churchill and orwell, the freight fight for freedom. watch our coverage of the lit fest starting saturday at 11:00 a.m. eastern on c-span2 book tv. >> c-span, where history unfolds daily. in 1979, c-span was created as a public service by america's cable television company and is brought to today by your cable or satellite provider. >> the white house requested $1.1 trillion for the department of health and human services. the budget request includes cuts in public health and biomedical research. tom price talks about his department's budget adhering at the senate finance committee. the two-hour hearing begins with opening remarks by the chair of the committee, orin

hatch of utah. >> the committee will come to order. we will first listen to the senator from oregon who has to go to another committee hearing. i welcome everyone to this morning's hearing. the proposed budget for fiscal year 202017. i want to thank secretary price for being here. these hearings aren't annual event. since this is your first time around i will warn you these hearings can get unruly, but of course really know that.

i even work with congress to fix our health care system to ensure americans have access to affordable health care coverage. >> mr. chairman, thank you very much for this courtesy, and i know this is a in the morning. i also want to say thank you to the senator who is going to do an excellent job in my accent. they have preferred alternative facts and convenience into the truth. one of the most recent examples was its budget proposal which double counted $2 trillion to maintain some with and with of fiscal responsibility well it slashed health programs and protection for basic and essentially needs. the budget math is a that the

extreme agenda that deprives millions of americans access to healthcare and wipeout living standards is not. unfortunately, i will split my time between the finance committee and the intelligence committee so i will be brief. there are several issues in the budget. first, medicaid secretary price, the captain of the present healthcare team. he has been the premier advocate for trump care, a bill that cuts medicaid by $834 million in order to pay for massive tax breaks. 14million americans will lose coverage and millions more would see caps on their care. if that wasn't enough, the budget proposal that came out a

few weeks ago goes even further. will >> he responded and he went further again i quote, there are no cuts to the medicare program. he also said and i quote, nobody will be worse off financially. i have heard secretary price and others make the baffling

argument that people are actually worse off when the have medicaid coverage. that their health does not improve. often this argument is based on a brief and outdated study performed to my home state. here's the bottom line on medicaid. 74 million americans rely on the program for basic health needs. prince was sick is, people with disabilities, seniors in nursing homes of nobody to turn to for health their benefits disappear. in addition, thousands of those in oregon who are healthy under my home states model. it will be a hard sell for them to convince them that the chilean is more than a trillion dollars in cuts. public opinion is clear. two of three enrollees are happy with the program.

seven out of ten americans say congress ought to leave it as it is. no block grants, no per capita caps. fortunately it at the wall in congress and there's a lot of debate left to be had trump care. right now, the administration is causing turmoil in the insurance markets and is having disastrous effects for millions of families. the president issued a one-day executive order undermining the affordable care act. nobody on the trump team can give a straight answer about whether the administration will continue making cost-sharing reduction payments that are key to making insurance affordable for working families. because of the sabotage, insurers are pulling out of the markets people are left without plans to choose from. don't take my word for it, the insurers are very clear about whether making these decisions. the campaign trump care shrink

saliva medicare and extends the mandatory cuts between the budget sequester by more than $30 billion. the fda, the national institutes of health, all slashed in the budget. same is true for programs aimed at basic human needs. meals on wheels, child care, foster care, this is the budget you write if you think seniors and working families have it too easy. i think the secretary for training the committee. i apologize for the hectic schedule. never an easy appointment for cabinet secretary. i think he knows there's going to be some vigorous discussion this morning. i want to express my thanks to the chairman for his very gracious and ongoing courtesies on these matters. thank you for being willing to fill in. i look for to returning with the

calyx. >> i'm grateful the president and hhs are working on this effort. and are eager to work with congress to fix our system enable to ensure americans can access affordable coverage. this may not be something that will be easy to do. as we know, time is of the essence in regard to this effort. earlier this week more pulling out of the marketplace potentially live in more than 10000 patients and consumers and 20 counties without any insurance options in ohio's exchange for 2018 this is particularly frightening as we expect to hear more notices from anthem as they evaluate their participation in obama care

exchanges. this recent story is just the latest in a long line of failures. mike colleagues on the other side seem to wanted to continue under the guise that this is working. it's not working. all of these demonstrate the need to move forward with repealing obama care and replacing it with a more workable approach. one that will we can take seriously the ballooning healthcare cost impacting every american family. let me talk for a few minutes about the specifics of the budget, the budget assumes $250 billion in total savings from the repeal to the replacement of obama care despite insinuations to the contrary, the budget does not incorporate the specific legislative proposal.

the american healthcare act that is before congress right now. therefore it is not accurate to associate the specific medicare savings they have estimated with the president's budget. to do so would assume a level of specificity specificity that for obvious reasons is not there. moreover the budget does not cut $1.5 trillion for medicaid. nor does it assume the specific medicaid reform proposals will be enacted into law i'm quite certain we'll hear about that today. any attempt to make that connection is unfounded. any senator who harps on the numbers here today, either does not understand explicit language and estimates provided in the budget, or they are simply attempting to muddy the waters in order to scare those who rely

on health care coverage. the president's budget seems to accept the reality that the senate will need to come up with its own health care reform proposal that includes a fix to medicate which is quite frankly long overdue. anybody doesn't agree with that is not living in the real world. in addition to that savings the budget assumes $610 billion in savings from putting medicare on a sustainable path by capping funding in fiscal year 2020 through per capita caps or block grants at the state option. most of the budgets overall would be achieved by returning the focus of medicaid to serve in those with the greatest needs, the elderly, the disabled

and needing mothers and children. by giving states more flexibility to run their own medicare programs. any senator who wants to argue the federal government should spend more medicaid dollars to provide coverage for nondisabled childless adults at the expense of patients who remain on waiting list should explain why. furthermore, any senator who would like to argue that the states are ill-equipped to handle their medicaid programs should explain why that's the case given the overwhelming consensus we've heard from governors nationwide over the last several years, is that states want more independence and flexibility in the medicaid program. washington needs to stop measuring the success of a federal program to how much money it spends or how many of the programs are a part of it. instead they should focus on how

well a federal program helps those it is intended to serve and how efficient it is that fulfilling its mandate. we need to stop focusing on spending and pay more attention to outcomes. we may not be able to spend more. it doesn't appear we will be able to. at the rate things are going under the current system it's a national tragedy. the budget by no means is flawless but it recognizes this reality and the president administration deserve credit for that. i look forward to having an open and frank discussion with senator pryce about his thoughts. before i get to that, let me just say that i like to say

