better and we should continue to do better in this regard. >> i'm disappointed we do not have a vote in the house at this stage on the senate bill or a bill like that. but let me ask you another question, my last question. and that is, there's some discussion by members, that have asked you questions in terms of your ability to send people back. can you be clear about your fiscal resources to do that right now. what you're capable of. are you capable of sending everyone back? how much do you need? if we're really serious about this, how much do we need to fund your agency so that we can do what the members of this committee are asking you to do? >> well, the answer to that question is reflected in our current budget request. and let me say this, i know that there are some contemplating some form of short-term c.r. for

the department of homeland security to get us to march. that is, in my judgment, a very bad idea for homeland security. because, during that period of a c.r. we cannot engage in new starts. we've got some homeland security priorities that need to be funded now. for example, we're back in a presidential election cycle. i cannot hire new secret service agents until i get an appropriations bill passed by this congress. not another c.r. for a couple of months. i cannot continue to fund our enhanced detention capability in texas with another c.r. that gets me to march. i need the help of congress to support and build upon border security, which i believe all of you support. so, i'm urging that we act on our current appropriations

request now for the -- for the purpose and for the sake of border security and homeland security. >> thank you, mr. secretary, for those direct answers. i yield back. >> chair recognizes miss miller from michigan. >> thank you very much, mr. chairman. good morning, mr. secretary. appreciate your attendance here this morning. obviously there is a huge divide, certainly in congress, and i think out there in the heartland, as well, about whether or not this is a constitutional overreach by the president. and just listening to your testimony, and i read through your testimony last night, and hearing you answer some of the questions, you obviously had a very, heavy, heavy, heavy reliance on the olc's opinion, the 33-page opinion that they issued in here through mr. holder's department of justice. and you said, i wrote a note when you said that they were very, very thorough. but yet it seems to me that the questions that you did ask them were specifically tailored, the three questions that you asked the olc, were very specific in nature, and perhaps there were some questions that you could

have asked that you did not. but i would just -- could you tell us the process in which you actually asked these three specific questions of the olc? because i see some of the states are going to be suing. i'm sure this is going to be a question probably determined by the courts, and you -- your department had such a heavy reliance on them. >> well, i know from my days at the department of defense, and now, that the way we typically work with olc is to put to them specific questions. do we have the authority to do "x"? do we have the authority to target "x" "y" "z" military objective, for example? and so, we developed the two or three most significant questions that would be part of this executive action package to be put to olc for them to consider. they came back with this very thorough opinion, and i will say

that as a lawyer myself, and as someone who's been a lawyer for a government agency i'm fully comfortable with what's been in here. i know i'm going to have to be the one to defend it. >> well, if i could, in 2012, when the -- this administration created the daca policy, there's nothing that we could find of any opinion from the olc regarding that. just would seem to be sort of a glaring oversight from there. so there's -- is there such a memo? if there is such a memo we would like to see that. >> i can only speak to 2014. and we wanted to be thorough -- >> but certainly as you were looking at this you would have asked olc was there ever a memo in regards to daca? never asked that question? >> i am not aware of one. based on everything i've asked and been told i'm not aware of one, have not seen one. i wanted to be thorough this time around though. >> we think there was a glaring omission about that, as well. and again in regards to the olc and this will be determined in the courts i think, since i mean

i certainly believe this is a constitutional overreach by this administration, and as i say, it appears that some of the states are going to court on that. i was also taking notes here, secretary, as you mentioned, about the fees. the $460 fee. i did some quick math, probably not right, but times 4 million, $1.84 billion. just wondering, because you're again the olc is saying you need to do it, guarantee it, on an individualized case by case review is what they're saying. so is some of the questions even this morning we're talking about the limited amount of resources that you have, so are you going to do 4 million case by case reviews. how in the world are you going to pay for this? really is that going to be enough? i mean right now you have a couple of dozen field stations. i'm not quite sure the mechanics of doing a case by case review and i think that will be such an important critical component for the department so that you're not just doing a free for all, and just rubber stamping and

really taking a look at all of this. so how do you envision that all unfolding as you do a caseby case review of over 4 million individuals? >> we have an implementation period of a start-up time of six months. daca was 60 days. we determined that for this one we needed six months to make sure that we get it right. we know from the daca experience that the program, if the fee is set at the right level, will pay for itself. so the fee for daca is $460 per applicant. and that's the same fee that we'll be charging here. with regard to the number 4 million, let me say this, 4.1 million is the estimated potential class of those who would be eligible. not all of those will come forward. as the daca experience shows. the estimated potential class of daca kids is over 1 million. but the number of those who are

