just with moving the rcmi in. so we appreciate your willing tons work with us, and thank you for your testimony. >> thank you. >> we have a follow-up on each side if you can stay for that. >> and mr. mark too. >> thank you very much. >> this is my 36th year on the committee. on the health care committee. so it's been a long time, trying get to this point where we have a 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, that is with only 5 million americans having it, by the time the baby boomers have retired the cost is going up to just $600 billion a year just on alzheimer's patients if we do not find a cure for it. it's a budgetary crisis that is looming. we thank you for issuing your draft, national plan, pursuant to the national alzheimer's project act which i'm the principal house author of, along with congressman smith. and i think it's great, one thing that i wanted to talk about here today is that at nih, there's $3 billion spent on aids

and less than that on alzheimer's and so we have to find the cure. i congratulate you on announcing the addition of $80 million more in this coming year's budget on the research for alzheimer's i think it's absolutely a critical thing. and i congratulate you on that. i just think it has to be dramatically higher. if there's one thing we should 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's going to be a medical disaster coming. all the things that we have cured have us living so long,

that we have a large amount of people in homes with alzheimer's. it will cost us a fortune. in the affordable care act, i was able to include language for an independence at home pilot project. and there are now more than three times as many applicants, that are medical institution that are applying for those slots in order to conduct this experiment. i would like to draw to your attention the fact that the va has already had a wildly successful program that handled 11,000 people in it that reduced hospital stays by 60% and nursing care days by 80%. and so, i appreciate all of your efforts in this area, but i think it could help us to

telescope the timeframe that it will take us in order to put together a program to keep people at home, share it with the institutions that are working hard in partnership to keep them at home, making the patients and their families better able to deal with the disease. i'm looking for wisdom from you on what your agency is doing and how much an importance you see in for our country? >> i want to thank you for your leadership on the alzheimer's issue and continuing to raise it and make sure it's an issue that is focused on as you know, not only is there 80 million new research dollars in the 2013 budget, there was reallocated

$20 million in nih, we have proposed a portion of those funneleds, additional funds, not those funds for care giving and at home care because we know that family care providers are the largest number of providers for family members. but i would share your interest and we look forward to working with you on what is the long-term strategy, how fast can we get there, as you know, timetables were set for the first time in the national alzheimer's plan. there's a lot of agreement that we probably need to move ahead of the pace, at least we have pa -- we have a pace, we look forward to getting the research, and funding and care strategies in place. >> a program for home could save billions of dollars a year.

if we can just verify what the va has accomplished. thank you for your great work. >> recognize dr. burdgess for a follow-up for five minutes. >> i'll point out, this is one of the rare instances of bipartisanship in the affordable care act where we worked with yours of on getting the independence of home language refined and included. so, perhaps there's hope down the road. but, actually, going back to state exchanges for a moment. some states are concerned that without the final rules on the exchanges they are bumping up against a deadline that will be tough for them to meet. they need these rules probably within the next couple of months. if they are able to finalize their issues to meet the deadline. >> and they will have them shortly. >> we have a interim final roll out and we intend to finalize the rule in the near future.

>> so we can look at that for the end of march, april fool's day -- >> shortly. >> they will have them in the next couple of moss. -- next couple of months and they said that they will need them in that timeframe. >> the essential health benefits rule? i'm. >> i'm talking about finalizing the exchange rule, that will happen in the near future, they will have the exchange rule and the medicaid exchange rule, and the essential health benefits rule will be put out in the near future. there's detailed guidance right now that the states are not working on. >> i'll make a prediction that it will not happen until after election day. let's say there's a state that is worrying about what is happening with the federal affordable care act and they are hesitating to set up a state exchange. i can think of a state that may fall into that category.

i may be going there this afternoon. so you are preparing a national exchange for those states that will not either because they have not had time or because they do not have the idea, will not have an operational state exchange? >> there will be a federal facilitated exchange, in some cases operating fully -- >> so the federal government will step in and provide that operational control? >> yes, sir. >> will that be administered through your office or the office of -- >> we will be operating the federally funded exchange. >> there will be a for profit and not for profit offered under the language of the law, is that correct? will there be a not for profit federal exchange? >> no, there will not. no. >> i thought the language of the law said that there had to be -- >> you are talking about the

co-op situation? >> no i'm talking about the federal exchange or the public option -- >> no there will not be a not-for profit. states have that option, it's not at the federal level, sir. >> let me ask you this, a lot of talk about the contraception issue go issue, and the essential benefits. are you proposing that an institution that refuses to comply with your contraceptive mandate, what happens to them? >> sir, i'm hopeful that the rule that we intend to put forward in the near future, which will be informed by conversations with not only religious employers but labor leaders, women's groups and others and actually greatly informed by the 28 states which have a frame work like we are talking about already in place,