today we have the pleasure of being joined by secretary thomas pryce, secretary price, thank you for coming. yours sworn in as the 23rd secretary of health and human services on february 10, 2017 is a policymaker and physician. he brings to the department a lifetime of service and dedication to advancing the quality healthcare for americans. secretary price began his career care for patients is an orthopedic surgeon. he followed in the footsteps of his father and grandfather and began a solo medical practice in atlanta, georgia. since its founding that practice has grown to be one of the largest nonacademic orthopedic practices in the country. hoping to make an impact on healthcare he ran for public office. he was elected to four terms in the georgia state senate and i

believe would have continued on forever if you wanted to. during his tenure there, secretary price served as minority and -. most recently he served as u.s. representative for georgia six congressional district from 2005 until 2017. during his time in the house he served in various roles including chairman of the house budget committee. chairman of the house republican policy committee, and chairman of the republican study committee. he received his bachelor and dre university of michigan at which he completed his orthopedic surgery residents at emory university. secretary price, we are grateful to have you here. will be happy to have you proceed with your testimony today. >> thank you so much mr. chairman and ranking members and members of the committee.

thank you for inviting me to discuss the president's budget for fiscal year 2018. it's an honor to be with you. whenever a budget is released most common question is, how much? , she does is spend on this program, how much does it come from the other programs. as a former legislator i understand the importance of this question. but too often is treated as you question worth asking as it relates to the budget as if how much a program spends is more indicative of whether the program actually works. this budget request is not confused budget spending with budget success. he understands that setting a budget is more than establishing topline spending levels. done properly it's an exercise in reforming our federal programs to make sure they do her job and use taxpayer dollars wisely. the problem with many programs is not that they're too expensive or underfunded the

real problem is many sibley don't work. fixing a broken program includes redesigning structure and redesigning resources for those most in need. that's what trumps budget will do across the government. consider medicaid that has been discussed the primary source of medical coverage from millions of low-income families and seniors facing challenging health circumstances. the amount of government spending burned measure of success, medicate will be held this one a most successful programs in history. twenty years ago the spending was less than $200 billion. within the next decade is estimated to top $1 trillion per year. despite these one third of physicians who ought to be seeing you patients don't some research shows that enroll in a medicaid doesn't improve your health outcomes this suggests that we need structural reforms

that empower states to serve their unique medicaid populations in a way that is compassionate and sustainable. under current law and prevent states from focusing on the most wonderful and from testing new ideas and access to care. this budget changes that. the mission of protecting the health of the american people involves more than overseeing the nation's health care and insurance programs. hhs is the world's leader in helping the healthcare sector prepare for cyber threats and responding to and protecting against health emergencies. recently i witnessed this work firsthand visiting ebola survivors and representing the united states in berlin and the world health assembly in geneva. to support the federal role in preparedness and response the president's budget provides $4.3 million in response

planning. and development and stockpiling of critical medical measures. we face new health crisis that we have been far less successful in resolving. their serious mental illness, the opaque crisis in childhood obesity. i'm committed to leading a chest chest to address each of these in the present budgets calls for policy reforms that will enable us to do that. calls for investments in high-priority mental health initiatives for psychiatric care, suicide and homeless prevention. focusing on those suffering from severe mental illness. 2015 over 52000 work instead of overdose, most from opiates. we call for $811 million to support and fight this epidemic. to invest in the next generation

and the school-age children who are obese leave healthier and happier lives we establish a 500 million-dollar health block grant. the budget prioritize women's health programs by investing in research to improve health outcomes for women and how they start. across hhs funding is maintained for those serving women including health centers women's cancers street screenings this budget man's tough choices with this budget the new administration charts a path toward a sustainable fiscal future finishers the dedicated resources provided enhance and protect the well-being of the american people. i think you for the opportunity

to be with you today and the continued support of the department of health and human services. it is my privilege to serve as secretary. >> were proud of you know that you are next what member of the house and so far it looks to me like you are on top of what these problems are. although you are pretty well on top of them before as a member of the house. the opaque crisis seems to be spreading across the country affecting families and communities in unprecedented ways. the new york times reported earlier that overdose deaths are at an all-time high, tackling the crisis is a priority for you and for president trump. can you describe the efforts their undertaking to address this ongoing epidemic. >> this is one of those things across the nation that tears your hair out. 52,002,015 died of an overdose.

33000 of an opiate overdose. we hear day after day what they are put in place a five-part strategy to make certain were identifying the treatment and recovery efforts that work on assisting the state. be to make sure we have the overdose reversing drugs available wherever they need to be another were trying to survey a prior to strong drugs get into the street. there's a public health aspect to determine what's going on and why is it as large as it is were putting resources into that. we want to make certain were doing the highest level of research to identify those treatments that are able to make it so there's not the reason for

people to have to seek efforts euphoric effect. and how do we manage pain in this nation. twenty years ago we started as measuring pain is a vital sign. let me suggest that has resulted in significantly greater use of opiates and prescription medication that would have otherwise been the case. you have been incredibly helpful to make certain through 21st century cures and otherwise to provide resources so we can allow the states to identify evidence-based programs that can help me to get the challenge. we continue to move in the wrong direction and we will not rest the department or administration until we been the curve in the other direction. >> dj just recently published of report using the previous ministrations data showing how much health insurance premiums a market has increased since 2013. could you tell us what the principal findings of that

report? >> when i visited with folks in my previous position and since i've served as secretary i hear over and over again about how folks are terribly concerned about the cost of health coverage for them and their family. there is a disconnect with individuals talking about the wonders of the program in place than you had individuals concerned because they cannot afford the coverage or get the care. the study was undertaken within hhs identified the average premium increase of the last four years has been over 100%. more than doubled across the country. in fact three states they were tripled. in alaska, alabama and oklahoma. it means there are individuals

who cannot afford the coverage and even when they can afford the coverage the deductibles have increased so they may have an insurance card but no care because they cannot afford the deductible. that's the challenge were trying to address so that individuals are able to afford the coverage folks want for themselves and families. >> this committee has been interested in the large backlog of medicare claims. the most recent reports we've heard indicate the backlog has been reduced from a high of nearly 1 million claims to current number closer to 750,000 claims. that number is still unacceptably high. what is hhs doing to address the unnecessary backlog of medicare claims?

