language that was put in the appropriations act. but you do leave no part of any appropriation contained in this act shall be used to pay the salary expenses of federal, state, but you do leave in for locals. congress and the state legislature, but you strike local? so you take that language out so it seems that you're -- that the proposal of the grant access to the local because it says in the law that no money shall be enacted by congress without express authority by congress. so it appears the way i read this that you're asking for authority at the local. but anyway, but the current law the way i read it, now that's going forward. obviously it's not enacted because it's a proposed budget, but the grants were put out under the existing laws as you said. i think you said it applied to you but not the grantee when at the end of his comment. you said that the language applied to us, i guess meaning the government. but not the grantee? i'm not exactly sure what you meant by that.

>> the original language that has been part of the law that we have administered and had our grantees administer it applied to grantees lobbying the federal government. that's part of the underlying law. what is added to our appropriation bill in 2012 and what i was trying to explain is that no new prevention grants have been issued under this new language and we are retraining grantees is that prohibition for grantees to lobby at the local level or the state level is now an additional piece of the law that was not part of the underlying statute. that's new. we will administer the directives to grantees to comply with that. there have been no funds that have been issued under the new law and i think the pages of examples which began to be

recited were grantees who are lobbying at either the state or local level, not lobbying the federal government. >> okay. well, it says -- the current law that you cannot use the grant money, and in my manner of congress or jurisdiction to favor any ratification policy. so i don't think -- current law doesn't limit you to congress. but any lobbying. because u.s. code 1913, so the point is -- that's the way i read it. well, i have it. it says any member -- a member of congress, a jurisdiction or an official of any government to favor or oppose vote or otherwise. maybe that's the misunderstanding because in the recovery act on the website, one is connecticut said a grass roots koertd nater spent 1 --

coordinator spent 163 hours to advocate smoke free policies. and in idaho to address obesity through nutrition and says working for proposals in the 2012 legislation for vending machines in the schools. then in the grants -- so that was the recovery act money and then it's gone to community acts. and in the grant proposal says they want to past the policies to enforce affordable. then the new york public funds they want to lobby for the tax on the sugar sweetened beverages. but is the department thinking it's only federal government? >> again, congressman, i apologize. i do not have the existing statute here. i would love to answer this question. i can tell you fy-12 appropriations through congress that we just have added new

language. >> right. >> the new language which was not part of the underlying law applies to grantees at the -- >> based on -- >> it didn't cover what is covered in the new language. >> that may be where we -- i'm agreeing with you that the money that -- you haven't seen grants out with the appropriation language in section 503 -- i know you haven't had a chance to read it, i agree with you, you need to read it. but any member of congress or jurisdiction or any member of any government. and i think that would be state governments and if that's not the case i would like that in writing. appreciate it. >> chair thanks the gentleman and recognizes gentle lady from tennessee ms. blackburn for five minutes. >> thank you, mr. chairman. madam secretary, thank you for staying with us to take these questions. i want to ask you about section

220. and we had section 220 the president supposedly -- >> section 220 -- >> of the obama bill -- >> affordable care ability? >> yes. >> and the president said we'll have transparency and open government and this was a major push. fiscal yeahat the president signed included section 220. this was an important thing we're going to have transparency. going to let you know where the money gets spent. on this bill. yet, is we get the 2013 budget and section 220 has been removed in its entirety. so we have a lot of concerns about what is happening with the transparency components and how the money is going to be spent.

so i would encourage you to look at this and see if you can find out what has happened with the money that was going to be designated to transparency. we'd like to have an answer to that -- if you do not mind. >> i would be glad to do that. >> thank you. i appreciate that. and in light of that, in trying to keep track of where the money is going with this bill, you and i have talked about ten care and the lessons that should have learned from public option healthcare. one of those we repeatedly or i repeatedly discuss and i know you didn't think this was a traditional public option program, but nonetheless, your estimates for the obamacare bill were to be a trillion dollars in spending and now i'm looking at the figures for 2014 through

2023 as being a $2 trillion estimate. so you're running ahead of estimates. forbes is looking at these pr programs being about 30% over budget. forbes had an article out on that. so i want -- you know, our problem with tin care, madam secretary, within five years it had quadrupled in its costs over the original estimates. so how do you see this playing out and what accommodations are you and your team making for this program doubling and then possibly quadrupling in its anticipated costs? >> well, congresswoman, i would be happy to try and get you an answer. i don't know what you're quoting. i don't foe what it's based on so i would be delighted to get you a specific answer. we don't think that the program all double or quadruple in accurate an estimate as we could at every -- >> let me ask you this --

