? >> i think this would create a discussion in negotiation. they will generate a discussion about spending in and all of that will be addressed in the fall and i'm not opposed to negotiation. i would remind you when i was the leader of the minority we did three different deals together, so we will talk about it and try to figure out what the way forward is and each side will have to give some things they don't want to give, and we will get to an agreement. ..

to me it's a different kind of an issue. this is not your typical political debate. this is an enormous national security debate that the president will be behind under the constitution to year and a half from now, and the rest of us will be dealing with the consequences. so i wish he would tone down the rhetoric and let's talk about the facts. i can't handicap the outcome but i think mine members are going to delve into the details and

make a decision based upon what they think is in the best long-term interest of our country. >> of that iran, d.c. the senate taking any other votes our action in september speak with this has been an incredibly productive first six months of the new majority. for any americans who were paying attention there was a difference between this majority and the last one. we are going to continue to look at things that we can make progress on. let me give you some examples. i would love to finish cybersecurity this week but we have not an agreement that will allow us to finish it in september. very important issue. on top of the ones i've already mentioned. highways, trade promotion authority, rewrite of the no child left behind, defense authorization, justice for victims of trafficking, we have been wrestling with that for 17 years.

fixed. this is going to be extraordinarily productive congress. even though we are in negotiations we're discussing over here much of that will not take more time. we will move things like cybersecurity. toxic legislation is another example of something important that enjoys bipartisan support and am going to continue to look for things that make a difference for the country that can clear the senate, a body that requires 60 votes to do most things. >> you have spoken a lot about the d.c. it has been for the first time since the '50s. nation of democrats today will agree to move appropriations bills if you are schneck what concessions had to make parks would there be some spending cut or things like this that's pretty important. >> won't surprise you to know i can energy in negotiation with

and i'm not going to pursue all the hypotheticals. what i can say is as i said your question a while ago we will talk about all of this. we have divided government, we we have to talk to each other we wouldn't be good the way forward. >> senator ted cruz has been somewhat of a thorn in your side when it comes to these big negotiations, bigger issues. how do you plan on dealing with them when it comes to government funding, when it comes to the debt ceiling when he said he could use all means possible to get active specific priorities? >> for any of our members there's a lot of procedural tools available to slow things down. they have been used frequently and we've worked our way through every one of them. we worked our way through it on the highway bill. we worked our way through it on the justice, victims of trafficking bill. it easier for any senator to make it more difficult to pass

bills. it's routine, which is why the senate doesn't do things as quickly as the house. we been able to surmount those challenges all year long added to throw out by one-third or another on one side or another and we select an extruder record of accomplishment. we have a lot more left to do. >> on the issue of budget reconciliation, are you considering letting the senate consider and pass a budget reconciliation bill that would be put together and passed by the house as opposed to the senate putting together its own reconciliation bill? >> use of reconciliation is an active discussion by the senate and the house. obviously you of anything done through reconciliation is likely to be of republicans alike exercise. unlikely to be signed by the president.

we are looking at ways in which we would deploy budget reconciliation in a way that might, that he might not agree with but it's still important to us. the biggest candidate for that not surprising to you would be to try to repeal as much of obamacare as his reconcilable. the entire law we believe based on discussion of the parliamentarian is not reconcilable but much of it is. so if you're looking for candidates for the reconciliation process i would put someone that one at the top of the list. >> when you expect to see changeable movement towards the conference report on reauthorization? one quick follow-up. do you think that debate on the legislation could threaten congressional perception of the broader trade agenda particularly -- [inaudible] >> i don't think so.

we've got two bills in conference that i suspect to get out of conference here sometime soon. defense authorization and customs. so i don't think so. however, on the trade issue we are watching carefully what's going on in the negotiation of the tpp. and with giving getting the president ex ord a grant of authority which i am enthusiasm in favor of, not only for him but the next present -- president as well since this is a six-year bill. we are interested in what comes out. i would remind froman, the president and the administration and given the politics of trade on the democratic side they would need virtually all republicans to pass whatever they do negotiate. and many of us have taken an opportunity to convey that to them. so we will see. we will see. >> any timeline on customs? >> as soon as they finished.

>> i did not who you are -- thank you. thank you, senator. regardless of what procedural tactics senator cruz and other side to pursue do you think of the votes today to pass a bill to fund the government at september without language the funding planned parenthood speak with you all keep trying, don't you? i don't blame you. it's your job dauphiné libéré we will fund the government -- [laughter] i can't tell you what will end up in or out of any government funding resolution. i can tell you without their contradiction to be no government shut down. >> you told us freedom -- you'd like to see abortion legislation on the floor. there's not a lot of time left in the session. there's a lot of must-pass legislation. they expect to see that by the end of the year? >> will come as a although it takes 60 votes to everything except the budget process.

we anticipate having a vote to proceed to the 20 week pain capable real sometime before the end of the year as well. >> returning to the iran issue, could you respond to the president's contention which is very much doubled up on yesterday that the alternatives here is military action is war if congress rejects the deal. how do you see the alternative? >> that's an absurd argument and it's one they made from the beginning to that it's either what the president negotiates with iranians or its war. has never been the alternative. let me suggest that have the president and his team spent as much time trying to ratchet up dissension on the iranians over the last two years as they of entering into an agreement which most of us are highly skeptical of as to having any positive impact at all we would've ended up in a better place to it's not his deal

versus war. that's the argument they been making this deal negotiation, it's either this deal or a better deal or more sanctions. i think that's been a huge mistake on his part. he is gambling that is going to completely transform the middle east. it probably will. you've got a sunni arab allies who, except for the public statements, are scared to death that america is no longer dependable ally. you've got the israeli government overwhelmingly opposed to the agreement. it has the potential to transform the middle east all right but it strikes me not into a safer middle east but won more rock with discord and i think

jimmy carter summed it up the best i can't recall ever quoting jimmy carter in my political career. we can probably stick with that something routine on my part. you may seem what he said three or four weeks ago about the president's foreign policy. i'm paraphrasing but i'm totally i could jimmy carter said he couldn't think of a single place in the world where we were better off today than we were when the president took office. that's jimmy carter. i rest my case. >> it sounds like you do this decoration as sort of like a global negotiation involving appropriations debt limit highways. no, with a limited number of offsets to do some of things. do you view it is one sort of big global negotiation in which the democrats may depend on one facet and you would do better on another? secondly when you characterize any discussions you or your

office have had with white house as far as laying the framework? >> let me take how we ended up where we are. for the first time in six years the senate appropriations committee reported all 12 bills, for the first time in six years. the democrats quite publicly has said we will not pass any of them given the number of democrats voted for most all of those bills on committee. because we want to ball the process up and force you into a negotiation in the fall. so that's how we got to where we are. excuse me a second. i would have devoted weeks to passing appropriation bills had we been able to bring to a. they wouldn't even allow us to proceed to the bills.

so they wanted to force the negotiation that we will inevitably have and they wanted to force it sooner rather than later. mikey was with other business to do, and i've listed repeatedly the things that we've been doing to try to improve our country. and so yeah, we're going to the discussion in the fall. they forced it and we will have it but i can't handicap the outcome. [inaudible] -- former campaign manager was indicted yesterday. knowing what you know now they have any regrets? >> i think we put out a statement yesterday about that and i will just refer you to that. >> i was just curious watching the debate tonight and -- >> i do. spend what are you hoping to see?

>> i'm hoping to see a two-hour debate. should be a lot of fun. >> about highway to you talk about possible conference in the fall to pass a long-term bill. i know their current goal is to get international reform. if they're able to pass a bill like that is something they can develop in conference, like are defined a middleground with international tax reform? >> let me just tell you how i look at it two separate issues. two separate issues. senator boxer and i put together a multiyear highway bill with credible pay-fors and passed it. the speaker has asked chairman shuster to come up with a multiyear highway bill and pay for it and pass it in september, go to conference with us. that's one issue. i separate issue is the issue of

tax reform and there's been a lot of focus on the territorial going to a territorial system. i may well be enthusiastic about that but i view it as a totally separate track and let -- unrelated to the high would issue. >> the other part of the bush with d.c. extenders on the highway debate or -- >> you're getting back to the multiple things we will be talking up this fall. i don't blame you for bringing it up i don't know the answer to all that yet. we will do an extended package. i sure hope we don't do it at the end of the like we did last year because taxpayers end up having to go through the whole tax your not knowing the tax implications of the decisions they're making and then you drop the package on at the end of your to cover the year you're just been injured i don't like that hopefully we won't do that. have you already have one? you are up.

