care androniors to our doctors. so i say take the opportunity. we've talked than. i think that you use enthe word opportunity. i believe we do have the opportunity to do this. it really is a question of will. and i think we have the will. i think we even have some of the language. we have the ability to get this done. so we ought to do it. and deferring this, denying it, kicking the ball down the road, whatever you want to call it is just not acceptable anymore. i urge my colleagues around this table to work together to put an end to this unpredictable, unstable, unsustainable policy once and for all through full repeal and the use of more savings to do it. let's set medicare on a more stable and fiscally sound path for our current beneficiaries and our future. it would be remarkable for us to get it done. but i would be proud to see it happen. i yield back. >> all right. dr. hayworth? >> thank you, chairman.

well, and congresswoman schwartz we have the will and we may indeed have the way to accomplish this goal that is broadly shared, and it should be. just to respond to senator cardin regarding therapy caps, and i agree with chairman camp and with chairman baucus that we have to approach these issues in a more global context, if you will. but we did provide for a waiver mechanism in the house bill. so it wasn't a matter of setting a cap that was inflexible. it was a matter of -- and this is a theme that i think has to be emphasized when we talk about the great responsibilities that we have taken on as a society. to our seniors through medicare. we also have to remember the responsibility that we have to those who currently pay 40 cents

of every federal dollar in debt who are going to be paying that debt, and it's going to grow. so that's why we provided for that possibility of instituting those caps with a waiver so that we can thoughtfully approach these obligations. and in terms of sgr fix -- >> would the gentle lady just yield? >> yes. >> i understand that the waiver is in the law and that's what we're extending, and that's where we end up, we can survive. the question is what rationale is there for the cap. there is -- when it was first put in place, there was no rationale for it. it was about 1500. now it's about 1800. but there is no medical rationale for why there is a cap on this particular service. >> well, it's a matter, respectfully submitted sir, because as a physician i have had myself to attest to the value of extending certain therapies when there is statistical evidence that there may indeed be a tendency for

them perhaps passively. it doesn't have to be a matter of endeavoring to commit fraud. but perhaps passively certain types of interventions are extended beyond their useful limit. and i think that's the issue. and it is one that we have to approach, i contend in a global and holistic and systematic way. there is no question. but we have a marvelous opportunity. and i want to thank congressman price for his eloquence about this sgr issue. our doctors have taken more than enough abuse from the medicare system, if you will, and it is the patients and our seniors whom we care so much about. so i look forward to working with our colleagues in this very virtuous endeavor together. thank you, chairman. >> thank you. we have a few minutes left. we want to try to do one more lightning round on this issue? maybe on extenders.

>> you don't know what you're asking of the senate. >> i -- if we had time and somebody wants to say something. >> i think mr. brady would like to speak on one of the extenders. >> all right. one of the health extenders. okay. >> but we can go in order if there is anybody would like to speak on one of the extenders. mr. levin, anyone on your side? >> does mr. brady want to say a few words and i'll say a few. >> i'll be very brief, mr. chairman there is a provision in the house package that essentially says if you like your hospital, you can keep it. that isn't the case today. as you know in regions -- every region has a different mix of how they provide health care. some are for profit hospitals. some nonprofit. some academic tied to a university. others are physician owned hospitals. those are all born of a need and meet that need. unfortunately, current law

includes a ban on any new physician-owned hospitals. and this hurts patients and hurts the communities. and at the time it was enacted, it actually stopped approximately 40 new hospitals dead in their tracks from being built and actually serve the community they're in. this common sense provision allows these types of hospitals to be created where there is need. so the ban on new hospitals is lifted, as it should be. as importantly, it allows existing own hospitals to grow with the needs of their communities. right now the survey done in november shows nearly half of our physician-owned hospitals see an immediate need in their community to build new beds. after all we do have 10,000 new seniors a day signing up for social security and medicare. and almost 90% will need to expand in the next five years. i think it's important for the federal government to get out of the way of the regional and local solutions to health care.