will indeed satisfy the religious liberty issues and make sure the benefits are provided. >> are the noncompliers going to be fined? >> as you know, this is a situation where -- >> let me share with you something, it bothers me that for the first time in this country, regardless of what the issue is, and i personally support the issue of contraception, but at the same time, it bothers me that there could be a fine for faith. i do not think that has happened before in the country. >> no one will be fined for faith. this is a issue with -- >> why propose a two-tier system, some churches may be exempt but a catholic church may not, that sounds like the direction you are going. >> the exemption which is in the

rule finalized in february, is the language used in the majority of state laws which have some religious exemption that is a definition that is in the irs code, it's not something that we invented. it's a language of churches and church affiliated -- >> if a statewide sterilization is required for citizenship, would you be prepared to do that at a federal level? >> i'm not going to answer that question. >> bring finish up, mr. witfield had a number of observations that he wanted entered into the record. we would like it accepted with unanimous consent. >> we would like to take a look at it before we agree to unanimous consent. >> all right. wait until you take a look at

that, and recognize ranking member for five questions for follow-up. >> thank you. madam secretary, i want to give you an opportunity to address a follow-up of dr. burdgess and others that said that coverage for contraceptions has become controversial, unfortunately what i thinks that been loft in the debate is an understanding of how the decision was arrived to. i ask you to take a few moments i have four minutes or so to provide the broader picture and tell us about the provisions on preventive health services and women's preventive health services the role of the institute of medicine, and coverage for women's preventive health services and the process in developing the regulations that are now under attack. i know you started into that with dr. burdgess, take the four minutes to explain it a little more. >> well, the affordable care act had a provision that as part of

a definition of essential health benefits, various populations should be looked at. the recommended strategies for children around immunizations would be included. the strategies for preventive health that are recommended by the united states preventive health services task force would be included. and recognizing that too many insurance plans often did not include benefits that were specifically recommended for women's health, we were asked to develop a set of preventive health services for women. we turned to the independent scientifically driven institute of medicine and asked them to make recommendations to us, they came back with eight various health benefits domestic violence screening, mental health visits and the full range

of scientifically contraception services. we promulgated their rules as a strategy as an interim rule and added a religious exemption and to be informed on what language should be used we looked at the 28 states that have some kind of contraception mandate in place right now. often for a decade or more. operationally right now. and we included language that was used by the states in the majority of cases that have an exemption, many states do not have an exemption at all, that language was put out and finalized in february and -- and an additional acommendation was made. we announced that we would have an additional year for religious based organizations who had a religion us -- i mean an

objection to the provision of confr -- of contraception, and we will allow them to uphold their religious predomes not -- freedoms, not pay for or provide contraception. but still make sure that the employees, the spouses of employees, and the daughters of employees would have access to this critical health benefit, so we will be promulgating a rule around that strategy for preventive health services which will be a huge step forward for american women knowing that contraception is the most commonly prescribed drug. 99% of all women of all

religions use contraception at some point in their health lives and if you purchase it out of your own pocket, it can be an expensive strategy if it is provided within an insurance pool, it is no cost, but often reduces the cost of the pool. >> thank you very much. i appreciate it. thank you mr. chairman. >> chair, thanks, the gentlemen, i think that concludes all of our questioning. thank you, secretary sebelius, for again, taking time to be with us today and for all of your answers. i ask unanimous consent that all members opening statements be made part of the record, without objection it is so ordered. have you sen consent request for dr. burdgess? >> they will need some time. >> i remind members that they have ten business days to submit questions for the record and i

ask the secretary to respond to the questions promptly. members should submit the question business the close of business thursday march the 1 h 15th, without objection, the sub committee is adjourned. coming up live road to the white house coverage today ahead of super tuesday, which is this march 6th, this coming tuesday. santorum has a stop in ohio.

live coverage will starts at 7:00 eastern and be on c-span. mitt romney will be live on c-span 2 at 7:00 eastern. ohio is one of ten states that will vote on tuesday. it's the second largest contest on tuesday. the latest ohio poll conducted by the institute for policy research at the university of cincinnati shows santorum leads romney 37% to 26%. >> louisiana govern bobby jindal is going to show his budget. it's mostly cloud id and 37 degrees at the airport. you are listening to shreveport news radio.

this weekend, book tv and american history tv explore the history and culture of shreveport, louisiana, the union army's failure in louisiana from the red river campaign of 1864 and a look at the over 200,000 books housed at the lsu archives. then a walk tour of the city, with neil johnson and on american history tv on c-span 3, from barksdale air force base, a look at the role of the base on 9/11 and a history of the b-52 bomber. visit the founding fathers exhibit and from the pioneer heritage center. medical treatment.