>> the house this have to do -- [inaudible] is that approach would work when it comes to raising the debt ceiling? you think republicans understand what it takes? >> all of your questions on this type of thing are good but we don't know the answer to them. i can only say that we have divided government. the house and senate don't always see things exactly the same. i'm reminded of that old story that tom foley, or speaker used to tell uninsured some of you heard. he was asked by his young members at a time when the democrats were majority. he was asked who the opposition. the opposition is the republicans that the enemy is the senate. i think the speaker and i worked very hard to minimize those and

have had a very open and respectful relationship which we intend to continue. sure, there are going to be challenged. anytime you ball of the appropriation process like a minority did in the senate this year it creates the big negotiation. that's regretful but that's where we are. >> you've already addressed this, president obama statement on around the last couple of days. i want to talk about a method which which he conveyed yesterday. he responded to you on twitter. i'm one of you give any thought to the using that method of medication and messaging to make this point that republicans -- [inaudible] >> well, i think the president ought to treat this like a

serious national security but rather than a composer coal -- rather than a political campaign and talk about the facts. i think it would be beneficial for all of us. regardless of what kind of rhetoric he uses, that's how i choose to try to conduct this debate in the senate and i assure you that's what we're going to do. thanks a lot everybody. [inaudible conversations] >> this weekend on c-span networks --

>> next, health and human services secretary sylvia burwell reducer department programs and policies before the house education and the workforce committee. she testified last month on capitol hill. >> the quorum being present the hearing will come to order. good morning secretary burwell. thank you for joining us. as is often the case when a cabinet secretary appeared before the committee, have a lot of ground to cover in a short period of time. it is especially true for a

department as big powerful and calls as the department of health and human services. the end of the current fiscal year hhs is expected to spend approximately $1 trillion admission numerous programs affecting millions of americans including child care welfare health care, early childhood development. at a time when families are being squeezed by a weak economy and record debt, we have an urgent responsibility to make sure the federal government is operating efficiently and effectively. it is a responsibility we take seriously, which is why this hearing is important and why we intend to raise a number of key issues. for example, we are interested to learn about the department's progress implementing recent changes to the child care and development block grant program. last year, the committee helped champion bipartisan reforms of the program to strengthen health and safety protections, empower parents, and improve the quality of care. this vital program has helped countless moms and dads provide for their families, and we hope the department is on track to implement these changes quickly and in line with congressional intent. another vital program for many low-income families is head start. earlier this year the committee

outlined a number of key principles for strengthening the program, such as reducing regulatory burdens, as well as encouraging local innovation and better engagement with parents. the committee then solicited public feedback that would help turn these principles into a legislative proposal. it was in the midst of this effort to reform the law that the department decided to launch a regulatory restructuring of the program. some of the department's proposed changes will help improve the program; however the sheer scope and cost of the rulemaking raises concerns and has led to some uncertainty among providers who serve these vulnerable children. strengthening the law is a better approach than transforming a program through regulatory fiat, and we urge the administration to join us in that effort. these two areas alone could fill up most of our time this morning, and i haven't even mentioned services provided under the 1996 welfare reform law and the older americans act. of course, as you might expect, secretary burwell, on the minds of most members are the challenges the country continues to face because of the president's health care law. families, workers, and employers are learning more and more about

the harmful consequences of this flawed law. for example, patients have access to fewer doctors. to control costs it is estimated that insurance plans on the health care exchanges have 34% fewer providers than non-exchange plans, including 32% fewer primary care doctors and 42% fewer oncologists and cardiologists. the law is plagued by waste and abuse. in 2014, investigators with the nonpartisan government accountability office used fake identities to enroll 12 individuals into subsidized coverage on a health care exchange. just this month, gao announced 11 of the 12 fake individuals are still enrolled and receiving taxpayer subsidies. more than seven million individuals paid a penalty for failing to purchase government-approved health insurance, roughly 25% more than the administration expected under the worst case scenario. according to the associated press, at least 4.7 million individuals were notified that their insurance plans were cancelled because they did not

abide by the rigid mandates established under the health care law. the nonpartisan congressional budget office estimates the law will result in 2.5 million fewer full-time jobs. this reflects what we've heard over and over again from employers who have no choice but to cut hours or delay hiring because of the law's burdensome mandates. health care costs continue to skyrocket. according to the new york times, health insurance companies are seeking rate increases of 20-40% or more, suggesting markets are still adjusting to the shock waves set off by the affordable care act. finally, after all the mandates fraud, loss of coverage, fewer jobs, higher costs, and nearly $2 trillion in new government spending, it's estimated more than 25 million individuals will still lack basic health care coverage. and yet just last month president obama said the law worked out better than some of us anticipated. of course for those who opposed this government takeover of health care, this is precisely what we anticipated and it is

precisely why the american people deserve a better approach. in closing i want to thank you for joining us us again. it irresponsible to vote you and the administration accountable when we believe the country is not in iraq direction. there are areas where i believe we can find common ground and defense policy solution on behalf of the american people. today's hearing is an important part of those efforts and i look forward to discussion. i will not yield to ranking member scott for his opening remarks. >> thank you, chairman kline and welcome secretary burwell, look forward to your testimony. today with their puppet president fiscal year 2016 health and human services budget proposal and the department's budget priority. on the budget was released months ago i'm pleased to see that were priority is included in today's, the title of today's hearing. achieving requires making tough choices at the budget is, in fact, a reflection of priority.

as much as we decide what our prayers are and how best to invest in our country. i'm pleased the president's budget request is reflective of many important figures such as protecting access to health care, insurance for all americans giving all children the chance to succeed at reducing inequality around the country. in many areas i believe we've made great progress. for example, the passage of the affordable care act has given millions of americans access to health care some for the first time in their lives. the aca has also slow the growth in health care costs come close the donut hole for seniors and encouraged and improve access to mental health services and preventive care. just weeks ago this supreme court decided in another case pertaining to the affordable care act in king v. burwell the letdown of subsidies for those obtaining health insurance to the federal marketplace instead of statewide marketplace was

upheld. the affordable care act type of structured and designed to improve health care insurance coverage and access across the entire country and it has another those living and those living in virginia have enjoyed access to the insurance of which is like something minnesota. because of the outcome of the case to continue to do so. i want to thank secretary burwell for her artwork in implementing the aca. recognize the challenge that her agency faces in implementing the law with limited resources and unlimited attacks but despite these challenges the aca is working. i'm also pleased to see this presidentpresident budget because placed third and giving all children a chance to succeed by ensuring robust funding to increase the access to and quality of berlin and childcare programs. the republican budget adopted by the house reflective of these shared national priorities despite research showing that for every dollar spent on early education,

there is a return of $7 in reduce cost and other parts of the budget. we must invest in quality early learning programs because all children deserve to enter kindergarten with the building blocks of success. decades of research has shown droplet nurturing children for the first five years of life is instrumental in supporting enhance brain development cognitive functioning and emotional and physical health. low income working families like access to high quality, affordable child care and early childhood education and these children tend to fall kind. in addition to this achievement gap children who don't participate in high quality early learning programs are more likely to have weaker education outcomes, florida earnings increased involvement in the criminal justice system and increased teenage pregnancy. child care is a to generational program. parents of young children need

childcare to go to work or go to school. and lack of stable childcare is associate with job interruptions and job loss for working parents. child you ought to be a national priority for america's children and for helpful our economy. these two programs outside the drive the bulk of the federal role in early education, head start program and the childcare development block grant. unfortunate because of limited funding to future will have access to the unmet needs to continue to grow. only four out of 10000 votes short have access to head start and a one out of six federally eligible families receiving childcare subsidies. where decades of evidence that investing in programs like head start and the childcare development block grant work. the time does invest in these programs and ensure they were giving all children the chance to succeed. lastly it's past time for congress to raise the question of discretionary spending caps