especially as the need for beds will increase as new health care is required. i think this provision is a very common sense one. i yield back. >> mr. chairman? >> yes. >> shall i say, frankly, this is a very sensitive issue, this subject. i don't know if you can hear me or not. >> yes, i can hear. >> it's -- there are many hospitals in this country who feel that specialty hospitals are getting an unfair advantage. and the goal here is to have a level playing field, at least not give an unfair advantage to a certain provider. this has been a topic of discussion for a couple three years. especially hospitals. and i know the argument which special, and they provide special care. on the other hand, nonspecialty

hospitals brought just as good care. you don't have to go to a specialty hospital to get good care. and second, these other hospitals have a lot more obligations. they don't skim the cream, as a lot of the specialties do. i urge us to just kind of do what is right here and remember lots of folks who do not -- who are part of their provider groups, they're not specialties. there are other obligations like ambulance, emergency care and so forth, and that we don't go overboard and give a special break to specialties. >> all right. >> yes? ms. ellmers. >> thank you. i would just like to make a couple comments about the physician-owned hospital extenders as well. there again, if we're talking about a level playing field, by denying them their medicare

access number, currently under construction hospitals that is, 40 across the country, you know, not only are we limiting access to our patients who receive medicare and receive services, but let's look at it from a practical standpoint of jobs created just through the construction of those hospitals themselves, which came to a stand still. but to the issue of effectiveness, if there again talking about patient -- in a patient-centered perspective, patient -- or physician-owned hospitals have high marks on their effectiveness. i'll just put one out there. for 67 medicare severity adjusted medicare diagnosed groups, the typical medicare patient treated in a physician-owned hospital accrued charges $734 lower than the same case treated in a nonphysician-owned hospital.

and that was a study done in 2009 by the oxford outcome study. so, you know, have i other statistics here, and i'd be happy to share them with you. but the fact of the matter is physician-owned hospitals are very effective. they're a great use of taxpayer dollars. there again, we're providing the benefit of care to our medicare recipients in these communities. not all states have them. but those that do, there is a high rate of effectiveness. and i just think that it is something that we really need to look hard at. thank you. >> is to keep things fair, is there a house democrat? >> just briefly. i think senator baucus has indicated, we've been discussing this issue for endless years it seems. and i think we just need to be careful. we were on a somewhat court note

about sdr and the wisdom of a permanent solution. i think on the extensions, i think the senate provisions myself should be those provisions should be extended. we'll talk about them. but as we get into physician-owned hospitals, i think we should all be aware, and you have been through this, mr. chairman, that we've tried to wrestle with this issue over the years and with some care. and before we go back, i think we need to be careful. it's an example of these policy issues are not easy issues. and for those who think we're facing basically technical issues or easy issues, that's wrong. we've got a lot of work to do. i think closing up our

discussion on ui i think illustrates the serious responsibilities that each of us has to millions of people. and unfortunately, they're unknown. and therefore faceless. and i think if we could look at them and hear them, it would be beneficial and we would come out with the right solution. thank you. >> thank you. i see our time has expired. senator baucus, there anything you wanted to say by way of closing? >> not on this subject. i think it would be important for us to determine when we next meet and the subject of the meeting. >> thank you. i want to thank everyone for the productive discussion we had this morning. i think we have begun to start to narrow on some of these issues and identify some of the areas of agreement. well will meet again tomorrow at 10:00 in this room. and we will get to you later

today the topics for discussion tomorrow. but i look forward to seeing everyone at 10:00 in this room. yes, senator? >> and if i can just reconfirm, the senate will be sending an offer to the house? >> yes. >> today. so you'll have ample time to look at it before we meet tomorrow morning. >> that's why i wanted to leave the topics open. >> good. >> so we'll look forward to reviewing that this afternoon. >> thank you. this meeting is adjourned.