>> these are peels that providers have said they don't believe the government is providing the resources necessary for them to be able care for their patients. the numbers are staggering. nearly immediately and claims were down to 700,000 now we can take care about -- we met with the individuals and their high-quality folks. they're trying to get the appeals through the process of trying to make the right decision. we have encourage them to talk to stakeholders and individuals about why we have the increase in claims there is a problem there, it means the system isn't working. to the degree it should to allow individuals to care for the patients and be compensated. we've identified the opportunity for law judges to review higher claims and have magistrate

judges to lower claim so we can get through a larger volume of claims on an annual basis. no we tried to decrease the burden of reporting. for the providers so that there is less likely possibility they would need to feel the need or desire to file a claim. it's a major problem that we're working through and we are committed to getting that number to a reasonable number. >> given here did a tremendous number problems. know your fully capable of solving those problems. i think you are well on your way. the ranking member -- >> thank you mr. chairman. welcome back doctor price. last time we're here we're confirming you.

we are here to help you. all the georgians are proud to you you just returned from your first trip overseas as secretary began that in librar liberia. what did you learn particularly with regard to the ebola break which ground zero think was liberia. >> thank you. i appreciate your support and service to our great state. my first trip overseas we stopped in liberia. i wanted to do that because i wanted to express our appreciation to the americans working there during that ebola crisis and also demonstrate our commitment for global health security and think the liberian government for what they had done to elevate and increase their ability in the area of infectious disease. what i saw was incredibly inspiring. you'd be so remarkably proud of

the american people who are forward deployed in global health. individuals from the cdc, nih, and herself who are doing what they can to make certain we address the health challenges that exist around the world especially around infectious disease. it paid off a remarkable benefit. we saw that because of the most recent outbreak of meningitis and that outbreak the surveillance that was done in detection and treatment was only possible because of work that have been done in liberia since the outbreak and since the challenge was resolved. i was uplifted and inspired by the work of the american people were dedicated their lives to assisting those overseas. >> the cdc did a phenomenal job.

the president's budget is cut by 136 million. lot of which went to initial response to a bowl in africa. in the first place that we could bring the victims to the state. when each work to make sure the funding is there we are the world's clinic if you will for emergencies and disasters like that. secondly you had a partner by the name of john knox. >> he operated on my son kevin 30 years ago and saved his like from a terrible injury and accident. to give nine months to recover my wife and i went to school, we took lessons and how to clean ports and put down drips so we could fight infection in his bone marrow. since 1989 we home infusion went

away and you had to drive everyone to the hospital to recover. the senator worked with us to see that we worked on durable medical equipment in the 21st century care zach. i hope you work with us to expand coverage to get home infusion wherever possible so more people can recover in a more hospitable environment and hospital facilities. >> healthcare and medicine is dynamic. it changes all the time. what used to be able to be done only in hospital can be done as an outpatient were often times at home. home and community-based services are imperative for us to have the flexibility to do. were trying to concentrate from the labor standpoint and different programs as well as

and sent the flexibility within existing programs so we can cover the treatments not necessarily in the venue previously selected but a new venue because it works better for the patient. >> i just want to underscore what you said about experimenting to make sure medicare coverage is robust. your state my state, georgia we have 1.9 million people on medicaid. 50% of all my bursts and george are paid for by medicaid. as we go through the forms we have to remember over thinking about first and foremost children who benefit from being those are hurt if there cut. i look forward to working with you to incentivize the needs to meet the needs for children in georgia.

>> thank you mr. chairman. emma from secretary price. there's many things i would like to talk to you about a debate you about what has been said in the positions of the administration. i want to start with an important basic assumption that you have made in that is that the affordable care act is falling apart, oh my gosh look what's happening we have to dismantle it, we have to do something different because it's falling apart yet, to me it's like pulling the rug out from under somebody listen oh my gosh they fell down. we have seen consistent moves by the administration whether cutting in half the number of days that citizens have to sign up for insurance, whether it's no longer aggressively doing outreach to younger and healthier people making sure everybody's in the pool so cost"

whether it's doing what's been done to take away the commitments made to the insurance industry to make sure they're covering pre-existing conditions. it's laid out this morning in the washington post where look at the question of whether or not the white house will let the health care system die. i want to quote in there because this is coming from the industry. the biggest source of industry exam anxiety is whether the administration congress will continue to fund cost-sharing subsidies that help 7 million americans with plans and affordable deductible and co-pays. absent that funding i don't know for how much participation in the exchange market in 2018 that set a republican who also serves

as president-elect of the national association. the uncertainty is one of the top reasons insurers have cited when explain whether posting higher rates for next year or withdrawing altogether. two weeks ago blue cross blue shield of north carolina filed a rate increase 22.9%. they said it would've been a .8%, not 22% if the administration had committed to pay in keeping the commitments that were passed as part of health reform on tuesday blue cross blue shield announced it was pulling out of the federal exchange. the president seem to cheer that. i don't know why were cheering the people have less opportunity for healthcare. if we spent a tenth of at the time undermining the health care system working to make it better we'd be making traffic strides

to lower cost. here's what was said by brad wilson a blue cross blue shield. we have to take a snapshot in time which is right now. the lack of action by the administration yields a result that we are currently seen. higher premiums rather than lower. my question is why do you believe it's in the best interest of american families to sabotage the healthcare system that is today allowing american parents to take their children to the dr.? >> let me correct a few statements. nobody's interested in the system time. we want to make sure the system works for patients and families. >> why are you not willing then to indicate that as long as we have the system we have you will keep the commitments and

reimburse the insurance companies they have certainty. >> nobody's interested in sabotaging the system and nobody's cheering the challenges we have in the system. in your state alone premiums read 90% before this president came into office. the number of insurers were down before the president came to office. >> with the meeting of the blue cross of blue shield and missing michigan though file to rates. one of they keep their promise someone if they don't. they don't it will be much higher. the question is, why wouldn't you keep the commitments made. understand you have a different view of what the system should work with. in the meantime you have insurers that are saying the reason rates are going up

because of uncertainty and instability created by the administration. why is that good. >> if you read further in the article it talks about the increase in cost and decrease in insurance availability before this administration came into office. >> i have more questions for another round, let's start by making sure the administration is keeping the current commitments following the current law while we debate what should happen next. >> did you have enough time to answer that question? yes, sir. >> we will turn out to senator cassidy. >> hello. a couple of things i'm encouraged by in your budget pleasure we put in a bill regarding drug primary care. for those unfamiliar with it as

physicians we know the way you lower cost is empower the patient physician relationship so if the patient has a problem with regard to the er she could call her physician and the physician can give her the advice. the contractual relationship so there's more investments perhaps then an urgent care center where you might see the person wants and not again. i like it because it can decrease utilization and by decreasing that it can decrease healthcare cost and ultimately we don't decrease the cost of insurance. any comments on the direct primary care model? >> it's a helpful program and gets to the dynamism of healthcare. the opportunity individuals have to have a personal primary care physician in all settings across