that are hunting for progress we've made as a nation. these caps threaten nearly every program under the jurisdiction of this committee from low incomecome from low income home energy assistance program to older americans act and others. this, of course, has led to woefully inadequate investment in critical national need and put us on path to another government shutdown. coming back to the idea of priorities investing in our nation's future should be congress' number one priority, not corporate tax rates are boring the estate tax. our focus should remain on historic investment that strengthen our nation's middle-class and help hard-working american families get ahead. so thank you, mr. chairman and thank you, secretary burwell for being here today. spin thank the chairman. person to committee will all mayors will be put to the written record included in the permanent record. that record will remain open for 14 days to allow such statements and other things that you referenced during the hearing to

be submitted for the official hearing record. it is now my pleasure to introduce our distinguish witnessed, ma the honorable sylvia matthew broyles, secretary of health and human services. prior to joining hhs secretary burwell served as director of the office of management and budget where she oversaw the develop of president obama's secondsecond term management agenda. and the clinton administration secretary burwell clinton administration secretary burwell served as deputy director of omb, deputy chief of staff chief of staff, and staff director of the national economic council. welcome, madam secretary. i will now ask the secretary to stand and raise your right hand. thank you. do you solemnly swear or from the testimony you're about to get will be the truth the whole truth and nothing but the truth? >> i do. >> let the record reflect the witness answered in the affirmative. before i recognize you to provide your testimony let me briefly remind you are more importantly my colleagues of our

lighting system. we typically allow five minutes for each witness to present although i will be flexible on this timeline given you were the only witness and you are a cabinet secretary. i would ask you to to try to limit your marks because we have a lot of members who want to get to questions, and i will be strictly enforcing the five minute rule and perhaps the four minute rule. sector has a hard stop time at 12:00. we will honor that i would ask my colleagues to be patient. again on the lights when you start and will put a timer on but you can ignore it if you like. it would be green and to turn yellow when every minute to go and then read when the five minute mark is over. that applies only to the secretary. to my colleagues when five minutes is up, five minutes is up. now you recognize, madam secretary.

>> turn one and ranking member scott, as well as numbers of the committee. think you for this opportunity to discuss the president budget for the department of health and human services. i believe firmly we all should, interest and, therefore, we have a number of opportunities to find common ground. we saw the power of common ground in the reauthorization of the child care and development block grant and development block grant that happened last fall as well as the bipartisan sgr repealed earlier this you. i appreciate all of your work to get that aspect the president's budget proposes to in sequestration fully reversing our domestic priorities in 2016 matched by equal dollar increases for the department of defense. without further congressional action 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 and how both parties can work together to achieve a

balanced and commonsense approach. the budget before you makes critical investments in health care, science, innovation, public health and human services. it maintains our responsible stewardship of the taxpayers a dollar, strengthened our work together with congress to prepare our nation for key challenges at home as well as abroad. for h. s. the budget proposes 83.8 billion discretion budget authority. this $4.8 billion increase will allow our department to -- but a stronger foundation for the nation or tomorrow. it is a fiscally responsible budget which in tandem with the company legislative proposals could save taxpayers an estimated $250 billion. the budget is projected to slow the growth in medicare by securing for hundred $23 billion in savings as we build a better, smarter, healthier delivery system. in terms of providing all the

americans with access to affordable, quality health care the budget builds on our historic progress in reducing the number of uninsured and improving coverage for families who already have insurance. the budget supports our efforts to move towards a health delivery system that delivers better care, spends dollars in a smarter way, and puts the patient at the center of they care to keep them healthy. the budget improves access for native americans. to support communities throughout the country the budget makes critical investments in health centers and our nation's health care workforce. particularly in rural and other high need areas. to advance our shared vision leading the world in science and innovation the budget increases than nine funding by $1 billion to advance biomedical and behavioral research among other priorities. it invest in precision medicine and you cross department effort focus on developing treatment

diagnostics and prevention strategies tailored to the individual's genetic characteristics of a patient. 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 to working and middle-class families. specifically the budget builds on important legislation passed by this congress last fall to great a continuum of early learning opportunities from birth to age five. this change would provide high quality preschool for every child, guarantee quality childcare for working families while the supply of early learning opportunities for young children and expand investment in voluntary evidence-based home visiting programs. to keep americans safe and healthy the budget strengthens infrastructure with $975 million for domestic and international preparedness. it also invest in behavioral health services including more

than $99 million india funding to combat prescription opioid and heroin abuse. finally, as a look to lead the department stronger the budget invest in our shared queries of addressing waste, fraud, and abuse. initiatives that projected to yield 22 billion gross savings. the budget addresses the department medicare backlog with a coordinated approach. mac significant investment in the secret of the department's information technology and cybersecurity. i want to conclude by taking a moment to say how proud i am of the hhs team and the employees that work on the people. their work every day and their commitment every day. i want to assure you i am personally committed to responsive and open dialogue with members of this committee as well as with your colleagues. i look forward to working closely with you, and i welcome your questions. thank you. >> thank you, madam secretary. the light didn't even turn red.

i'm unprepared now. i'm at a loss. seriously i want to thank you for your ongoing efforts to keep us informed about the department's progress in implementing the childcare development block grant act of 2014 as well as the opportunity for committee staff to commit directly with your staff. can you update us briefly on the timeline for the release of guidance and the proposals in accordance with the act? >> with regard to i think our staff had an opportunity to go back and forth, and that's hopelessly producing the guidelines and am hopeful, i'm not sure which particular piece you areyou are referring to somewhat immature, and we can follow up on that but over we making progress to help you get another one piece of like to recognize with regarding limitation of the authorities you gave us, there's an important piece of the budget that is related to the invitation and one of the things that we are told with regard to the authorities improve the quality, improve the safety.

also improve our ability to serve communities that sometimes are not being served such as parents to work in different hours. there's funding and a budget that we're talking about today on the discretion aside i think it's important to do that. i do want to raise that as a part of this conversation. there is some funding to do that that. >> i'm not sure that's exactly what i was getting at but that's the. thank you very much. >> i will get back on the specifics of the timing and happy to get back -- exactly. >> very much appreciate the exchange between staffs, very very helpful. i wanted to take the remainder of my time no doubt and i will try to be brief that there is an issue having to do with the affordable care act that's just sitting out there that really, really needs to be addressed. and that's the maximum out of pocket limits for caution but i'm sure you've heard about.

i've heard from several employers resort about the unilateral change the department made cost-sharing maximum out of pocket limits. we can't seem determine where this is coming from. the statute is pretty clear. the are two separate and distinct types of coverage. self only and other than self only coverage each with respect out of pocket limits. before this new role any combination of family members out of pocket cost count towards the maxim these out of pocket, coverage limits. now the department has declared that started in 2016 the individual out of pocket limit applies first before the family limit applies the techniques the cost of the employer coverage will increase because insurance will pay 100% of the out of pocket costs sooner. i understand you are aware been led to believe you are aware of these concerns so i'm sure employers have raised this issue directly with you and your staff

probably many times. certainly have with us. would like to understand and what statutory authority you did that. and then i'd like to get into the record letters from the american benefits council and now the coalition of benefits and thank their grave concerns with the department new embedded maximum out of pocket limit rule. the letters also convey that complies will not be possible i 2016 given that employers plans are already set for next year. it wasn't until may when additional guidance was issued that most large employers knew this change apply to them. real confusion out there, madam secretary and again on her coverage of doing some of this dreck but i want to make sure you heard from me. can you commit to least delay the impact of the truly significant role change for at least a year? and if not, why not? >> with regard to the issue of

the question of delay we are now hearing and receiving feedback on what you take in a corporate that. determine what we should do before. it's important to note why the change was put in place. the change was put in place about the consumer and the fact that when one consume any family hits the individual limit and the question of should they kept the family limit and whether you should aggregate or the individual because i think when consumers purchase and how the consumer thinks about this issue, i hear and understand and we are hearing from the compass in terms of how to think about the question of the maximum out of pocket limit but if you're an individual and the family do think that limit is your individual limit and there's a broader family limit for all? once you get your individual limit what would happen if you would keep going. you would not have the things to pay for and you signed up in a place where you thought your individual limit which are individual limit under family limit was for all members of the family. that's how the consumer has tended to think about and what we've heard from the consumer side.

