield back. >> mr. johnson? >> thank you, mr. chairman. i hardly know how to follow that. i guess i'm supposed to thank you for being here but i have to tell you i'm not in agreement with much of what you are saying. let me just ask you. you know we are trying to to

get the health care back in shape, and it sounds like to me that you want to go your way and not try to work with us. and let me just ask you if there are any proposals that hhs supports that will reduce costs for consumers without setting price controls or imposing the restrictions will reduce access to care speak was yes in terms of there are a number of things that are part of part of our budget and that we're currently implementing that are reducing costs. we know that since the passage of the act -- >> but it looks like to me everything is going up. >> well, medicare spending come if we look at what is projected to be in terms of the previous 10 years up to 2008 to where it has been since 2009-2014 we

saved $300 billion. with regard to per capita health care costs in the country, in 2011, 12 and 13 the cost growth is at the lowest that it has been in for the district so that taxpayers say things. that's also savings -- >> but insurance rates are going up, not down. everybody is paying more for it. let me -- >> insurance rates before the affordable care act were going up off an individual market will about double digit numbers. so what we've seen since the implication is while those rates are still continue to go up there going up at a much lower rate. >> okay. let me just change the subject for a second and ask you about an effort by my colleague, lloyd doggett come and i've been after for a number of years confidence indices of social getting numbers on medicare cards. as you know that finally became law earlier this year as part of the medicare access and authorization act. let me ask you is hhs poverty

and limiting that? and fsb think you'll be able to issue cards without social screen numbers on them? >> first, let me say thank you, having put this in the budget when it first arrived at omb i thought as i told you on article it would take years so thank you for your leadership and effort on this. we were pleased and i was personally very excited. right now we're putting together the work plans to do that. we have an established exact timetable put us as it was passed, the next as the team for the workplace. we want to do as quickly as possible and in ways that will serve the consumers. the are a lot of medicare consumers are going to make sure we're not disrupting them for their services but we very quickly want to do because, like you we believe this is an important part of privacy and security. >> well, i thank lloyd doggett for helping me with that. but how easy do you think you can make it for seniors to get a new car to? >> i think that's the part in terms of us in the tiny because we wanted to be easy for seniors and make sure they understand.

want to do things we don't want to do by making this improvement is great confusion. great confusion. said they didn't have to wait we can enter into new people coming in very quickly with the card but those with existing cards, because we don't want of a confusing situation so that's what we are working to do and look forward to staying in touch with you in your office about how we do that. >> thank you, ma'am. thank you, mr. chairman. >> thank you. mr. rangel. >> thank you, mr. chairman but i do want to thank my colleague mr. johnson, for not drinking all that kool-aid that you have in the back against obamacare. people know we're trying to provide health care is very healthy and i certainly, i can't try that kool-aid because i was a former altar boy and i went to school and all the religions, and i just thought that the right thing for americans to do is to believe in health care was part -- it doesn't even seem like a political thing if a kid

is sick and someone says that you can't have health care, it should paint us as human beings if a person goes to a doctor and find out that the child has a disease but he can't get insurance. if we find the good samaritan on the side of the road we know that most people, middle-class people have a choice but poverty sometimes restrict people from getting there. it just seems to me that instead of tearing out a system where you know in your hearts you for getting health care that you would say, i don't like the way you have done it mr. president. i don't like the way you democrats have done it. let us help you to do it better. but to take some sense of pride that the supreme court will just strike down the opportunity for people to get just basic health care to me is not just mean

spirited -- >> would the gentleman yield? >> i don't think so tricky because you are on a roll now and i don't want to have you to become a nice guy at this point in time because i am glad that -- the attack that you intend to do. and i don't care who the secretary is if you're on the side of giving assistance to people that cannot go see a doctor, i can now prevent going into intensive care because they've had preventive care, they can now get insurance that they couldn't have insurance from a political point of view i wouldn't want to be in your shoes explain it. of course, those who are already covered, it's no problem there. i've got mine, jack. you do the best you can. but i don't care what religion you believe in, and even if you don't believe in any come it seems like compassion should override partisanship. and we don't like what's before us we should work hard to repair and to fix it and improve it. and so you know i'm 85 years

old. if i have to decide what law on the side i'm going to be raising issues on, i can't find a better one than this. you know it goes without saying. if you're crippled, if you're blind, if you're disabled, if you want help and get money and insurance is what is keeping you from getting it you cannot give a better political homerun ball to the american people to decide a basic question which side are you on. so i'm glad that politically my party would never put me in this position. and the only position i would rather be, and it's where you're sitting, madam secretary, to be able to see that you are on the right side of the issue. you can see that people don't really want to discuss the millions of people that are being helped. and we're not talking about, we