our health system would be beneficial to the that individual patient to get the care here she needs. right now you can't do that. we want to move toward a system that allows work care. i think this holds great promi promise. >> we look at the incentive between the patient and physician. when we talk about the per capita cap or the per beneficiary payment. was first introduced by president clinton as a concept and centers phil gramm and rick santorum simultaneously as a way to line incentives for the patient, the state, and federal government. i think receive a modified version of that estates are going to medicaid managed care aligning that with the medicate

company and then the patient. the way i look at the payment because i introduced a bill in 2010 which brushed off the phil gramm, bill clinton proposal and updated it if you will. incentive between the federal and state government. >> so important because having taken care of medicaid patients in our practices the medicaid population is not monolithic. as individuals who are seniors, disabled, blind and disabled individuals. all of the need to be treated uniquely because of their unique individuals. what we do is a system of state

you have to take care of all those people the same way which doesn't allow for that dynamism and flexibility so states can tailor their medicaid programs to suit the population we do the payments somewhat different than the house does. as an example, as we know right now states recover waste fraud and abuse they have to get back to the federal government the portion that the taxpayer put in. if it's a 40% state, 60% of that goes back to the federal government. that works to disincentive eyes the state to go after waste fraud and abuse because after kick it back, they would keep a hundred% if you would align incentive for them to bring out that waste fraud and abuse. >> those modification and improvements to a system that i believe we ought to all be embracing.

that will allow us to have those incentives also make sure every individual and that interaction is working for the benefit of the patient making sure there's not fraud and abuse and you can see the position you want to see. the patient has the treatment they desire. states like california actually get more money and some big blue states actually too well. florida does better. terms of having more dollars for certain categories of patients and when i hear folks condemning without understand it i feel like it could be a missed opportunity to improve patient care and protect the state taxpayer. they'll back.

>> want to commend you and senator grassley for something you did 24 years ago. you cosponsored legislature that call for creating in every state marketplaces and exchanges. you call for establishing that in every state but also say that in order to make sure insurance companies had a healthy pool of people to ensure there is an individual mandate people needed coverage. and he had to find them somehow they didn't. i congratulate you for cosponsoring that for employer mandate and also provided for the idea that insurance cannot tonight coverage to people with a pre-existing condition.

all that and those ideas are part of obama care in massachusetts. and frankly all of those i do are part of the affordable care act. the part that republicans like the least are those ideas. there's a real irony in all this. i like market forces make them work. you came up with a good idea 1993. i just wish that you would work with us to try to make sure those good ideas have a chance of working in the reason why the marketplaces are very near places like ohio through some other networking is basically undermining the individual mandate so people don't have to have coverage.

and young people are. we've taken off their training wheels to stabilize the marketplaces and insurance companies lost their shirts divorce less money in 2015 and then racer co-pays and deductibles and then they did better than rather than the marketplace be in a death spiral actually recovering until a new administration came in. by the way, we don't know if they're going to extend the car sharing arrangements. that provides uncertainty. they say they're going to racer premiums more. you're disabling the idea of these guys came up with 24 years ago. >> those were ideas that were part of the anti- hillary care bill. >> they were good ideas.

if my life depended on i can tell you. but i know what you're build it. frankly they were good ideas. now are undercutting them. why? >> i appreciate the observation. i would add to that there are significant challenges out there and there were so before this administration started in your state alone premiums for 108% before this administration started. there are fewer insurance companies offering on the exchange before it started. over trying to do is address that individual and small group market the scene increases. >> what are you doing? how are you stabilize in the marketplaces?

the three rs, what are you doing on those? risk insurance risk adjustment, what are you doing there? >> we put in place a market stabilization role this year that identified the special enrollment periods to make sure they were more workable for both individuals and insurance companies we love the states greater flexibility to try to provide greater stability for the market. we put out word tall governors across the nation on both 1113 and 32 waivers on waivers of what they can do for greater market stabilization and their state we look forward to working with you and other senators to make certain all the individuals has damaging to gain access to the coverage that works for them and their families. >> when i came to congress before as governor race to think medicaid was healthcare coverage for mostly poor women and children. most of the money we spent a

medicaid today is for old people in nursing homes. and a bunch has dementia. more talk about cutting a billions out of that it's the old people who will be heard and people between 50 and 65 who are veterans their only hope and getting access to medical care is through medicaid. the last thing is this, i extend this idea with good intent. i spent eight years as a governor. i love being part of the national governors association. john and i used to come here we see testify on welfare reform and we was said these are the views the governors this is what we think we are to do come this is an issue that cries african governors to sit at the table

this is why the system works or doesn't work, that's what we ought to be doing. i must say, the 13 folks that are coming up with alternative is a mess. that's something that could move us towards a principle compromise. people want us to get stuff done in the idea that it's all democrats are all republicans is crazy. >> i think it's important to appreciate the work the department destroying we met with national governors association of governors on both sides of the to solicit their input on the suggestions they would have on the waivers so we are doing all that we can to try to make certain states are able to address the challenges. >> when barack obama left office

it was in a perfect administration but there is an insurer in every county of every state in this country. thank you. >> center price thank you. i've heard your commitment to make sure you'll do everything you can to help all people in this country to get access to quality healthcare. that's something we all agree on i want to get to some practical problems here. i was in -- on monday so the eastern shore of maryland, caroling county. they do not have the same access to healthcare providers that we have at our urban centers. i visited the l elementary school wellness center will have

the center that provides direct services to our children in the elementary school. for many of these children is their only real ability to get access to primary care and have someone who can check up on their health. they are able to do that under current law but they tell me as the legislation passes from the house to the senate that direct reimbursement would be cut off. they also told me that if they cannot continue their flows through the medicaid program that they will clearly not be able to continue the services they're providing today and caroline county. my question, i understand your commitment to help all areas, today our centers are provided lifelines in many communities.

they rely upon creative ways and rural areas to provide care including school settings. they depend on those covered under -- to maintain their presence. how do we ensure that as we go through the transition the administration is talking about that the children and caroline county will be able to continue to get health care needs met? >> there are challenges in the rural areas for nation, those have been present for long time. there's a strong commitment on the part of the department of the president to make sure rural health services are available. whether through grants to the states when opportunity for various programs in schools or

elsewhere then we are committed. one thing the budget includes is something called a new american plaque grant which would provide resources to states to do this and make certain folks in rural areas of states have the opportunity to gain coverage and care they need. i look for to working with you to make certain that will happen. >> the other area i want to cover we talked about it in the confirmation process is that i want to know your commitment to deal with minority health and health disparities. we have separate agencies to deal with it. evan instituted nih. as i look at some of the historic discriminations within healthcare and recognize healthcare is not equally available in our focus has not

been to all communities equally were trying to compensate for that today, i worry about what you're doing in medicaid particularly. every minority community ago to they mentioned to me medicaid that there is no capacity at the state level to pick up the slack if the federal government withdraws its commitment either in the numbers of people covered on the benefits reimburse. so, how do you square commitment to continue down the path to reduce minority health disparities in the country not only the reduction in the bill that passed the house but also the president's budget was such a large cut?