that is why we have gone forward. we are hearing comments and want to incorporate those and understand if it is implementable. >> i understand the point of view of the consumer and for not making light of that put the statue we think is pretty clear. because there is so much confusion out there and there is the uncertainty and arguably the inability to comply, we are hopeful that she will commit sooner rather than later to delay of this rule change. i'm going to try, so rigidly to the route -- the light has turned red to me. mr. scott you are recognize. >> secretary burwell, i want to ask a few questions about the affordable care act the first i want to thank you for your departments outreach efforts particularly joanne, the regional director in mike carey has just been outstanding. outreach into the committee making sure people know about it

and doing the sign-up period was all over my district. i'm sure she was all over the region. can you say a word about what the affordable care act does for people with insurance in terms of preexisting conditions and job lock speak with two different things. with regard to pre-existing addition to grace a situation where anyone with a preexisting condition is able to get insurance. whether it's the people that i've met as i traveled out of concern for their children as their children get older because a child has asthma or other conditions or some of it was gotten cancer and is now well. their ability to implement the lockout. preexisting conditions is something that are no longer something that creates both health and financial worry for people and assisted with regard to the question of lockout and job lock there are many people who would not make changes because of the fear of losing coverage. that is a part of the numbers that the germans did in terms of the changes that occur. with regard to the

employer-based market we have notnot in the two years that the affordable care act has been up seeing a shift from employer-based coverage in terms of production and percentage of employees better and employer-based coverage. we haven't seen it should. estimates are about people go who will choose to make a decision to go do something entrepreneurial if you want to start a business or make other changes in the lives. the loss that was created because there were fearful of losing coverage doesn't exist because they have an option and that option is for the marketplace. >> what example about health care costs because with regard to the growth of health care cost, thinking about in terms of we've had some of the lowest price growth per capita that we've seen in 50 years in terms of slowing of that growth. when discussing the question of growth and cost growth, one needs look at the stroke of growth and then what growth is. if we look at what was released in the medicare trustees report

which is much reflect on the public sector cost what we saw is growth of 1.2% over the period of the last four years. what we saw in the period before then was 3.6% growth. what we've seen is a slowing and logical place for both public and private of that growth. >> the programs under your jurisdiction can use a word about the effect of the sequestration if we don't do something about the sequestration? >> and look at this issue of being funded the lowest level in a decade when one account for inflation it is across the entire department and whether that's an issue head start or childcare that will focus on in this committee, it also is in places like the nih and research what the cdc has been so active this year in so many ways whether that's evil or measles -- ebola armies of companies

like the fda for doing things like making sure our food is safe and that we're watching and taking care and that our drugs and diagnostic a separate its across the entire department and and also another point to this predicament is interested in china is the older americans. the programs that we have there to support those older americans around food and transportation as well as elder justice. >> thank you. head start is not in the department of education. it's in the department of health and human services. can you explain what the services that low income children get remaining in health and human services that would not be available in just an education program and what head start is so important? >> i think the program of head start we have it as part of our continuum at age as a source with him visiting. thank you to all of you all who supported the sustainable growth rate bill that had extension of the him visiting an evidence-based program that starts with a care in the home visiting home and helping star

children on the right track. we believe that continuum as well as the changes and authorizations and head start you all have done to push to improve quality, it is all part of the continuum and the continuum is related to the issues that we work abroad at hhs and whether that starting the month on the right trajectory with regard to her maternal health until the child is born with certain companies are invited to the danger for the nine months and continuing the early care starting out learning early and the brain development. the science that we know and have a five and seven year old of a quickly that development is occurring and how fast they're learning, sometimes it surprises me. it is what we believe is the continuum of both health and the building blocks of healthy productive life that we just at hhs. >> thank you, mr. chairman. >> dr. foxx. >> thank you, mr. chairman. madam secretary, welcome to our hearing. madam secretary, i appreciate you bringing up the older

americans act. we are looking at, the committee is looking at ways to promote best practices to combat elder abuse, and i wondered if you could talk a little bit about how the department is working with other agencies to protect vulnerable elders? >> working across the department and the department of justice is a partner with some of the work but most recently whether it's with our department and status with other stakeholders the white house conference on aging at an approach this year where we actually went out to communities across the kochi. this was one of the pillars an issue we focus on. and use that to bring it engagement and involvement of both ideas as well as how we can implement better as a department in terms of issue of elder abuse. we are seeking the input to improve what we are doing both within the u.s. government also with a number the place to

implement. is a stakeholderthe stakeholder on the ground in states that many of the programs are actually delivered and implement it at that level. >> would you discuss a little bit those delivery models of the older americans act and what makes them work well for working with other agencies i'm sure is the right thing to be doing. but are the ways to implement these similar delivery models across other programs, across the country? and how is the department providing leadership to do the? >> i think there are many things but i will choose to focus in a short time on two things that i think are important in this space. one is actually the awareness of the issue held abuse is something that is not an issue that many focus on and whether these providers and organizations are a part of recognizing the issue.

it is like out issue that is also the victims in trafficking, creating a greater awareness of it is an important thing to do. the other thing we think is important is when these acts occur that justice is served. so that people know when they are taking advantage of the elderly, and that's a place where we need to continue to work with state and local officials on that as well as federal. >> your candidate wins a specific example of that is the recent takedown that wasn't done on medicare but you all probably know that our most recent takedown which was a joint effort with us, doj, fbi hhs oh i cheated, oh i cheat and semester was over $700 million in false billings. many of those examples were around elder justice issues where patients were being told they're being treated for dementia in the simply being moved from one location to another, been charged for that and medicare was therefore charge. i think it's a combination of those things we try to bring

together. >> thank you very much for that. we know that you are congressman scott brought of head start performance standards. we know that head start is the largest program we have working with young children to we are concerned about the impact of of the new regulation that you're putting out. we want you do not, our reauthorization in 2007 required you to have regulatory provisions not result in the elimination of a reduction in quality and scope of services. but you were talking a reduction of 126000 children slots, elimination of 10000 teachers jobs. how can you ensure that the revisions you are proposing audit and compliance with the 2007? >> we have done three

regulations with regard to implement the law. this is the third of those. the first in terms of one of the things we do is make sure they're serving low income communities. the other was making sure the reviews and people had to reapply for the money. we set standards. this is the third part. we are using evidence-based studies to improve the quality and safety which we believe that the authorization is what it told us to do. one of the things that you mentioned i think is important to mention is we got rid of one-third of the guidelines in terms of simplifying and making it easier. with regard to some the things referred to i think you're referring to the extension of the day and of the year. the evidence that we've seen all the scientific evidence shows moving from three and half hours to six hours is an important effort to provide the quality that we need to provide and consumers having to do right now going through their summer what they lose if they do not have that kind of continued education

we proposed government would take in our budget. we are hopeful we can move forward on that and the other thing is if grantees can meet and have reason not to there is way for ability. >> thank you. >> mr. and also -- mr. hinojosa spent i saw support the health and human service budget request and ask tasks of the work together to forge a consensus on how to ensure that our families continued access to quality health care coverage and adequate funding for head start. we can invest in our preschool programs today, or in juvenile detention tomorrow. we have heard pope francis deliver a very strong message all over the world urging leaders like us. the pope says we must make right amount investments to address

poverty found in older senior persons, and children in low income families. madam secretary, thank you for your testimony and the departments enormous progress it has made since the enactment of a see a. it's a pleasure to have you testified before this committee. today, in my congressional district because of the affordable care act that are over 100,000 individuals who know have health insurance and 88,000 seniors who are not eligible for medicare preventive services without paying any co-pay, coinsurance, or deductible. we know that another program, head start is a crucial developmental program in my congressional district known as the lower rio grande valley. this program serves between 15,000-20,000 children and families. head start has made a

significant impact on improving the opportunities are eligible children, especially our nation's latino and african-american youth. thank you for your strong budget support for this program. my first question, what is at stake for our nation if we ignore the ever growing audie of research and we failed his official invest in quality early learning for our nation's minority children? >> i think this is why this area in our budget that we discussed the head start portion of it but there's also a childcare proposal. part of a childcare proposal of the discretion aside comes to part of the chairman squish in terms of implementing the authorization to that's on the discretion aside. the broader proposal that we have which is a larger mandatory proposal is about making sure that access on this continue. what we do as we take care of the child from the moment of at home visiting and the pregnancy through the early years of education and that we do that

both for those at the lowest level of income and head start is focused on that. that. but childcare another part of what we're proposing is childcare for working families that the supplements so they can afford that. through that school-age. what we're trying to do is create a continuum which we think is what was a part of the authorization and so the concept of the authorization to this budget funds it for the within its one of the most important priorities. as we reviewed the budget and put it together it is a place where we make choices that we would prioritize and put a lot of our dollars because we think it is so important to the long-term health of children the well being of our society. >> i agree and i recommend you consider adding more emphasis on early reading and writing for children from cradle to the fourth year so that they can love books and improve their vocabulary and able to stay at grade level and do well.