are talking about life-and-death in the true sense of the word. and if someone had a conscience that when the doctor said i wish you would see me earlier, and they said i wish i could but i didn't have insurance to do it doctor, or how many cases we have in intensive care saying this woman, this man should never had to to have been. it was detected earlier. we have a mechanism for it. >> the gentleman's time has expired. >> well, thank you, mr. chairman. spent i understand the gentlemen spent good. spent there was another minute their budget cut that off. >> we are doing four minutes so we can get to members of the other guy is here. i would just ask members if you do have a question ask earlier on so that the secretary has a chance to respond. gentleman from texas is recognized. >> thank you mr. chairman, madam secretary. health care is about patience, not politics. i was pleased to hear your answer mr. ryan that if the

court rules the ministers will do everything we can. can you give us some guidance? will be president signed legislation other than merely sending this subsidies to the exchange is? >> with regard to the question of legislation and the affordable care act, that has been a question and a comment and where we've been is when there is repeal of fundamental elements -- >> but i'm going forward i appreciate looking backwards but going forward, if the court rules for the plaintiffs, will the president signed legislation other than extending subsidies speak was the president has anything to continue to signed legislation that we believe improved affordability, quality access and takes care of the deficit issue speaks of the answer is come and thank you for saying what i do say the president will sign legislation other than simply extending this subsidies to the federal exchange spent we have always --

the sgr velvet we just recently signed includes very important provisions that actual extent the affordable care act's efforts to do delivery system reform spirit that's not in the supreme court case. specific to that, ask your guidance, the president will sign legislation? >> the decision -- >> specific to the supreme court case, if the question is the supreme court case, i want to return to what the supreme court is -- >> i'm just looking, we are looking for your guidance and a bipartisan. so your answer is yes, the president will sign legislation other than extending this subsidies of federal exchange is? >> with regard to the question of the supreme court case that isn't asia subsidy. that is all that is about. if your question is if your the question is, are we willing to consider things that would improve or enhance affordability, quality and access? we're open to those things.

with regard to the supreme court case i think it's important for me to be clear. that is about one item. that is about one item. that is the subsidies. >> i want to make your own to look to work together to put patients ahead of politics you are saying yes, the president would sign legislation other than extending this subsidies in federal exchange is? the answer is clearly yes? >> i want to distinguish between the question of how one resolves the problem that gets created. that doesn't have anything to do with any other part of the affordable care act. >> but no, no, no. this is such an easy question to it can be yes the president will sign the legislation or no he will sign only that legislation spent i think it's very hard for me to answer a question about hypothetical legislation spent it's actually not hypothetical. as we know the court is going to be rolling, not hypothetical. if they rule for the plaintiffs guiding us you're saying the

president would sign the legislation. you will not as mr. ryan said he will not say my way or the highway? >> with regard to fixing improving the affordable care act, these are two different issues. the subsidy issue is -- >> i don't mean to interrupt i'm really seeking to guidance. so the answer though to finalize it is yes? >> my answer, congressman, is we will review any legislation we get that has to do with the affordable care act based on -- >> but asking about signing. so the answer is no? >> with regard to legislation that we think of we will judge you by four things accessed -- >> let me ask this. again, guidance. will the president signed legislation to extend of those subsidies while we work towards a long-term solution? >> with regard to the subsidies as i said the critical decision is with congress. if the congress rights

legislation that make sure that those subsidies are available, that is something -- >> so the answer is yes. >> if the president's biggest yes, he would sign legislation other than extending it, corrective? >> i apologize but when is the other, i want to make sure -- >> the gentleman's time has expired. mr. mcdermott. >> mr. chairman thank you. ms. burt welcome it was nice out in seattle get on the should make the right choice coming back here to work spend time in the wrong washington is that what you're telling? >> i listen to does come and we're all talking about if the president does this and whatever, but let's talk a specific because i think we haven't heard a specific come out at the republican since the bill was passed the they never put anything on the table. now have a bill, 1016 put in by senator johnson from wisconsin. his solution if the bill fails and as i read it quickly it