>> i can't remember what i mentioned regarding my confirmation hearing but, the disparities in health outcomes are unacceptable to all, what we see, it's not just rule versus urban, their areas and urban centers, i know of one in atlanta where the health outcomes are astounding in terms of mortality in the chronic disease that exists. it's not because lack of services close by because it's in the center of the city. imagine a system that allows for the system to provide increasing resources to that zip code to provide a case manager for every individual that has a chronic disease that's not possible, can't do it that's the

partnership that's so important to make it so we identify those folks because there are for going to end the disparities. >> i'm all for flexibility of the state. i also know the pressure on state budgets. my set of maryland a legislature has been aggressive in helping the medicaid population, they cannot pick up the slack. the waiver will not give them what they need to make the commitment to underserved areas. >> we will turn to senator casey. >> thank you. it's good to be with you this morning, i wanted to reference a letter that i and 14 other senators since he recently about

the house bill hr 1620 particular i wanted to reference the budget report that came out on the 24th of may and this is a nonpartisan report by the congressional budget office assisted by the joint committee on taxation. i just delivered to the table copy of the cbo report i direct your attention to page 17 of the report on that page, the following statement is set for, medicaid enrollment would be lower throughout the coming decade culminated in for 2 million fewer medicaid enrollees by 2026. a reduction of about 17% from current numbers. it then references this chart on page 19 showing the numbers going down from medicaid over

that time between 2018 and 2026, i reference that in the context of what you said on cnn on may the seventh quote, and the transcript is right front of you, there are no cuts to the medicaid program", that's what you said, do you still stand by that statement you made on cnn. >> the medicaid program under the president's budget. >> yes or no, you can explain that do stand by that statement you made a may the see seventh. >> i stand by. to stand by that statement. i think there are eight words there are no cuts to the medicare program. >> was the baseline.

>> if it's no cuts yes i stand by that statement it's relative to something. if the baseline is today's amount of money being spent a medicaid the president's budget provides for an increase, cpi medical for the programs. >> susana statement is not accurate? >> i'm saying the statement the cbo made doesn't include the constellation of activities within the administration regarding how to move forward. >> they said that they'll be 14 million fewer enrollees. >> to have the report on the aca when it was proposed in 2010? because what they said the. >> were talking about the house republican bill that was passed. the cbo had a similar grant in

fact. >> let me direct your attention to the same cbo report on page 13, the top of that page it says the following, the introductory sentences, a reduction quote the total deficit reduction includes the following amounts shown in table three at the end of the document. the first bullet is a reduction of $834 billion in federal outlays for medicaid. do sir sir, in light of that in the previous cbo statement there are no cuts to the medicaid program? >> it depends. >> i just want you to tell us if you stand by that. >> i stand by. >> limit go to a statement that was me on page 19 and 20 at the

bottom of page 19. the following is set forth quote, under the act, meaning under the republican bill passed in the house, under the act, premiums for older people to be five times larger than those younger people in the states but the size of the tax credits for older people would only be twice the size for younger people. as a result, for older people floor income, net premiums would be larger than under current law on average. there refers to table five at the end of the report. i ask you that in context of another statement. this is meet the press of march 12 quote, you said nobody will be worse off financially and so result of the bill. december that statement? >> i don't believe that statement was in reference of the bill it was in reference of the health care plan we put forward.

i stand by that. >> senator, your time is up. >> i hope you focus more and not just the proposed reforms, i hope you focus on people like the 15 million americans that get medicaid because i have a disability. crawford discussion about making programs better. but be truthful when you're commenting on something as important as american lives. i would argue sir, you have been deliberately misleading based upon the statements. >> with respect, that is precisely what we are focusing on. the american people understand and appreciate the healthcare system we have for many of them is not working. many of them in the medicaid program is not working. what we're trying to do it without ever support us make

certain we have a system the response to the wishes and needs and healthcare needs of all americans. >> we all agree on that. . . >> >> i don't know there will be another hearing but we have invited you to

participate. >> mr. chairman i watch carefully all of their hearings on the affordable health care act i was not a member of the committee at the time of the why would like to of ben senator grassley was the ranking member dozens of republican amendments are offered and accepted in the hearing process. and they're hurt you just say we've above your support for what? we don't even know. we have no idea what is being proposed. there is a group of guys in a back room somewhere making these decisions. there were no hearings in the house. this is hard to take in one of those criticisms was bipartisan you cannot have a more partisan exercise than

what you are a gauge children now. we will not have an opportunity to offer single amendments. i am stunned that is well leader mcconnell sanctimoniously said is the owner of the day. we're now so far from regular order the new members don't even know what it looks like. i know that doesn't make you happy senator grassley beecher issue have been in the senate so long you know, the value of the hearing and the amendment process even though the vote ended up being partisan just as yours will be, the amendment

process was not. but if you had amendments put in to that bill as did other members of that committee i want an opportunity. give me an opportunity to work with you. that is what is so discouraging about this process. mr. secretary there is a 17, of a 27 year-old man is finally making enough money he can either buy a health insurance policy or a new harley motorcycle. you tell me which you will die because he feels john and invincible and wanted with his wife. he lays them on the pavement on the interstate the 18 wheeler cuts of what should the hospital treatment?. >> absolutely we have an obligation. >> we treat you if you are

injured or not spirit there is a mandate that he buys that. >> you will do away with that. >> is a working?. >> but under your scenario he does not have to so he buys though hardly in his wife fled with traumatic brain injury we have $3 million worth of care for him. who pays for that? sadly it is sprung up -- spread among a the system and away from the federal government's. >> the people. correct. >> where they provide the services without any compensation and so the hospital cost the insurance company said we had this amount for the uncovered services and says we will reassure prices then they say we will major premium because the hospital charges

as more. >> their premiums were up one heard 45% between 2013 and for teeseventeen. >> that is not true. >> will be glad to show you the numbers. >> i am glad to debate that but adding 24 million uninsured who will pay the bills? to record your not adding 24 million speesix a you disagree with the cbo scores. >> absolutely. >> and who pays the bill?. >> with those 20 million grey now we don't have insurance under the current system. >> i know we are paying their bills by the higher premiums. >> exactly. >> your time is up. [laughter] senator grassley has one country. >> dial it went over 35 seconds fake i did okay. [laughter]