in my district a majority of the uninsured population falls under the medicare, excusing them fall under the medicaid coverage gap and does not qualify for assistance in health care marketplace. according to the kaiser family foundation up to 950000 uninsured people would gain health care coverage if the state of texas cited to expand medicaid. what justifications, if any have you heard or received and how as hhs responded to discussions graduate with the governors like in texas because with regard to the conflict with, i just spent the weekend at the national association. if you before i did that as well because in terms of any concerns that governors have we want to expand the program. want to expand the program and the way the templates the statute which is about expanding access and doing it for love income populations so it is affordable. we want to do that anyways the

work for states. in terms of answering concerns and questions whether it's the negotiations that we do with governor pence and i participated in a number of other governors so that we can make sure that we do this in a way that serves the citizens of states that may have different needs. that's in terms of what issues that comes up. want to could articulate we want to work with governors. >> yield back. >> the gentleman yield back. i'm going to yield to doctor robonaut to give members a headset. we are looking at a clock, i will be recognizing dr. roe for five minutes and publicly mr. davis maybe and mr. walberg. after that will we'll have to start dropping down so just start tailoring , four minutes and see if that will i'm not trying to go to three or two but i want to give everybody a chance to be involved in this conversation. dr. roe. >> thank you, mr. chairman. thank you, madam secretary for

you. just to put some questions i want to bring up. begin with and they will get to the questions but these are things i want to shop to answer. one, are the medicare wage index, if you look at those around the country there is never intended to be like that. 20 by the highest court in california and massachusetts. 14th of the most ardent alabama and tennessee. what you get paid in california this 1.7 with the medicarecome and its 1.3 where i live and that's putting us out of business. ..

medicare is not an unsustainable course as you well know. last year 2014 medicare spent $613 billion took in $304 billion. that is unsustainable. concepción, $3.6 trillion making their premium over what we spend and out like to know what your recommendations are to put this on a more sustainable course. we did save 2.9 charlie it over the budget. that's a start. i'd like to know what the other issues are. regrettably i've got to ask the extremely important task and one last thing an ipad do you think

one person should have the power to determine how medicare dollars and if it goes over this for him? there's nobody on that panel on board right now. recently, we have seen two videos that show planned parenthood positions basically having wine and eating a salad bargaining over the harvesting and sale of dismembered baby parts. have you seen those videos? >> i've read the articles. >> last week to report you couldn't comment because you had the neck, but you need to see those secretary burwell and it's only eight or 10 minutes but you need to see what the rest of us have looked at. given planned parenthood which i think is terrific conduct, americans may be troubled to realize planned parenthood gets

over $500 million a year through your shop, medicaid and title x funding. having said that with a significant financial relationship could you tell us what you done to investigate activities? >> first because it is related to the budget issues we discussed today we have put together a strategy because it is such an important issue i want to make sure there's the budget issue in terms of extending the number of people we have because there are legal judges we have to bring in. that can come of their statutory changes in the bill is moving to make changes so i just want to raise that. the broader issue you've raised with regard to the issue that people have passion deeply on

both sides of the issue and whether that is the issue of research that are important for either generative diseases, down syndrome, autism. with regard -- >> my time is about a year cap you have any contact with planned parenthood? >> with regard to this issue. >> no, planned parenthood stunning in the 500 alien is a state number and with regard to medicaid -- >> 41% of funding comes through the federal taxpayers. before my time runs out we are limited. i find it amazing to me that plan parenthood could complain about a woman having an ultrasound before she terminates her pregnant they can use this so they can harvest body parts to be sold for fetal tissue.

i find that absolutely astonishing. mr. chairman, i yield back. >> the gentleman yields back to admit davis can you recognize. >> there will be plenty of investigation on that by my colleagues. i want to go on and ask unanimous consent that a repeal of the affordable care act which would 137 billion to the deficit in the next decade that this report be entered into the record. thank you, mr. chairman. >> thank you very much for being here, for your service and for joining with us today. you mentioned nih earlier. i know that you care deeply that we continue to fund this at higher rates. we absolutely cannot fall behind the global community and how we address science and innovation. that is very, very important and i'm pleased the president has a preset funding. i also want to talk about not just the innovation piece of

that, but the access fees and affordability and particularly focus on the changes you have recommended in reforming medicare part e and specifically ways you call for the budget request in terms of reducing medicare costs both for the government and the consumer and lucky not to question the giving authoritative to you in the department to negotiate drug prices in medicare part d. can you talk a little bit about that and why that is part of the budget and why you think this is so forward? >> we believe the ability as we look and address the issue brought up the question of the long-term health of medicare and how we work on not as we look at the issues driving cost we believe they are part of that. we see that happening in terms of the numbers we see now but

we also hear from the privacy there. the police having come from the private sector and the company that is known for negotiating on price, the idea of for mechanisms to put pressure on prices something we think is important. that's why we've asked for those authorities that we can try and work with the pharmaceuticals and negotiate to keep downward pressure on the price. that is what we hope we can do and we see a part of the overall issues about how a transfer in the system for the long-term. we believe there are things we need to do. >> what do you see as the key problems you'll be having as you move forward with this? >> with regard to this issue this issue, it this issue, it is a legislative and statutory issue so it will take a statutory change to grant the authorities to negotiate. that is not something

administratively we can do. it is something where the action was that with congress. >> thank you for working i'm not. not a simple way of moving forward but it does need to make a difference and there so many stories lately about the high cost of families for people to access. i wanted to for a moment also talk about the increasing access for folks here and we know the aca has been a huge success and help in reducing number of the uninsured. the district is going regularly to get the medications she needs and now this means that they have to do that.

i wondered if you could just talk a little bit about how dramatic the increase in the uninsured population has been the implementation of the aca and what this additional coverage is meant in terms of the presentation outcomes. >> with regard to that we'll be brief in terms of numerically the number is over 16 million is the number of the reduction in the uninsured. what tells the story better our individual and that is a woman who was 26 uninsured her mother told her to sign a good a month later she discovered she had stomach cancer in half the coverage she needed. the coverage helped her from her health and she's now recently married and in addition to that the financial security in terms of her business and availability to continue on in that way as well. the individual story combined with numbers in terms of what we see about the extending coverage

means. >> i particularly have heard about that and it comes to the diabetes prevention. thank you for your service. >> in the latest time has expired. mr. walberg for five minutes. thank you, mr. chairman. thank you for reaching out to us before this as well. i want to ask you the first question how many fake dishes claims have been paid to the enactment of obamacare and how much is lost due to fraud but just bring it into context earlier this month gao released a report that investigated health care.gov through various undercover 2014 coverage year. the report reveals some stunning things that the marketplace approved subsidized coverage for 11 out of 12 fictitious applicants created by gao

resulting in a payment day state of about $30000 to insurers on behalf of the state can release. for seven of the 11 successful if it pushes applicants gao intentionally did not submit required verification documents to the marketplace and the marketplace did not give those subsidized coverage for the applicant despite the inconsistent and incomplete information. subsequent to that how many fake dishes claims have been paid to the enactment of obamacare? how much has been lost due to fraud? >> with regard to the example we take serious leg and want to improve it. we look forward to the recommendations out of the study. we look forward to understanding what they are. gao didn't find there worth the