>> two years in we are underspending a lot of the estimates, not overspending. >> as we worked on this legislation, i asked repeatedly if you had any example where spending these near term -- ramaling up the near term expenses had resulted in long-term savings. to my knowledge, you had no example of any program that showed where ramping up these near term expenses would yield a long term savings. were you ever able to find an example because you're running over budget. you have got a budget that has increased 25% since 2008. your estimates are running ahead of what they have been and we have at record spending record deficits, record debt in this country. so if you ever came up with that example i sure would like to see it and i have some constituents that would certainly like to see it.

let my shift gears for just a moment. i want to go to your narrow religious exemption rule and a fee rule out there. "usa today" had a -- an op-ed, an editorial and they made the comment that not only had you crossed the line on religious liberty, but you had galloped over it. i just have to ask you, madam secretary, did you all consult the department of justice before you made this decision? >> which decision are you referring to? >> religious liberty, the first amendment. >> which decision are you referring to? the promulgation -- >> the mandate to the catholic churches. i think you know what i'm talking about. >> we have consulted with a number of people.

did we consult before we finalized the rule on prevention? >> yes, ma'am. >> with the department of justice, no, we did not. >> you did not. okay. thank you. my time is expired. i yield back. >> chair change the gentle lady. chair recognized the gentleman from pennsylvania, dr. murray for five minutes. >> thank you, madam secretary. i want to follow up on the religious freedom first amendment issue as well. if an employer is saying that he or she cannot find it in their conscience in terms of practicing their religion that they cannot pay for a plan or have a plan that allows for or requires provision of abort afaceant drugs do they pay the $2,000 tax for not having it or

the $3,000 tax for having a plan in violation? >> there is no penalty attached to the provision of preventive care. there certainly are penalties for employers who don't comply with the law. there also is no abortifacient drug that's part of the contraception -- >> that's not true. >> well, the scientists -- >> is the morning after pill or something like that an abortifacient drug? >> it's a contraceptive drug -- >> yes or no? >> it is not an abortifacient. it does not interfere with a pregnancy. that's the definition of the abortifacient. >> i appreciate that's what your terminology. >> that's what the scientists -- >> we're not talking about

scientists here. i'm asking you about a religious belief. in a religious belief that is a violation of a religious belief based upon those in that religion. so if an employer says i cannot have this plan provided for by the employer, whether it's paid for more directly or someone says it's going to pay for by somebody else, do they play the $2,000 tax or $3,000 tax per employee? >> the rule we plan to promulgate around the immeltation will require the insurance company, not a religious employer, but an insurance company to provide coverage for contraceptives for employees who choose to access that -- >> ma'am, that's not what i'm asking you about. this is very important. this is a first amendment issue. which you keep talking about these things in a different way. let me try and help to make this clear.

if -- one of the things that i think you say if an organization has people within the organization that are not part of that same faith value system, that they therefore couldn't claim an exemption, am i correct if that? let's say catholic charities has employees who are not catholic or a jewish hospital may have doctors who are not jewish or catholic charities may provide services to non-catholics. that they therefore could not claim a religious exemption. is that correct? >> they will fall under the secondary rule of the religious objection to the service. >> but under that they still have to provide the objectionable medical services. >> absolutely not. the religious employer who objects to contraception because of religious beliefs will not provide, will not pay for, will

not refer employees to an objectionable service. on the other hand, the insurance company -- >> ma'am -- >> will provide the service to -- >> let me make sure i understand this correctly. if a child in school -- >> uphelds religious liberty -- >> no, no, you're wrong. you're wrong for this reason. you're setting up a rule that not even jesus and his apostles could adhere to. jesus was jewish and said, you know what, because you're not bringing religious people into the fold you can't do this. if i go to a tire store, it was three three get one three tires. i know i'm paying for the extra tire by the other three being b pumped up or the costs going up somewhere else. i'm searching for ways to make

sure you understood it. whether or not you have someone else pay for it or under the guise of being free, as long as it's imposed on someone to have this available that is still a violation of their faith which gets into the first amendment. i don't understand why this isn't clear. >> well, first of all, i think that the tire analogy is not quite accurate. >> who's going to pay for -- who's going to pay for the -- >> providing -- we know because it was done in the federal employee -- >> who pays for it? there's no such thing as a free service. >> the reduction in a number of pregnancies is compensates for the cost of contraception. the overall plan -- >> by not having babies born we're saving money? i want to get this on the record. so you're saying by not having babies born we're going to save money in healthcare? >> providing contraception as a critical preventative health benefit for women and for their children reduces health care --