>> you did so much better there the rest of your colleagues. [laughter] >> mr. secretary i have one question because i have to run to another meeting so i will ask you this one question and then submit the rest in writing. the rule community hospital program establishing a bipartisan manner to protect patients access to health care. they're collectively called cleaners''" end quote. in the third legislation from the 21st search small negative century jurors act extended the program the language was clear it was to be extended beginning of the dates immediately following the last day of the initial five-year period. despite this sivas proposes implementation of this on or after october 1st 2017.

the gap is inconsistent with congressional intent which requires a seamless extension of this critical program. furthermore it is inconsistent the way the agency implemented the first five-year extension. i have a bipartisan letter to rabil administrator asking her to look at the alternative payment timing included in the proposed rule i would like to submit a letter for the record mr. chairman. >> without objection and. >> you were carp -- copy of a letter so i hope you can give consideration to this request because in several states, and many states, this is an issue projector the rule states one is alaska's. i hope you can help us to

make sure we have a seamless implementation of this program. >> absolutely agree would get back with you because maya understanding is that as a was extended the proposed rule put out in april to allow for the hospitals to apply literally as we speak but it is so importuned for rural areas. >> i yield back. >> senator?. >> thinks for joining us. called the of opioid epidemic the key health priority highlighting the budget proposes a $50 million increase through a hundred $11 million that may seem like a lot of money but a bigger number is

$9,309,000,000 the amount of money one states spent fighting the open your a epidemic this chart from governor case six web site and in 2016 investing $939 million over 70 percent of that total $650 million despite this investment investing $1 billion with medication insisted there be an to treatment today eight people will die from the overdose. 4,000 died last year or entr'acte to exceed the

number in some counties the already exceeded from the year before. forty-three people in -- died in the second largest county in the state. this continues. we're not winning the fight but confident will lose far more lives in families turned upside down if we were not spending this money your $650 million. two weeks ago our colleagues held important meeting about this epidemic to discuss a proposal -- to discuss proposals. to be a doctor in day police

chief from of a new town ohio, former head of drug control policy and corridor to end the medicaid expansion or end the program. experts brought to the committee don't cut it so anything like medicaid expansion to limit people's access i cannot see any good coming from this crisis. and especially with a high rates of mortality. he is in the front lines and said we should not be decreasing medicaid.

like sending people love for medicaid then get them in for treatment right now 200,000 families are getting treatment who have insurance because of medicaid pay your administration continues to knock down to criticize him to just cuts. so to say taking that away could make this more difficult progress not want to imagine the deaths we would have had an ohio for our republican governor, i am proud of what he did his catalog of criticism but if he had not expanded medicaid to those families. the budget proposal cuts medicaid by $6 billion and one-third of all substance abuse treatments you have

taxpayer funded health insurance and the 200 republican plus members of the house are all willing to take it away from those 200,000 ohio in getting treatment. you say you're interested to fight the epidemic player policy proposals tell a different story. you reduce spending on prevention programs, you cannot treat a disease with just grant money you cannot do all kinds of things to brandt's compared to the size of the problem i think probably senators who don't meet enough people are benefiting buy you never propose we fight cancer

through $50 million increase of the grant program. is said increasing access to substance-abuse disorder treatment is part of your department's plans to address the root puree crisis but what you're not telling all you are really doing. how do you plan to increase access to treatment when you cut the biggest single funding for spice $600 billion? how does that add up in 2017?. >> that visit to the southwest corner. >> one mom told be about her

son who died in the bathroom of a macy's of an overdose. this courage we have running across the country is unacceptable to you or me or the president. we are certain we put in place is a program that works. the numbers continue to go the wrong direction so we will be very to a system resulted in 52,000 deaths that is the system and want to be married to. and the the system now works for the parents because they lost and those who want to gain a carefree and treatment. and as i look forward to working with you whether or not is pay for medicaid or

whatever it isolates and then focus on those but imagine the system working better than the one the resulted 52,000 americans a. >> but that resulted in the 50,000 deaths. how do you do this when 200,000 people right now or treated? and then know that you mean that but how does

this work if you cut the biggest revenue stream that takes care of these billions >> you are way over your time senator. >> that is what i and trying to encourage us to look at for a system that works for those individuals suffering from this addiction to focus attention and treatment to recognize we need greater public health assistance in pain management is what so we can turn this curve in the appropriate direction which is down. we continue to tolerate a system that allows for addiction and overdose it is unacceptable level lusty and for its fall negative and i will not stand for it.

>> took to work to rule to deny birth control for employees. are you aware of this?. >> there is a proposed rule out currently on so they are allowed to discriminate against woman to. >> debt is currently solicitation of input in the process i cannot make a further comment. >> you cannot make a comment if birth control is part of a basic health plan?. >> i think if they should be

available. >> you are promulgating their rule? period the proposed rule is to mix a you think employers should offer birth control and not people to just say they don't believe in providing it?. >> believe women who desire access should have access. >> through their employer. >> believe it. >> to believe those who want to access deserves to have access. >> women cannot be discriminated against by the employer who wants to do a cherry pick women's health purpose of that is the intent of the rule i guarantee there will be a big fight on this issue so

with a cut of hospitals and draw hospitals to be a 30 billion cut, does your budget include that? to record think we were referring to is the continuation of current law with the budget that accommodates or reflects current law. >> so you is said the extension is not a cut to medicare? river and again is your baseline. to this current law there is a reduction. >> see you believe we should be making of reductions?. >> we need a health care system and financially viable to make his or the

american people have access. >> and i will take back to as a yes and there is lots of the efficiencies with the delivery system. to ask you about rebalancing of the medicaid budget for nursing-home care and that is something the states are doing it is a huge savings to the budget and then to be accommodating so you

identified in an area where the system should allow for that. >> senator nelson?. >> good morning. i just want to ask for clarification things that are in the proposed budget something we heard about was cost sharing reduction in subsidies from the 72% of the affordable care act benefit -- consumers benefit. it is hard to get a clarion serve. the private market providing