reveals individual mandate. it reveals the employer mandate and it says that the states can continue the funding down and the standard of benefits that people get are not a national standard whatever the state of mississippi or alabama or georgia or texas or one of the states that has not had an exchange, whatever they set as a benefit. we know it will be lower because it already is. they won't cover people and medicaid. so they clearly don't care about the level of health care. but explain to me how you would -- >> would the gentleman yield? >> no. i'm not going to yield. >> takeback the disparagement -- >> she has the right to explain what the president would think of a particular piece of legislation that's been put forward as a serious thing i

said in the united states senate spent with regard to the johnson piece of legislation that piece of legislation is, from our perspective, is repeal because it gets rid of preexisting conditions. it stops the funding for preventative services. it undoes that people up to 26 would be covered, and it actually takes away subsidies from all over time. and so with regard to that particular piece of legislation that is a bill that from our perspective is repeal come and we spoke and issued something to reveals the affordable care act is something the president will not sign. >> so in answer to mr. brady's question from will the president signed a bill that we passed come if we pass this bill with the president signed that? >> as i said this bill in its current form is to go and the present has said he will not sign something that repealed the act. >> is there anyplace that you

see that there is a proposal on the table by any member of the house or senate that looks at this point as though it deals with protecting the aca in general, and fix the one specific problem? >> we have not seen anything. >> and you look at all the legislation and read all the press releases and everything else? >> at this point we have not seen something that addresses the specific issue of this question. although i think there's also the issue, i think we're all very focused on the scenario, i think it is aborted focus on the win as well. in terms of how we all go forward if there is a win. >> tell us about the cost of health care. we hear the chairman says the president promised that they would be a reduction in premiums. now, would you explain why that a little bit misleading?

and i certainly everything is going up in society but they're not going as much as was predicted how i think is what -- i would like you to talk about that. >> that's correct. and as we have seen the premium increases that occurred in the individual market and the employer-based market we are seeing smaller increases in those premiums and we saw before. and so while the art increases, the increases that we were historically singular driving cost individuals, for employers and in terms of medicare and the cost of the government, that is what we've seen shrink. >> thank you. mr. tiberi. >> thank you, mr. chairman. thank you, secretary burwell. the reason is your repeal the past a couple months ago include a bill a bipartisan bill that i sponsored to require binding bids from suppliers participating in the durable medical equipment supplies competitive bidding program. the provision removes fat

actress from the program. ensures seniors get quality medical equipment. in a compromise with the administration, the log requires that cms template the provision not earlier than january 1 of 2017 but not later than january 1 of 2019. i think that the 2019 is a very generous timeline. to implement the bill. and would help with your leadership that we could move it closer to the january 1, twenty-second timely because at the end of the day, as you know again there's bipartisan support for this concept. my good friend bill pascrell is over this issue as well. we think this will ultimate help separate the good from the bad and ultimate help our seniors. so your leadership would critically important to moving it closer to the beginning and

end. >> so it is related to mr. johnson's question. as soon as the bill passed in which is such a very important though, i don't think i need to articulate to this kind of important things. we have been able -- we do try to meet and we can beat deadlines. we been able to do that on some bipartisan legislation in behavioral health that was supportive of in the house and the senate in terms of beating deadlines we are given. and where we can we will try to. thank you for support in helping to do. if we did for the help and support i will come and ask. but it is something that is a priority. >> the other issue is intellectual property rights incentivize the creation of innovative new medicines that improve people's lives in supporting u.s. jobs. we're talking about trade this week or i want to ask you specifically about india. over the past couple years india's intellectual property climate has unfortunate deteriorated significantly and in the usip intensive indices

have suffered including pharmaceuticals and have expressed significant issues with respect to the indian market. most notably courts in india have issued compulsory license as of night or revoke several patents for popular medicines held by u.s. companies citing an indiana law that many believe covert from india's international trade commitments. has a compulsory license ethanol, revocation of patents on medicines been part of any hhs discussion with its indian counterpart? i know this is kind of a question that might have come out of left field based upon what you've prepared today, but would you agree it would be ill-advised for any u.s. government employee to undermine the policy of the u.s. to promote strong international property rights in foreign markets? if you're prepared to answer that would you mind looking into it and getting back to us as we have those trade debates this week's? >> yes. i'm happy to get back.

ustr would probably be in any of those conversations that were in that space so something what i would is coordinate with ustr to get back to you together pick because i think you probably know those conversations with the governments are being led by ustr. we give our policy of programmatic input to them and they lead. we will make sure one of the to be the hhs or ustr gets back spent thanks so much. appreciate your leadership. i yield back. >> thank you. mr. neal. >> thank you, mr. chairman. madam secretary, the opioid addiction issue is pronounced now across my congressional district, and there are all sorts of stories now that indicate a nationwide trend. and curious about the response of your department, the agencies that you overseas and also to ask specifically about the prescription drug misuse. >> yes. >> the evidence that you're coming across on that basis?