>> not having babies born is a critical benefit. this is amazing to me. i yield back. >> family planning is a critical health benefit -- >> you said avoiding pregnancy. >> according to the institute of medicine. >> it's about religious freedom. >> the chair recognizes the chairman from new jersey, mr. lance, for five minutes for questions. >> thank you very much, mr. chairman. madam secretary, the president's budget requests the level of exclusivity for follow-on biologics, reducing it from 12 years to seven years. and i think that that might be counterproductive and i'm wondering whether you would be willing to re-examine that. and in a bipartisan basis, this committee has repeatedly indicated that it favors the 12-year period. there was a bipartisan vote of 47-11 on that issue in this committee.

>> well, i think mr. lance, this is an important and ongoing dialogue. the balance of making sure we protect research and development, making sure that companies can in fact make a profit when they find a successful strategy and opportunities for patients to have an affordable option that may be life saving is i think what's at risk here and certainly i think there is a difference of opinion of whether 12 years is the appropriate time, whether seven years adequately compensates companies and yet makes more cost affordable options available. >> thank you. i would encourage you to work with us on that. >> i would be glad to. >> i appreciate any work we might be able to do together on that. we're hearing from those who have to implement the new summary of benefits and coverage

requirements that the time period may be difficult to meet. given the fact that employers and plans need to get this done, and if they don't comply there are significant penalties might the department consider any sort of delay of the nonenforcement period? >> well, i think the -- again, the essential health benefits are critical component. we put out very detailed guidance because we were hearing from a lot of states from insurers and saying, tell us what's going on. i think the strategy of suggesting that a benchmark plan already marketed and in place in a state is a really accelerated strategy. this is not something that has to be started from the ground up. this is an ability at a state level to choose a plan, the most popular small employer lal heth

state health benefit plan that is in place, is marketed, is priced at the state level. we made it very clear in the guidance that this is what we intend to propose. we're trying to get as much feedback as possible from insurers and states. we have had a robust discussion and in the near future we'll be issuing the interim rule. >> thank you. regarding the supreme court argument on the healthcare legislation, undoubtedly the sew his iter general's case will be arguing that. is it exclusively the solicitor general? >> it's the solicitor general who will be involved in the oral argument. >> thank you. i'm willing to yield back to any member who is interested in further questions. thank you, madam secretary. >> thank you. very kind of you to provide additional time. you were here before and we talked a little bit about the difference between a voucher and

premium support and you had some difficulty arctic dating a difference between the two. i'm going to try to help you because of course under try to because of course under the exchanges, you will provide a subsidy. but that subs city not coming in the form of a check or cash to a household. there will be presumably some acknowledge thamt this help is available to help you purchase your insurance so that might be regarded as a voucher, a coupon that you could take to the exchange, and in return you get a discounted price for your health insurance. a premium support, i don't know, you might have your insurance through the federal employee health benefits plan. many people in the administration, the agencies do. that's premium support where the fehbp goes out, takes requests for proposals from all of these different insurance companies. there is in fact a bill, hr 360 members of congress are going to be required to buy their insurance in the exchange after 2014. members of the administration,

members of the federal agencies are exempted from that requirement. you, in fact, could experience the world of a voucher versus premium support by supporting hr 360, which would move all members of leadership, leadership staff and the administration and the agencies from the fehbp into the exchanges. would that be a good idea? >> we'd be happy to look at it. >> i would appreciate your response. >> thanks, gentlemen. that concludes the first round of questioning. we'll now go to doctor christiansen who is member of the committee who has sat patiently since the beginning of the hearing for questions. >> thank you. i really appreciate the opportunity to sit on this hearing and your generosity in allowing me to participate. and welcome, madam secretary. >> thank you. >> your being here gives me an opportunity to formally and publicly thank you for the unprecedented efforts that the department has taken under your

leadership to end inequalities in health care and health status through your national strategy to end health disparities. on the other hand, i want to just say briefly that the 2013 budget does raise some concerns about our ability to meet the goals that you have set out. but i also know across the budget that bohm has worked with agencies to -- wherever there are cuts to take steps to ensure that important programmatic activities are not really cut as might appear, that they don't suffer, but are covered in other ways. and five minutes doesn't give me the opportunity to go through those areas of concern. but would you be willing to meet with the tricaucus to go over some of those areas and show us perhaps where steps have been taken to make sure that those program@ic have not been cut.