>> hi. how are you.

tuesday you can watch the house and senate conference committees continuing negotiations on extending the payroll tax cut. we'll have that live at 10:00 a.m. eastern on c-span.org. . this past week, house and senate lawmakers continue negotiations to extend the payroll tax cut for workers. they'll continue their work on tuesday with a fourth public meeting. the cuts expire at the end of the month, and all sides agree it should be extended. the talks are focused on how to pay for it. >> i don't hear a fundamental disagreement in the philosophy that if people get a gad, that enhances their lives and that

enhances the ability for them to get a job down the road. i don't hear a disagreement with that. i hear an excuse as to why not to do it, but rather the fundamental philosophy of trying to rearm people with an education so that when they go into the workforce, they have an additional tool. >> to link a social insurance program designed and for 70 plus years functioning to provide financial support when you lose your job to a requirement that you have to be in this training i think, first of all, won't work for some of the practical considerations. but second, i don't think it contradicts the notion that i'm agreeing with the more education you have today the better off you'll be in this economy. >> watch the rest of this meeting or the two others they have held online at the c-span video linebacker at c-span.org/videolibrary.

now an update on the ongoing house and senate conference committee negotiations on the payroll tax cut extension. >> over the past couple of weeks, the house and senate conference committee negotiating a long-term extension of the payroll tax cut, unemployment benefits, and doctors reimbursement rates has held three public meetings. three more are plan in order week with the first on tuesday. steven sloan, a tax and congressional reporter. >> we haven't seen a lot of progress yet. we have seen maybe a little bit of agreement here on there on some of the small issues. but the big issues that have to be decided, the fate of the unemployment insurance program and exactly how you're going to cover the $100 billion cost of extending this package through the rest of the year, that hasn't been discussed. and both sides seem to be at pretty big odds over exactly how to address those issues. >> so let's take unemployment

insurance. where -- what are the specific areas where there is no agreement with that? >> well, there is no agreement yet on the reforms that republicans are seeking. republicans are seeking changes to the unemployment system that would require a recipient of unemployment insurance to have a ged, or if they don't have a high school diploma, to be seeking a ged. it would also allow states to conduct drug tests on recipients of unemployment insurance. these are things that democrats haven't been willing to go along with. republicans are also seeking to scale back the number of weeks that someone can be on unemployment insurance. right now in the hardest hit states you can be on unemployment for up to 99 weeks. republicans want to scale that back to 59 weeks. and so we need to kind of see if there is any middle ground, maybe, you know, an agreement on extending it for 79 weeks or something like that to see if there is any effort between both sides to come to the middle.

>> so on the flip side, what does the panel agree on? >> well, they agree on the need to extend the payroll tax cut through the rest of the year. that's pretty much it. >> okay. well, the price tag for the bill is reportedly expected to be at least $160 billion over ten years. how likely are they to reach agreement by friday, february 29th, when a two-month extension of the tax cut expires? >> it's a really tough deadline for them. it's not impossible. anything can happen, especially in congress once you get closer and closer to a deadline. but there has been no agreement at all on exactly how that cost should be covered yet. >> what happens if there is no agreement reached by the end of the month? >> if there is no agreement reached by the end of the month, then the payroll tax cut expires, that means the 2 percentage point tax cut that most employed workers around the country have seen for the past year or so, that would expire. unemployment benefits would go back to 26 weeks.

that's the amount that states provide in normal times.time. and reimbursement rates would also be cut back. >> what have you heard about a possibility of another short term extension? >> this is something that in the meetings last week the senate finance committee is saying that they couldn't agree on the big issues. they might have to agree to something more short term. now what short term means, if they're you will for debate, does that mean a one-month extension. or does that mean doing a nine-month extension that gets them through the election but doesn't run through december? and maybe result in a lame duck situation in the end. that's unclear. >> we appreciate your time. >> thank you. >> our coverage of the payroll

tax extension continues with a conference committee meeting from last thursday. the tax cut expires at the end of the month. this is about two hours. >> the meeting will come to order. good morning, everyone. i want to start by saying thank you to everyone for a really does discussion yesterday. hopefully we can continue to build on that this morning. for today's purposes, however, there are other issues that we have yet to discuss. and i do want to acknowledge that last night we received some proposals from senator baucus. wooet we'll get to those in a few minutes. for today's purpose, i want to talk about the agenda we have