dishes claims. they did when they had individuals who came to the system. first they came to health care.gov in terms of electronically. then they actually came through the phones and that's where they got through. at that point because they are gao, they were able to do things that forever would also be perjury that would have led to a $250000 fine. >> and they were successful. >> and were successful in breaking lot in terms of what they were doing. with regard to the next step. there's the gated health care.gov in terms of that is where prescott got through the question of confirmation of information and because they did not file taxes what will happen aspers statute it will no longer be able to get subsidies in the next year because at that point the irs to let us know. >> we don't know how many fictitious complaints may have

been filed already other than gao. >> we know 11 examples. >> 12 examples, 11 got through. >> those are the only examples we now live because gao said in the report they did know of other examples other than those they had created. >> they don't, but you don't need there. >> we do have a number of steps in of steps and place them within 90 to 95 days ago through data matching than this are already 117,000 people we don't know are fictitious, they have not provided the right documentation in the first quarter of this year 117,000 people came off. several other hundred thousand people close to 200,000 people received information thing we did not have enough justification for income and therefore they're a ptc tax credit would be adjusted

downward. we are on a comp and path of making sure we have information that the lines of what we've been told and if not we are taking action. >> without getting into specifics of these cases that were successful, which shows there should be comes to earn can you explain what process is likely fail to allow these fictitious applicants to gain subsidies? >> there are a series of processes that occur. in terms of the gates, when people lie about their information is something that can happen in all of our systems. the way to catch that is in the data matching and information. the depends whether they've lied about which part. >> do we know which one? >> we have not seen examples. one of the things that would be helpful is to see the example because all we know is what you

said. whatever information we can see where it may not be working. right now the examples i gave you. >> what is keeping you from the examples? this came out in july. >> at this point the gao has neither given recommendations. we've asked in terms of can we understand how you did this. they believe they are protecting sources. >> the gentleman's time has expired. thank you, mr. chairman. and thank you madam secretary. with regard to the gao question just received the gaming system that process at the rand annulment on under the very beginnings of the affordable care at or an issue in which you get more information.

>> at this point a number of gates and efforts on program integrity and plays an information gathering when that goes through when we don't have data matching would review those cases and take action. at the point of the filing of taxes and examples given, folks didn't file taxes. that the next ways that would occur in the next will in terms of people who chose not to file taxes for some reason. that is the point subsidies will go away. we have a number of gates in place. if we understand that they are working we do wonders and. >> cheerio shares methodology with you and the examples are waiting for that. >> are looking forward to gao which is the part that has not

occurred. >> thank you. >> the president of commitment to early childhood education is reflected in the budget proposal up 1.5 billion extra for early head start and for head start is alf. briefly tell us the budget levels established by the majority, what is that going to do to the fact capacity in quality of accountability or provide and what is that due to capacity? >> with regard to the levels if you are going to meet those levels and you want to fully fund head start for things like nih or cbc in terms of other places. we put together a budget but as i mentioned their savings in terms of deficit reduction from the hhs budget as a whole that

we put together a plan and an approach that affords us the opportunity and that the current cap levels he would not be what to do that so you would not be able to implement the changes in head start or you would have to make dramatic choices and other places. one of the largest budget areas for hhs's nih. >> the last point community health centers mentioned briefly in your testimony for this in my community is essential network for help delivery an essential part of the affordable care delivery system. if you could talk to the committee asked about role and how the budget you are talking about is reflect to continue the commitment the president made at the inception of the affordable care act discussion. >> we appreciate the work that was done in terms of these

issues. the community health centers serve one of 15 americans are served by community health centers. they're an integral part of primary care, an important part of making sure as we expand access that that's what extended part of the affordable care and are extended now assisting uninsured drops with places for people to go as part of that. we believe the successful part of coverage in communities that don't have as much and whether that is rural, minority or their communities that these are important part of that. also integrated behavioral health and primary health together to get to the place where the coverage is one. >> thank you. ideal that. >> the chairman yields back. we will move members to four minutes. we are watching the clock. i can't get it to slow down.

mr. guthrie come your recognizer four minutes. thank you, mr. chairman. i want to talk about their employers uncertain health insurance group definition. the affordable care act section or tino for expands to 100 employees. they are both mandated to provide one's view start rolling, you are able to self-insure when you've got a bigger pools of bigger businesses aren't having the same issues. the trap seems to be a lot of colleagues on both sides of the aisle on how we fix the problem. and i've seen estimates of a 30% increase from different studies. the issue is employees from 51 to 100 in the small-market group definition will have extensive mandated in the fed and a big

concern of bipartisan over here in the capital. i just wonder if you look at the issue and what actions are looking at taking. >> one of the things i would ask of a good follow-up with you and your staff to make sure we get the comments you are hearing directly from employers or other groups that would be helpful. there's another side expanding the market that would love to hear directly if you have those comments as we review that. it would be helpful to hear specifics of why people assume it works the way you describe it working. others argue the other side of the issue that would be helpful to follow up on the evidence. i want to understand a policy perspective than what we have authorities. but the two questions we examined right now. i could ask we follow-up with your team for you directly. we'd appreciate having facts from the field to inform

conversation. >> there is a bill h.r. 1624 is 158 cosponsors. it's very bipartisan look at what going on. having said that i have a letter we will share with you from 19 employer groups regarding -- unanimous consent to enter into the record. thank you. i yield back. >> mr. courtney, your recognizer four minutes. thank you, mr. chairman. and thank you bottom secretary for your accessibility. we had a great conversation to talk about the coding issue which still is widespread problem out there for folks discharging from hospital and i'm been ousted them find themselves in the coverage gap for medicare to medically prescribed services. since we spoke about that today

minute rule i got input from folks who i will share with you about why that by itself is just not a solution to the problem. the chairman mentioned earlier about the rate increases reported a while ago in the press. coming from connecticut, and state that embraced lot is now an year three of the exchange. couple days ago the insurers who participate revised downward their initial rate requests. and then came in at 6.7 and revised downward to 4.7 prior to insurance department rave review. the co-op which cut its rates by 8% came in with a 13% rate increase and revised downward to 3.4% in the largest insurer came in with a whopping 2% increase earlier and is now revised downward to .7%. i point this out to us as a

cohort with claims experience said they feared that the walking wounded in exchanges were going to spike up in the initial years. we are seeing incredible stability in terms of the raid. we also see new insurers in the marketplace. now knocking on the door to sell product. your department has been boosting the insurance department review piece of this. just wondering if you could share from a global standpoint whether or not these fears are overstated. >> with regard to the rate issue what you are pointing to is one of the things is about adding transparent to the end the light of day two things in the marketplace to make a mark of work so individuals have information there's pressure to make it work i was one of the

ideas. the rates reported i wanted to rates in most states about 10% because that is required. the company raises rates above 10% it has to be posed. we have to report while state insurance commissioners review it. it needs to be reviewed. if they propose about 10% they need to justify it. that's a part of the process at work in what you see what just happened creates downward pressure in terms of the public pressure in the requirement you have to justify any rate increases. we think overall pick last year if there's downward pressure. in states like connecticut in california yesterday and their rates for 4% which is lower than their increase last year. and so that is what we'll continue to watch and monitor. the reason we make sure and are

using the rave review to put the downward pressure which we believe is an important thing to do making the market work. >> of the farmers all employer has double-digit requests or increases were a matter of course to see 2% or .7% is eye-popping in terms of stability. >> the gentleman yields back. thank you mr. chairman. secretary burwell, my district is home to a number of small family-run businesses that sell premium cigars to adult consumers. job creators have expressed concern about the impact expansion of fda authority under the tobacco control act on their businesses. a distinctly adult clientele and i do not believe the category was the intent of congress in 2009 when the law was passed. can you tell the committee was

set to take to ensure such businesses which are a staple of main street america are not regulated out of existence? >> right now in the rulemaking process, you probably know we propose two different alternatives to gather evidence and information with regard to the question of premium cigars and how they are or are not children. that's a part of what we do and we're in the middle of the process now. as we are in the process upright in their your question was recognition of small employers and that is something that will be taken into consideration. it is something very important that we do as we think about implementation. forever the rulemaking comes out, i do want to recognize the point you've made which is making implementation for small employers and small institutions

possible is something they consider a priority and we believe no matter where you are weak and work on as part of implementation. >> the proposed rule has been under consideration for more than a year. regulatory uncertainty is challenging for small businesses trying to plan for the future to open new stores, hire workers serve customers. when you anticipate rulemaking to be finalized? >> the issue you've raised is one of many complex issues reverse these a number of comments and trying to work for a balanced and fair and we appreciate the points you made about uncertainty in terms of recognition for the business community, especially small players. >> i yield back, mr. chairman. thank you, mr. chairman. thank you from the secretary

burwell for your testimony and the department on so many issues health care precision medicine, mental health services. thank you for your work on early childhood education and support programs. i want to spend a short time talking about the older americans act which celebrated its 50th anniversary and i want to thank chairman kline and ranking member scott. they are committed to optimizing the oaa. thank you for calling up the issue of elder abuse and i want to emphasize physical abuse but also financial abuse. i have three questions and i think i will tell you what the three are to save time. the population is changing rapidly. what steps are you taking for community living programs as our older population is becoming increasingly diverse.