>> we have tried to work carefully with members of congress who have tried to share our concern about the health disparity issues, present around the country. and we have lots of strategies and agencies hard at work closing those gaps. and for the first time ever, have a national strategy on health disparities that is a real action plan. so we would be delighted to go over that with you and meet with you about it. >> thank you. and the president's budget proposes a single blended federal matching medicaid rate. i'm sure there are different opinions about that. but i think the time has come for the territories have the same methodology used for setting our match. and we did have that included in the house version of the affordable care act. and the senate actually agreed to it, but we were unable to get it done because of just technical reasons in how both bills were structured. if given the authority, would you be supportive of setting the

match according to the way the states are done on the average income? right now we are a 50-50 match in statute. and that's very difficult. would you be supportive of having the authority to set our match as the states has set? >> we would certainly be happy to work with you. i know it's a huge issue for the territories and the islands. and we are working on that. the framework does not allow us to do that, and we do not have the budget to do that currently. so we would be happy to pursue that discussion. >> if we went into if blended rate, if that does take place, it's my understanding you need about two years of history to be able to make the determination. so it would be helpful -- we wouldn't mind going into the blended rate if that takes -- if that's the way we're going to go. just one more question. the two new institutes at the nih, one is the one you mentioned on translational medicine, and the other one is

the national institute for minority and health disparity research. one created administratively, the latter and the minority and health disparity institute by the affordable care act. the budget for the national institute for minority and health disparities is one of the lowest ofll institutes, and that's despite the major initiatives that we have to help eliminate health disparities. is there language in budget, or would you accept language to bring the national institute of minority and health disparity research on par withe and i do know that the research centers on minority institutions -- that program was transferred to the institute. and even funding with it. but even that funding was insufficient to support the research centers. so it remains underfunded under the institute. so i didn't -- is there language

that would bring the national institute on minority and a health disparity research on par with the others, or woulouccept? >> well, again, congresswoman, i think you've identified that the transfer along with staff and budget actually has significantly enhanced this whole effort over where we were a few years ago. we would be happy to work with you around ideas and strategies for continuing improvement, but there has been kind of a big move forward i would say from where we were when we began this conversation. >> okay. but my understanding is it is still, you know -- it's still underfunded even -- even with moving the rcmin. so we appreciate your willingness to work with us, madam secretary. >> thank you. >> and thank you for your testimony and your answer. >> thank you. >> the chair thanks the gentlelady. we have one follow-up on each side if you can stay for that. >> and mr. markey too. >> and mr. markey has come in

and would like to ask a question. gentlemen, mr. markey is recognized for five minutes for questioning. >> thank you, mr. chairman, very much. this is my 36th year on the committee on the health care committee. so it's been a long time trying to get to this point where we actually have plan to deal with the long-term health care problems of our country. and amongst those includes the national alzheimer's project act to deal with this very important issue that costs the federal government, medicare and medicaid last year spent $130 billion on alzheimer's patients in america. unbelievable amount of money. and that's with only five million americans having it. by the time all the baby boomers have retired, the cost is going up to maybe $600 billion a year just on alzheimer's patients if we don't find a cure for it. and it's obviously a budgetary

crisis that is looming. and last week, madam secretary, we thank you. you issued your draft national plan pursuant to the national alzheimer's project act, which i'm the principle house author of, along with congressman smith. and i think it's great, you know. the one thing i wanted to talk about here today is that at nih, the $6 billion a year spent on cancer research, and $3 billion a year spent on aids research. but only $489 million on alzheimer's, even though 15 million baby boomers are going to have it. we have to find a the cure. so madam secretary, i congratulate you and the mission on announcing the addition of $80 million more in this coming year's budget on the -- on the research for alzheimer's. i think that that is absolutely

a critical and i congratulate you on that. i j it has to be dramatically higher. and if there is one thing we should just single out and say this has to be spared, it's the nih budget. that just has to go up and up and up, because the national institutes of health are really the national institutes of hope. in alzheimer's there is really going to be a mel katzify that hits this country when all the diseases we've been successful helping to cure lead to people living so long that half our population winds up in retirement with alzheimer's. it's going an absolute disaster, and it's going to cost us a fortune. and the second thing, madam secretary, is in the affordable care act, i was able to include language for an independence at home pilot project. and there are n