>> rick santorum defended religious life. on the talk shows this weekend, and in speeches santorum responded to comments made by president john f kennedy. >> i believe in an america where the separation of church and state is absolute where no catholic -- and no minister would tell his membership who to vote for. where no church or church school is grantsed any public funds or political preference. and where no man is denied public office merely because his religion differs from the president who might point him or the people who mighty electricity -- might, elect him.

>> more than 100 million americans, adults suffer from chronic pain according to a record from the institute of medicine, doctors at a recent committee examined the medical costs for pain and barriers for treatment and educating doctors and patients on pain relief treatments. >> the committee will come to order. chronic pain is a significant public health challenge that has yet to receive adequate attention, given the tremendous impact it has on people all across the nation. it's estimated that more than the number of adults effected by heart disease, cancer and

diabetes combined suffer from a sort of chronic pain. niece often debill tating conditions impact daily activities, making it difficult for individuals with chronic pain to meet their own basic needs. it pro foundly effects quality of life. it remains one of the most challenging conditions to assess and effectively treat. i will repeat. that it remains one of the most challenging conditions to assess and effectively treat even though it's one of the top reason force doctor's visits. because of the impact of chronic pain we have convened this important hearing today to explore the current state of research, and education with respect to chronic pain and discuss prevention and treatment strategies. as the chair, not only of this

committee, but of the labor and human health sub committee i've been supporting a more research strategy. the nih pain consortium was formed. even though every center addressed an aspect of chronic pain, the various institutes were not coordinating their pain research. this lack of coordination limited the attention given to pain research. and despite advances made by the nih, more still needs to be done at nih and across the federal government to address the unanswered questions, the unanswered questions, surrounding diagnosis,

treatment, and prevention of chronic pain. today he's hearing will largely focus, not exclusively, but largely focus on the recently released report by the institute of medicine. titled relieving pain in america. a blue print for transformi ini prevention, care, education and research. this crucial report examines the issue of chronic bain in america. and identifies barriers to more effective research and treatment and suggests a plan for addressing the barriers. the report advocates for enlightening health care providers patients and the public of the burden of living with chronic pain. and it highlights areas for improvement in pain, research, care, and education. education. we need to do a better job of educating in medical schools and

residencies about the different forms of pain and how they should be treated. and the so-called physical pain, that everyone recognizes, from a broken arm, cancer, where we know the physical source of that pain. but then how about the physical pain for which we do not know the source? irritable bowel, back pain, and so many others, where there does not seem to be underlying physical trauma a but we don't know the source. how do we educate? how do we educate our doctors to understand this? and to make the -- as i say, the right type of assessment and diagnosis. so, i look forward to the testimony of our expert witnesses who approach the issue of chronic pain from a variety

of perspectives all with the goal of addressing in neglected health issue. and it is a health issue, in terms of what it costs the country in term of loss of dollars and loss of quality of life. i thank you for being here today, and i look forward certainly to your testimonies. we will have two panels on our first panel we will hear from dr. lawrence tayback, he serves as the director of the national institute of dental and cranio-facial research, and leads the nih pain consortium, thank you for your service at nih, and your statement will be made a part of the record in its entirety and if you can summit up in several minutes or so, i should appreciate it. and i ask unanimous consent to

leave the record open by the senators that may be coming here later. thank you and please proceed. >> thank you and thank you for the opportunity to testify about pain. one of the most important public health problems facing our nation. i'll highlight what the nih is doing in partnership with other agencies to advance research and treatment and i hope to convey the promising opportunities that science offers to overcome the challenges of preventing and treating pain. pain can provide useful information warning our bodies of potential damage, hour chronic pain can be debill tating, in terms of many long-term diseases like cancer and others. programs the most important modern insight about pain is that chronic pain, however it begins, can also become a

disease in of itself. this recognition of chronic pain as a disease has important imindications for how we structure our systems to provide care for patients suffering from pain. congress took steps towards advancing research, and care and education for people with pain through provisions in the affordable care act. the act directed the secretary of health and human services to establish a committee, the iprcc, the responsibilities include summarizing advances in pain care, identifying gaps in duplicatations of effort across the federal research portfolio and recommending how to disseminate information about pain care. iprcc will hold its first meeting on february 27th. the secretary also engaged the

institute of medicine to issue recognition of pain as a health problem, survey the adequacy of care and recommend how to reduce the barriers to care. the iom report noted that progress will require a better understanding of the biology of pain, improvements in the therapy, development process, and removal of barriers to care in a health care system at large. nih activities drive improved scientific understanding, compliment private sector therapy development and inform the society and care deliver issues that fall in other agencies missions. it coordinators pain activities across the nih and institutes and centers with individual components of nih taking the lead on specific programs. the nih blue print for