>> so with regard to issue that you've raised thank you for raising them in our budget there is 99 million additional dollars to open an evidence-based strategy on the problem. let's just quickly touch on the problem. when we think about the problem as you articulated in your district across the country, opioid an overdose death have exceeded the number of deaths from car accident or any other accidental death. in the year 2012 there were 259 million prescriptions for opioids. that's more than one for every -- >> would you say that they can? how many prescriptions? >> over 250 million prescriptions in 2012 for opioids. so that sony prescriptions they were. that's more than the number of adults in our country. so that was one prescription for every adult in the country. in terms of what our and the magnitude of the problem. let's go to the solution space. we have worked and worked with states and worked with the congress. there are a number of bills upon the hill. three basic areas we need to

focus. one is prescribing. a big part of the problem is you can see from that number is prescribing. what we need to do their kids we need to provide new prescribing guidelines for pain and pain medication. that will help the problem. but also into prescribing space states need to do what are called prescription drug monitoring plans. there's almost in all 50 states and they are the means by which a physician as the opportunity to look up and see that a controlled substance was already given to you and control it that way. same thing with pharmacist. number two is the use of malloc zone which is very important drug that actually stops death when there is overdose. and making sure that first responders have access to consider important part of that picture. number three is the issue of medicaid assisted treatment combined with behavioral issues and making sure that we do treatment for those who are

addicted to so those are the three things. and 99 additional funding in our budget cuts across cdc and samhsa as we do this. were doing this in conjunction with state i've been in massachusetts with your governor and then a joint event with your governor. this is a bipartisan, bicameral and statewide issue and whether it's governors are both sides of the legislative body in both sides of the aisle. certainly your own colleague from kentucky is leading in this effort on the house. so that's our plan. that's what we are trying to do. >> it's noted that in some places in new england heroin is selling for $3.50 a back on the streets of some of our old induction cities. i have house bill 1821 that i would invite members to take a hard look at. senator markey as a companion bill in the senate, and what specific action should congress be taking along these lines to assist you in building as you have at the are now more deaths

from overdose than from automobiles to? >> so on the heroin point we know that the second two elements, and not prescribing elements of the strategy we will work on. with regard to places where we need help from congress to them but that strategy companies in the area of you for noticing which is another drug that helps in this. the question for describing pashtun prescribing. the second place is in making sure people are trained with the guidelines. thank you. mr. boustany. >> thank you, mr. chairman. welcome, secretary burwell. last fall the mr. schmidle as a child support enforcement rule and former chairman dave camp along with senator hatch sent a letter expressing concern about this. and issues that were raised without the administration in this area was usurping the authority of congress to write law and was in effect writing law. this has been everything would

think i think chairman ryan raised this issue with regard to certain issues relating to obamacare that we've seen this with a in immigration, with obamacare, other areas of the law. so i mean why especially in this area where this committee in a bipartisan way has been willing to work with the administration on these child support policies why does the administration choose to travel on the constitution and article one powers in an area where we want to work together. i understand there's always tension where we disagree. i did it and that's a fight we are singling out in the courts but why in instance we do have willingness to work and cooperate on this important issue? >> we would look forward to work in this space but in terms of that particular role there were some important things that i know you are familiar with an effective some of these things were done in the 1990s. people had to do paper applications with regard to child support. a lot of the rule was things

like improving ability to use technology and other things and improvements in simplifications to the rule. is our specific policy areas that are of concern, we are listening to those comments that is coming. i think you know we are not finalized the rule and we would welcome the opportunity to work on the issues at a sensitive areas. some of the things have been mentioned in the release that happened yesterday are in areas where the states advice as in the state of texas come in terms of we are following what the states have asked us to do in terms of things like using money for people to do job training which is an issue that is important. important. >> chairman ryan and i introduced legislation yesterday dealing with this endorsed to protect our constitutional right to write law. i know there's companion legislation in the senate by senator hatch and senator cornyn. but we want to put the administration on notice that this body the legislative

branch, rights law and the executive branch executes it. and we getting tired of it in a special in a way we have some agreement. just be put on notice that we will continue to usurp our constitutional prerogative. on a different issue, the employer mandate has not been implemented, a lot of complications with the. we know how complicated it is. we've heard testimony in the past on this and i know it does not apply to small businesses 50 or fewer full-time equivalents. now, but those individuals would still be subject to the individual mandate. why hasn't the administration been reluctant to assist these kinds of small businesses? i question secretary lew when he was before this committee earlier this year with regard health reimbursement accounts and it was a move i think for six months we breathe unduly onerous penalties for small businesses, but six months.