under the changes knowing that the subsidies would be there when proposing rate hikes because of the uncertainty. so ken you confirm the administration will reimburse the insurers for these subsidies that helped so many constituents see a doctor? i notice it is in your budget through fiscal year 2018. what should we believe? director is not be

satisfying as an answer but the current case and i am the defendants with house obverses price by kentucky the budget reflects the pavement of this tsr payments through 2018. >> does that answer mean if a court case but basically that means the subsidies would be cut?. >> again the my like to be able to share more beth defendant cannot. but the budget reflects the pavements through 2018. >> the unfortunate the moment it predicts an

outcome and those that bring health insurance to millions of people to their wives could -- otherwise cannot afford it. and then to be there in the future. in fact, it to undermine the ability to project what their premiums will be and protecting themselves to jack up their premiums which undercuts the old reason for having subsidies in the first place. so we will shift to the sikh

of virus. there are 1400 cases in florida alone. and dinners 2018 budget states it is not but what is needed to prevent and control but yeah it the administration and slashes the very programs designed to bolster capacity. as your budget cut more than $7 billion from nih?.

>> with this secret of -- to seek a buyer reside abroad of them working on a vaccine we're in the trials and the cdc is doing a phenomenal work. >> i understand. >> the budget accommodates handling any challenge from this threat. >> but the question is does it cut 7.$2 billion from nih ?. >> the proposed budget a devise a reduction in that we can be accomplished by increasing efficiencies end to make certain we have the core mission accomplished 7. 2 billion?. >> dave fink you're never is

it accurate to. >> i have a couple of other questions. >> go-ahead by your time is up. >> is just wanted yes or no question. does it cut more than six and a billion from the medicaid program on top of the cuts included what the house passed health care bill?. >> no. >> does it cut more than 1.3 billion from the cdc?. >> a 10% reduction of resources available through appropriate priorities we believe strongly the budget and what is needed to protect not just united states or the world.

>> is that a yes it cuts 1. 3 billion?. >> that affirms the president's desire to get folks to appreciable measure success by the amount of money going into it the weather and not the mission is accomplished. then the zero less resources to celebrate. >> very interesting and the reasoning but does it cut 1.$3 billion from cdc?. >> is day 10 percent reduction. >> does that equate? to read the number is accurate. >> does it cut the fda?. >> i don't believe so. the fda what we envision is to shift the resources coming to fda actually been

there is an increase roue a modification of the user fee process. >> senator your way over your time you can submit questions in writing. >> if this is okay with future ben nye will yield to senator roberts lewis weighed the level gore after him. >> that is very gracious. >> that 10 minutes per roll per hour? i'm assuming we're under the five men the role? welcome back. there are statements they your response will for people dying in ohio with

the problems of the affordable health care act reductions of funding in rural areas with the entire budget or omb and the chairman has been chided where we have cloture or delay in the lost hope. are you enjoying yourself? [laughter] >> the job as a great challenge and diane jury that challenge. >> i will get into the weeds because your prior life i know you chaired by a frustration with the

competitive bidding program per car will not go to which further except not provide those providers we still have the drive 150 miles for medical equipment and access to it. negative your we sought to reduce the payment changes so to preserve the intent of the program and reduce the amount and save money doesn't need to provide the implementation so were trying to get a sense if legislation is needed. >> that would be welcome under the direction to allow the equipment providers out there a greater opportunity to provide services to the patients across the land

regardless of whether legislation is forthcoming because we believe strongly that the previous program in place with is the access to appropriate services especially in rural areas spec i appreciate the at so with regard to my friends concerns with reference to what is happening to of terror have a question that would be repetitive and and you talked about what is happening with premiums and copays have blue cross blue shield announced they're pulling out of kansas in nationwide premiums have doubled or tripled the yet

macaulay says stated course what is now working? so that is amazing. like butch cassidy and sundance kid for jumping off a cliff or we are in the obama car is like filmland deliveries going into the canyon but we have to get out of the car. i think that is what you're trying to do and i wish you well in doubt because settled think you're responsible for that entire budget i am not in favor of some of the things like

agriculture we plan to change that i know when the senate ever has considered since reagan. so this other businesses of regular order but the days and nights that started in the health committee that is sitting on the shelf gathering dust and you know, who i am talking it failed on a party-line vote and then again i had the same amendment than the product went to the floor of the house and went behind closed doors and out came obamacare

and we have had eight years of this and they think maybe all of these deficiencies we're trying to correct on a bipartisan basis has been over the top. >> i endorse what you just said to appear ungrateful for you to hold this hearing mr. secretary is great to see you again. >> with the slate understanding of the medicaid cuts but the numbers is about $834 billion of cuts in the house bill and there is about 600 million in savings

or cuts so is a right to add those numbers together orator is there overlap? with a cattle believe it is correct. maya and understanding the budget does not assume passage of the house bill. >> my understanding is that it does. >> as relates to medicaid but what is but in places of what grant program to reflect over a 10 year period of time a savings of $610 billion. >> i appreciate the opportunity to work even if it is just a 800 billion that is 25% cut to the

medicaid program asked the governor's office to tell me who was on medicaid. to do you dispute this? when you look nearly half of the program more children. does the sound right? is more than 40 percent of medicaid spending supports disabled and seniors many are in long-term care facilities people in general to spin down the live savings for the privilege of being in of the nursing home funded by a medicaid. >> and the remaining adults the vast majority work and

those who have medicaid coverage. >> there is the tiny percentage that are not disabled and go work there is a small percentage of people. >> we can give you the numbers for your state do you dispute that?. >> i appreciate your account -- for candor to citizens supporting a bunch of people that should be working in her not to do you agree? fumigating cadbury's from state to state the individuals that are able-bodied without kids and not working.

>> but that is a very small percentage ago when to walk through the list but that is a small percentage. it is important because this is the secretary of health and human services e is announcing there are americans that our lazier on medicaid so that if we cut the program by 25% and i have a story of a share with the staff from the front page over the $700 million per year that the state will have to come up with to compensate of those medicaid reductions.

so what is your advice to us about how we handle those cuts when you have a bunch of people that are in nursing homes or working but unfortunately data for private insurance. >> and then to provide greater opportunity and i would remind people of 29 american without it we envisioned a system that responds for those that shows it is better for them not to be covered on the system that is more responsive. >> with respect i do respect

to a lot and the fact mueller dr. but to believe we just said he would have to first reject the findings of the cbo that the house bill froze -- throw 23 million in entries 23 billion warda does not have insurance you have to believe that ended 25 percent cuts to medicaid and it's a pile will magically sit. >> breakage tell you refuse set out to design a bill but to their critics, to

republican critics you could not live by a dave bill less responsive. my hope is in the senate be will not do this in a partisan way bet come together to address the health care system. >> bed justice not believable in ntb specs. not deceiving of democrats or independents. >> your the last one.

i don't think that's accurate there is no significant changes until 2019 with the financing standpoint bed is the point where in the majority of changes come into play is for real be happy to read view of the genesis of those numbers to see if they're accurate and how we can address that. >> have you had an opportunity to do research? we had a number of the delegation in new the conversation that you could convince him.