secondly, when i talk about the older americans act they knew about the nutrition programs like meals on wheels. when of the population of seniors is expected to double by 2050 so we support investment than would yield greater efficiency. can you talk about how the department is for vetting evidence-based practices and how you plan to spur innovation in this essential nutrition is services. often times that's the social contact seniors have is that meal. my third question has to do with family caregiving. 77% say family caregiver support services make it possible to continue to care for loved ones and keep seniors at home. it's hard work and training respite caregivers are very. many are in the generation where they take care of parents and

children at the same time. what is the department doing to prepare and support of large diverse community of caregivers. >> we are quickly trying to work through each of these. in terms of the modernization as i discuss how we went about the white house conference on aging because it was a different approach in terms of being in the community, using technology including people could participate through technological approaches. changing the way we think about work in terms of technology and the fundamental idea of people's engagement programs and feedback being more customer friendly in terms of the modernization. in terms of evidence-based practice to run nutrition and meals as part of a broader category of what i consider prevention and preventative care and making sure we do that correct way. that is centerleft and acl and

more with cms. it is also part of the affordable care act with people knowing they could have knowing they can do preventative wellness visits about co-pays. we need to increase the numbers more so people accessing services are improving but a place we need to send more time nutrition bonus coming as well and the broader thing that changes a larger piece. the last piece is family caregiving and ensuring community at home. using our most recent rulemaking which is an important part of reforming the overall system of delivery and paying in ways that encourage the terror at home. the rulemaking and demonstration of the most effective tools because those are the ones that scale broadly and payment is an important part of these

decisions about staying in a community versus making a change. >> thank you so much. >> i think the gentlelady. mr. carter, you're recognized for three minutes. thank you mr. chairman. earlier this year he received a letter from a group of employers who have variable hours. it was specifically to address the employer notice that appeals assess because it's very important for employers to get notification about employees who have received subsidies. otherwise employees are facing tax penalties if they decline a more affordable employer plan and accepted subsidies. this is important. it is my understanding as of yet, none of those employers have received anything from hhs. can you give me an idea of what you expect to get notification to employers. >> mr. carter, this issue is not

when i'm specifically familiar with. my understanding is it is a treasure reissue. what you are talking about is tax information in terms of an ap tc. >> get back with me on my map will be resolved. >> i'm happy to raise the secretary lou. >> fair enough. notification to the employers. the degree it would be better if they got one notification and that is something i'm concerned about and i hope you look into that as well. you do agree it is a burden on employees when they have attacked at at the end because they didn't accept employers more affordable plan. that is what we're trying to get out. >> we want to make sure were employer should cover and as the employee makes a choice to not accept the coverage that they don't receive subsidies they

should be a >> could help of employers cut notification. that is what we are trying to achieve. do you have any idea when you're going to a computer system. >> i'm not sure with regard to what you're referring to. >> i will get clarification. in your opening statement you said over $100 million would be given to stay amused for prescription drug abuse. i am a pharmacist, the only pharmacist serving in congress. i've witnessed first-hand people's careers, people's lives, people's families being ruined as a result of prescription drug abuse. one of the limitations as if medicare limits pharmacist as to what they can do in the wake of calm patient. there's a bill house resolution 592. this is something that needs to be addressed.

this is one of the biggest drug problems we have in this country, one that has really gotten out of control. as a member of the state senator george s. gone through the program that is now well. this is something we need to work on them we can help you in our profession we want to help you. please look at the bill. mr. chairman, i yield back. >> the gentleman yield back. thank you mr. chairman. auger really quick. first, glad to see nih increase in the budget funding as he knows the quester is especially hard. university of wisconsin has a lot of research going on. one of the things we've noticed is now the age of the average first-time grant was being escorted to and needs to be 36 in 1980. researchers look at other areas and i want to keep the talent

there. senator baldwin and myself and others have introduced the next generation research act. wondering if you could address how we can help younger researchers as we move forward. >> is about creating certainty in the years we are through with sequestered to shut down. the ability to create certainty is like the certainty we need first mall businesses referred to. people have uncertainty in knowing how things will run and how people make decisions. if you get a phd in a particular area, that is a long period of time you make a financial commitment. the thing we can do is create certainty around funding dreams of funding for this search does is going to be there. that's one of the things we work to do which is why we have a billion dollars increase. >> if you could look at working with those younger scientists

we've had some ideas would like to propose follows the quest to raise out there. secondly i'll piggyback on those that haven't done -- my saber governor walker is in the smaller numbers if it hasn't done this with a $400 million, almost 85,000 people with additional health care. i see looking i'm glad you just met with governors about this as a member of congress is very first reading. i see something like this. like a media for states states like wisconsin, and this bad bad because governors refuse to expand this. >> that is where the decision sets with governors and legislatures. i think one of the most important things is articulation of the benefit of the economic

job creation and what it means in terms of state budgets as well as individual. that is the place they focus their most attention. >> if you have names of people who told us they benefit from the affordable care act. i act. either towns in my district. small business come and grab there has been from upstairs to tell me this is the first time they've had health care. they've had caregivers in the grocery store crying because of the first-time in her adult life she's had health care. we are more than glad to share those their office. >> the time has expired. mr. russell, you're recognized. thank you mr. chairman. i would like to thank you for distinguished service to the nation in charitable work. as a small business owner that has a small workforce while under the 50 threshold, i seen a 68% increase in health insurance i provide employees over a two-year period.

do you believe increasing the cost of insurance will encourage or discourage small businesses providing insurance. >> is that people taking it up the cost of health? >> the cost itself. we are part of a pool and so we can't do the groups on the road but we have seen a 68% increase in two years. >> is a particularly incident driven having worked at one point in time as a small employer with a couple large cancer cases were a number of pregnancies. we want to get to the issue. what you describe is the case that is not the experience we've seen and i want to understand it. >> we've been in business for five years. my second question is in the hhs

2011 report entitled drug abuse that were common set of 455,000 emergency room visits were directly associated with marijuana use. further supporting documentation shows multiple adverse health effects. do you believe the president's policy is not enforcing federal law on illegal marijuana state to violate the law promote or prohibit hhs schools on emergency care reduction in drug abuse prevention? >> with regard to the hhs role where the researcher, regulator educator and treatment. in terms of the questions of the health impacts, it is something we are spending time. we recently changed a rule delays to increase research we hope will afford us the opportunity to do more and better education in the space of the damage. >> my final question and you

don't have to comment on the ongoing investigation necessary and that sort of thing. given hhs provides title x funding to planned parenthood, deeply personally the harvesting of infant daughter cards to be moral? >> this is an issue that has an issue with strong passionate strong beliefs about the importance of the research and what is important is hhs funding focuses on issues of preventative care, things like mammograms in cancer prevention screenings with regard to our relationship there. the attorney general right now is under review to make determinations on the appropriate next step. >> i got back my time. thank you, mr. chairman. >> ms. adams, you're recognized. thank you, mr. chairman. ranking member scott some of my questions have ready been

answered. let me first of all say i have over the years appreciated planned parenthood good work in promoting health care for men and women and i'm a little bit disheartened by all of the attacks undermine the good work they do. having said that let me move on to affordable care. my state of north carolina is one of the 24 that did not ask and medicaid. we are looking specifically with all of the great benefits i'm still perplexed by our governor and legislature decided not to do that 317000 north carolinians would have had it. you've met with the governors. my question when we look at north carolina have been one of the highest rates in the country standing at 24%, it is critical we take a serious look and what

are the options? are there options for folk in my state and other states that have not expanded medicaid who may want to consider it in the future. are their options? >> that is why community health senators continue to be extremely important and ensuring people don't coverage have care. with regard to the options of states making decisions we went to work with states and provide them with different options and opportunities. that is what the waivers are about. we've done that with governor pence of indiana and the program is running. other governors have conversations and we look forward to understanding the core consideration of the state moving to reduce the coverage gap you describe in north carolina which is one of the largest state in the nation.