which includes reforms to xepd the nation's primary welfare program or temporary assistance for needy families. regulatory relief, also known as boiler mack, a provision that insures unfounded federal relations are not harming our economy and costing families their jobs. and bonus depreciation. another jobs provision in the house bill that promotes investment in hiring. i believe that we brought agreement on tanf. we alotted about 30 minutes of time for discussion there. there is 45 minutes of discussion on boiler mack and 45 minutes on bonus depreciation. we'll follow the same order as yesterday. senate democrats followed by senate republicans followed by house democrats and then house republicans. so with that, i'd like to open up the first topic. the difference between the house and senate bill on expending the tanf benefits. this is a policy i think we can come to fast agreement on.

the house overwhelmingly passed legislation that would implement the important reforms with 395 house members voting yes, including all of the house conferrees on this conference. so with that, i will turn the floor to senator baucus for any comments and to begin the discussion today. >> thank you. i think you pretty much summarized it. senator hatch and i actually have been working on tanf authorization and agree with it and did someanbe made to the pr. but that's for another day. here i think it makes sense to extend tanf for another year. we do not have tanf in our bill, obviously. we made a couple minor clafrpgs

which i think are acceptable. i just urge us to accept that, accept those minor changes, extend tanf for the year. it's deficit neutral. it doesn't cost the taxpayer anything. and pretty much a no-brainer to me at this point. i think the senator was going to say a few words, excuse me, senator casey. >> thank you, senator baucus, mr. chairman. mr. chairman, you started this morning by reading what the words say, which is important. it is temporary. it's assistance to needy families. and i think it's really about two issues, really. one is trying to achieve self-sufficient efficiency in

the lives of people who have really struggled, and also getting back to work, which is vital. i think that's why we're getting the kind of consensus we are. in program is a lifeline for families that have be so devastated, especially in the aftermath of this recession. and i know there are a lot of reforms that the committees of jurisdiction can deal with and should deal with. but i also believe that getting an agreement right now to extend this is very important. just this fall, the joint economic committee, the democratic staff put together a report entitled "assessing the impact of the great recession on income and poverty across the states." obviously it outline and highlighted the poverty increases for all americans. but i thought it was unfortunately emblematic to highlight just one or two of the points. one of the summaries in the report itself talked about

children living in poverty. and here is the conclusion. the percentage of children living in poverty increased in 42 states. and that was measuring starting in 2007. so this is really about families that lead lives of struggle and real pain. and i think it's important that we recognize that. i also think it's important that as we focus on the needs of this population of folks out there that are still struggling, that we come together in a bipartisan way to extend this. so i'm happy to be part of this effort on this conference committee to extend temporary assistance for needy families, especially as it relates to children who have suffered so terribly in this recession. thank you, mr. chairman. >> thank you, bob. you want to say anything?

we may have a word to say later, mr. chairman. >> we have quite a bit of time left. i'll recognize now mr. levin. >> thank you. by the way, congressman van hollen is at a budget committee hearing, so he decided to stay there for a bit. i told him i thought he was using wise judgment, because the importance of that, and he'll be here as soon as possible. we need to extend this program to pick up senator casey with your comments. the last year we have the data for, 2010, only one in five poor children were receiving tanf assistance. one in five. and that's the lowest level since 1965.

i think it also should be mentioned that despite the depth of the recession, and these are the figures that i have, that since the summer of 2008, the tanf caseload has increased only rather lightly from 2008 july through 2011 june, the tanf caseload increased 15%, roughly 250,000 families. and this is at a time, as i said, of exceptionally high unemployment. and we're now trying to gather the figures. we don't have them. as to how many people have exhausted their unemployment insurance. but it's far larger a number than those who have become part of the tanf program. so this i think underlines the

absolute importance of continuing the unemployment insurance program in this country. and that's why we very much voted against and criticized the house republican bill on ui which would eliminate 40 weeks of unemployment insurance and would lead to almost three million people losing benefits compared to the extension of the present program, almost three million. so tanf is an important program. it hasn't been the safety net or the subsist assistance base for hundreds and hundreds of thousands of people who have