>> yes and there was specific language that accommodated that concern that is why i said don't believe any changes would occur but i would be happy to work with the governor in interstate and try to determine there accuracy. >> what do anticipate the growth rate of health care over the next 10 years?. >> that depends on what population renewed talk about? the annual growth rate is around 2.six a newly packaged could give you the exact number.

>> as we go to the changes leadership has had discussions with those particular changes we're looking at it if that is cpi and medical + 1 or the cpi of medical have you had any discussions? i'm trying to find the answer. do you have in sight what the rate might be that we're proposing?. >> negative as it relates to medicaid it is for those litter disabled. >> if it is anything below the it would you support that?. >> it depends what the live

site if we are accommodating challenges in a supplemental manner and then i have to look at that. and everything go but what was the other one? not just the cpi in medical would you approve that?. >> i did. and is what the entire program looks like in isolation and. but that doesn't address the entire constellation as there other ways to accommodate individuals that need financial assistance. >> what is the rate increase overall? and if we

calculate can you oppose that? him acquitted is important that we accomplish the goals we set out to make certain every single american has access to the coverage that they want but medical inflation as it increases the funding mechanism is not blow that because if it is the recant. >> and isolation i would agree. >> mr. chairman of via some

issues to tackle. but i wonder end have serious even after the to isis facilities with the center for medicare services cms defiance deficiencies with the media read jeopardy status. the systemic problems are what prompted them to introduce to restore accountability the bill will defy a just offer those

talented but will the department committed to working with kissinger to approve the care at day just director have been impressed with the resources we tried to return to fight for new facilities. one is to make sure we are living up to a hour responsibilities. >> but we've above to give you more to moose. >> really for word to working with you on that. >> pressure reworked to get competitive bidding rates to

the 21st century cheers act requires the department to study on how pavement adjustments affect that beneficiary accents when negative access. cad new give an update?. >> remains to in process and it works for all of those across the land. >> but put the department's approach for addressing these talented is the reverse from the current structure?. >> absolutely you cannot

have a system that rewards contracts to entities that have never provided services in the geographic area and that is the system we currently have four contracts so we looked at but then all the americans have access to the kind of services, hospital beds or wheelchairs whenever that may be this is quality of life issues and from my perspective we have failed to make certain that accessibility. >> finally it space expected

an interest of the non enforcement of this policy? "the shock doctrine" a data em with the stand and? a permit to own reinforcement we could kick his can tell the road to get a permanent solution somewhere. >> is is an area of significant interest in the work can progress but

secretary price thanks for being here there are so many issues i continue to of great concerns about but is certainly this budget impracticality liberal health care ad research the one type of cut that i know we need is not in the budget but the cost of prescription drugs president tried repeatedly stated he wanted to drastically bring down prescription drug prices to say companies are getting

away with murder and is supported medicare negotiations for gore and i have for a long time but this budget does not include any major proposals to bring down the cost of prescription drugs whether medicare negotiating it has increased by 208% in the last 10 years. however the house republican health care plan does give drug companies a $25 billion tax cut paid for by the people who see their prices go up.

is it fair to say that lowering prices is no longer a priority?. >> no. the president has made this a priority and charging as with making recommendations and over the past eight weeks we have had half a dozen stakeholder meetings with individuals and have charged them with coming up with specific proposals to make certain it the most effective way to reduce the increase in is a prayer to afford to working fluid interested to bring down on drug prices. >> to the family have to pay

$700 for the epi-pen? direct so to bring down as prices the but was prevented through the previous administration so we're looking at exactly the types of things so our goal is to make sure. >> that i wish was in this budget but it should someone who learns they have hepatitis c. >> you are defining a drug that is saving lives. >> $80,000 to have the opportunity to save their life?. >> what is the right price. >> there is no way to determine the price and how

do you make certain we incentivize to make it that they can identify those cures that are out there?. >> so if you have cystic fibrosis should you have to pay a $300,000? directory should be. >> that is difficult that is somebody cannot afford that so we celebrate that innovation if they have access to treatment to save their life.

is it appropriate to give pharmaceutical companies a tax cut in the health care reform bill when there is nothing to bring down the cost of prescription drugs? to rec as it relates to drug pricing some effect is not the tax cut is that the appropriate to the pharmaceutical industry that takes away health care from people and does nothing about boring the cost of prescription drugs?. >> it is imperative to have a system in place with their remarkable all productivity with the innovative spirit at nih and elsewhere that discover these drugs to save

lives. >> they should be spending more?. >>. >> the system needs to be such to realize that benefit >> for the record we pay for those as taxpayers just for the record but talking about day steady over and over what the record to say it is highly disputed steady the test on include the tax credit that's substantially brought down out of pocket cost per girl so i know in

michigan of these numbers. >> i have been in this health care business 41 years. every year we demand more and more money and spending an interference and more intrusions for crow why does it cost so much? we have never had the better secretary fake you for attending today is this is not the most enjoyable activity you would have participated in of a bike to work with anyone republican

democrat. health care is no joke and those with diminishing access it means the world so to hear from each of you in the coming weeks l.p. confined ways to work together so i asked that they submit them by june 15. >> he case to answer what of my questions. >> so very briefly my colleagues get tired of

myself saying as a retired governor brown i am such tried to give a governor's perspective so we ask for is the opportunity for wafers. and that was granted. and with the race to the top. so have the states apply for waivers. i think almost every state has a least one end and some they cannot get a waiver. if that makes sense i would

like to have some flexibility but that could be helpful. looking a blue cross blue shield with the health care act the single biggest reason to cross blue shield it is the lack of federal funding so to their credit they fund kashering and that is the questions that drive of the prices so we will keep that in mind the.

>> civic we appreciate that. >>. >> man i'd die happy. >> if you are doing a great job mr. secretary and guided wire you. and i know you know there is no? cancer and no one to personally thank you to adjourn the meeting. [inaudible conversations]

. >> opened in june 1941 he was still president. he had the inquisitive mind so there were 22,000 books in this room alone everybody brought was selected by fdr almost identical the day he died nothing has changed.