>> thank you very much. i did it in the legislature for 20 years. i'm still at odds with the governor and state legislature about it. can you give me suggestions on how to push them along and closer to ensuring the low income people? i would defer to you on how to work with your legislature and governor. when you look at the analysis done in the state of kentucky and this is an accounting firm, 40,000 more jobs and $30 billion by 2021. that from an economic dead aims to be an anchor of a place to talk about. >> it makes great economic sense. i was certain they continue to push that in north carolina. thank you, mr. chairman. ideal that. >> mr. allen. thank you, mr. chairman.

thank you, madam secretary. you have a tough job. it is hard to deal with that on the issues coming out of the process. in georgia obamacare is not real popular. we are having major problems. most physicians than it does say nothing has changed. emergency room people show up still without health insurance. they see very few. you might check with the hospitals. the elective surgeries are like 80% because of hide about the bulls. just one problem after the other. what i want to zero in on is this planned parenthood thing. i would like commitment here today on when your department will conduct an investigation on

this very very serious matter. not only is it unconscionable but they're breaking the law and the big people of the country. what a week going do about this? can you tell me when we will do something about that? >> just one moment on your affordable correct issue and the question of expand and and we've seen a percentage drop the number of uninsured in emergency rooms with the dramatic drop. the rural hospitals are an important issue in your status bar at my home state. with regard to planned parenthood, this is an important issue and one that there's passionate emotion and belief on many sides of the issue and want to respect that. with regard to funding, we do not fund abortion except with

the exceptions in place for many years. funding for planned parenthood with regard to the issue raised which is a question of a legal issue and laws and statutes that guide fetal tissue in place and should be enforced. with regard to investigate and are looking into issues because of the statutory legal issue the department of justice and attorney general have taken the issues under review will determine the appropriate next step. >> that would include your investigation. >> with regard to the legal matter and i defer to her colleagues we will support them in anything they need or want from us and always do that. with regard to making decisions of investigation. >> it on a personnel who could look into this? >> the department of hhs is not an issue of funding.

>> the gentleman's time has expired. thank you, mr. chairman. thank you madam secretary. on the issue planned parenthood i understand multiple investigations in california or the state attorney general investigating issues including people who violated the law. i have two areas for questions for you. one of prescription drug abuse as my colleague from georgia mentioned a very large issue. 45 americans die a day according to the center for disease control. the u.s. has 5% but we consume 80% of the opiates of the world. a huge cost issue and on the human side. we are switching to another comic monitoring system. even people who question it are starting to support it. my question is what you might think. given the time constraints.

we might be able to help states like california and new york and georgia. secondarily we are proud of the side of what the colleagues brought up from the bay area and attracting primary care physicians. if you could address those things quickly. the second question is the opposite side of high cost dates in reimbursement rates. because of that we have a difficult time attracting primary care physician, young people to go into the field. >> primary care in terms of how we structure our education proposal it is to focus funding on places like primary care and districts were shortages and other specialties. we tried to use our tools to

encourage people. with regard to the issue of prescription drug abuse 250 million people in the united states. one prescribing salicylate got to go with the congressmen prescription drug monitoring program is essential. that's a lot of what i'm spending my time in conversations whether governor baker in massachusetts or hick and opera colorado. second is a locked phone the drug when someone is an overdose saved their life. the question of how that effects that is very end creating a state-by-state basis. the third is medicated assisted treatment and all those who are they trying to get the transition. another woman in colorado has been clean for years and being

addicted and going to a journey we don't want people so getting that other things in place are three nonspecific approach is. thank you, mr. chairman. >> you are recognized. thank you, mr. chairman. thank you, madam secretary. i appreciate your testimony and i know there's a dozen windows open up right now. i'd like to talk about the enrollment issues faced in my office. it's an ongoing concern and i want to make sure i address the concern. the government accountability office put out a report highlighting various shortcomings of health care.gov which resulted in numerous that dishes enrollees gain access to subsidies.

from the chewing one and out after the next come a very frustrated regard to how it's working or tried to purchase on the website only to have coverage canceled because of a minor mistake made on the application. by the time they get to me they are furious and i can't say i blame them if the parent with the family, my heart goes out to them but it becomes the reason why. they have problems getting the issue corrected and what lester communication with the department and how we correct the issue long wait times. there's so many issues with regard to this.

they suggested finance fraud is being rewarded. minor mistakes are being punished. if you've had the same communication from other members and address them too quickly on that. >> with regard to communication in your office reach out to me at work for those individuals. please make sure to reach out to us. with regard to both sides of the coin but we don't know whether they falsified social security and the small issues. that is what your getting caught and because they've done that and we do it in a strict way. if you do not provide the data required to say your income is

xor europe a certain status. that is what is happening to examples. we don't expect they know because they haven't told us -- those are related things in terms of assuming the program. we don't know they are more than the examples you're talking about. we may know that but at this point we don't. we are trying to do program integrity but we want to make sure many other people don't have the right information but they still may be eligible. please let us know about this examples. >> i thank the gentleman. ms. wilson. thank you, mr. chairman. i ask unanimous consent the office of the assistant secretary for planning and valuations research brief with the increase in cost sharing can discourage low incomes from

assessing medical care which can have negative health consequences entered into the record. >> without objection. >> secretary burwell thank you so much for being here today and working with florida especially. have started other care all the other things. i appreciate your test money on how obamacare is working for american people and i call it obamacare because i believe it is about the people of this nation and that is why we have this health care law. it is here just may. the law of the land. the people of florida are much better off because of it. we have led the nation in new and roman through the federal exchange. my district 24 has the third-highest number of people in the nation who benefit from such it is. unfortunately, we have not asked ended medicaid, but i thank you for your commitment are working

with the florida legislature and government working with medicaid and consider me as a partner in this pursuit and hopefully a better outcome in the future. i also went to thank you for help securing low income pool funding for florida. i want to thank you for your testimony on the importance of investing in high quality early learning. i commend you in the president for your commitment to expanding and investing in early education. several questions i want to combine in one. the president's budget includes an additional 1.5 billion to improve quality head start. why is this crucial? what is start doing to ensure all the children in child care have access to high quality early learning. what is at stake if our nation ignores the ever-growing body of

research and can you describe how the revised program performance standards will help continue please speak to the negative impact of spending caps. >> i will try and get through as many as they can. one is with regard to the changes a number of changes are using evidence with regard to expanding the day and the question of extending the year. there are other important changes about curriculum should be used in terms of teachers and those participating. also a number of safety issues make sure grantees and others are doing services do it in a safe way. we also try to reduce the bureaucracy to make it easier for people to comment and apply and be a part of the system. we put the money in the budget to match the changes we propose as they go forward. >> gentlelady's time has expired. mr. messier. thank you, mr. chairman.

thank you secretary burwell for being here. the 40 niner phenomenon the idea of the affordable care act applies to businesses of 50 or larger and there's questions about some businesses stay in that threshold not been willing to hire the 50th person because they would make themselves subject to requirements and mandates of the president's health care law. the administration has seized the burden by delay and the 50 figure making it up to one hundreds of the businesses that were 100 would be forced to acquire to comply with the law. could you talk about the rationale of lifting that to 100? why was it business as 100 unless the administration said would be subject to the law until 2016. >> are also two different issues in terms of application proportions of the law and some

of those have to do with benefits but also by category. >> you are not subject to the employer mandate for businesses of 100 or less until 2016. i'm trying to get at what made you decide to lift it to 100 from 50. >> with regard to that issue as we look at the number of employers and even the higher levels we believe employers that level should be providing that type of care and can do that and we could do that in the way that is affordable ways. ..