i just don't get it eyed legislation that would actually make it more effective for small businesses to use these health reimbursement accounts, which are completely legal under aca, but yet for some reason your agency and the administration has decided to close the door on these. i don't get it shouldn't we be helping small businesses and their employees at a trouble to? >> so we agree with you and want to try to do more. in the budget right now the budget proposal that is before the congress right now for fy '16, we have proposed expanding the tax credits available for those up to 25 employees to we want to move it up to 50 to expand access to tax credits that they can get it sounds like similar kinds of ideas in terms of getting folks to access they need. >> health reimbursement accounts of infected it's a simple solution. >> the gentleman's time has expired. >> thank you, mr. chairman. >> mr. dotcom are you ready? >> thank you, mr. chairman.

think you secretary burwell, for being here but it seems to me the focus of this hearing and the focus of all of our work should be on how we can make this health care system work better and deliver services and ensure more families instead of speculating about some court decision as you know, madam secretary to complete a number of concerns about the way this law has been implemented, particularly in texas the fact that two out of the three of our texans to market eligible for these market places are not yet enrolled began to think there are things are office can do for more effective implementation. i would encourage you strongly to do the same kind of cost-benefit analysis that you did at omb and that is look at these contractors and see if they are delivered under services. as you know-number of queries to you about those. i'd hoped to focus on how we can make it better than how we can make the accommodations better but when i hear you're accused of being a person that you it

does get my attention. the easiest thing for this court to do, and i think the right thing is to not ignore the other 900 pages of the law and focus solely on four words. and if it is necessary to have a legislative fix the leading four words solve the entire problem and allows this law to work the way that congress intended for it to work. are many of the ways to address this problem and, in fact, apparently some states are beginning to look at the possibility that the best way to fix the law should the court render the wrong decision is to simply create their own exchange. it is also extremely impressive to me that of all the proposals that have come in here at the last minute of republicans to deal with the possibility of an adverse court decision, coming of those proposals attempt to include as much of a hated obamacare as possible,

preserving the right of young people up to age 26 to participate in their families health insurance program. attempted to maintain exchanges. if today we're asking you about how to make improvements to reach more people in our law and our laws, that would be a reasonable thing instead of the polemics that are going on. indeed i think it is probably best work. i could not find another circumstance in which members of the house and senate asked a court to deny thousands indeed across the country, millions of people an opportunity to get a federal tax credit to say please deny in texascome our two senators, please deny our constituents $206 million every month in federal tax with it. but let him keep paying taxes to finance at the same kind of tax credits for people in

california. or someone from wisconsin, since chairman ryan joined the same brief in the court, who says please have my constituents continued to pay taxes to fund tax credits in connecticut, but deny thousands of people tax credits in wisconsin the it is an unusual situation to say the least that that kind of approach would be taken. i believe we need to look for improvements in the law to strengthen the law but that the idea of denying relief to people who are receiving it right now is to take away from the federal tax assistance and to take away from them the opportunity to get the insurance that is working for the families. to say that there but it is a lemon to provide families the relief with insurance for preexisting conditions that they never had before something that is life-saving in many cases, is truly aimed misstatement about

the work of this legislation. >> thank you. the gentleman's time has expired. >> mr. roskam is recognized. >> thank you, mr. chairman. secretary, thank you for your time today. dark issues i would like you a couple minutes together on. the first is, they are related the discussion about cost-sharing reduction payments and also the basic health program. such as to set the table the cost-sharing reduction payments, the issue is whether the administration has the authority to spin out of an account that hasn't been appropriated as you know, chairman ryan and chairman upton wrote to you and secretary lew on february 3. in response back at a staff level, look i mean come it was sort of predictable. it we states the obvious in terms of a number of a twist about the affordable care act, and it says go talk to the floors at the department of justice because there's pending litigation. little bit of a cute response in my view, but it's your plate. ..

minnesota was the state said they were implementing the program. you're cannot illustrate the basic health program january 2016. new york estimated