actually enrolled is somewhere around 600,000 or 700,000. then of those who come forward some will not qualify because they didn't survive the background check or for some other reason they didn't establish proof of living here for five years. so the number 4.1 is the estimate of the total potential class. but not all of those will be enrolled in the program. >> thank you very much. i think my time's expired here. thanks, mr. chairman. >> thank you. chair recognizes mr. barber from arizona. >> thank you, mr. chairman, for convening this hearing, and thank you, mr. secretary, for being with us today. i want to start by just saying how much i appreciate, and i think i'm going by other members on both sides of the aisle of this committee, how much i appreciate the forthrightness with which you approach the questions and the concerns that we have, and the leadership you've provided to the department over almost the last year. as you know, mr. secretary, you visited my district within a

month of your appointment, your confirmation. and you saw firsthand, you heard firsthand from people who live along the border, work along the border, what their hayne issue is. they are concerned about people coming here illegally, seeking work. but they're even more concerned about the traffic of drug smugglers, and the potential violence that comes with them. that's one of the reasons i co-sponsored along with many members of this committee the border security results act which passed unanimously here. it's important to stress, unanimously in this committee. it has yet to be brought to the floor. i also co-sponsored with almost 200 other members hr-15, a bipartisan bill that would include the border security results act, and the immigration provisions of the senate bill which passed bipartisan passed the senate. i've said from day one that the

congress needs to act, and we have failed in our responsibility to act to secure the border, and to fix the broken immigration system. and because of that failure, unfortunately, executive action has been taken. i believe it should be done in concert with congress, but we have failed in our side of the bargain. i fully support the mccain flat bill which is sitting there ready for us to take up. could you, mr. secretary, initially my first question is, could you address how the executive action korts with the mccain flake bill particularly as it regards border security and immigration. i know it's not comprehensive, it can't be, but to what extent was that bill a template for action that can be taken and must be taken to security the border, and to fix the system? >> well, the executive actions that we have taken are no substitute for f-744 which does

a number of things, including an earned path to citizenship. that's what's contemplated in the bill. we do not have executive authority to provide an earned path to citizenship. we do have executive authority to provide deferred action to those who have been here for years, similar to the bill who have not committed any crimes and basically become integrated members of the american society to offer them the opportunity to be accountable. that is not citizenship. that is not permanent residence. it is simply you are deemed lawfully present in the country for a period of time. we also are, through executive actions, enhancing border security in a number of ways, but again, border security is something that's not cost free. so, we've reprioritized recent

illegal entrants, which we plainly have the authority to do. but i need help with resources. i need help on the southern border in arizona, in texas, new mexico, for added detention capability, added surveillance capability, added vehicles, added equipment. and i'm hoping that congress will support me on that. i received your letter about the eastern border along arizona. and i plan to, if you'll have me, come back early next year to arizona. i owe the ranchers another visit. and i want to come back to arizona now with the year's did the benefit of the year's experience in the job, to talk more about border security and see what we can do. >> i appreciate your willingness to come back, and look forward to having you there. let me just focus in my remaining time on the issue of border security. i think the answers, from my experience, having worked on this issue for congressman

giffords in my own right is pretty straightforward. border patrol agents at the border, not 10, 15, 20 miles back on the defense, in that strategy which i think has failed in that area. more horse patrols in the rugged territory. arrow statistics that will allow us to have radar looking down into the mountains to see where the smugglers are coming from. more mobile surveillance systems at the border. and i hope that your task force that you've established, the western task force, will look at these strategic options, and include stakeholders such as ranchers, business people, residents of the communities there, as well as others, to make sure we get it right going forward. thank you. >> congressman, i can affirm for you when i talk to border patrol myself, the one thing they mention always, aero stats so i believe that's a border security priority. >> thank you mr. secretary. thank you mr. chairman. i yield back. >> the chair recognizes the gentleman from south california mr. duncan. >> thank you mr. chairman. thanks for holding this hearing. it comes as no surprise that i

disagree with the president and what he's done with this executive action. it's not as much the issue of immigration, and dealing with undocumented workers, as it is what he actually did. i think he crossed a line with constitutional separation of powers. but, i hear a lot of double-speak. in his speech, and in the words that i've heard today. i give you an example. the president said in his november 20th speech about this unconstitutional executive action that undocumented workers broke our immigration laws. and i believe that they must be held accountable. that's directly from his speech. felons, not families, criminals not children, gang members, not a mom who is working hard to provide for her kids will prioritize just like law enforcement does every day. but, in the hill publication may of 2014 it documented that dhs released 68,000 illegal immigrants with criminal convictions. immigration and customs

enforcement officials last year released 68,000 illegal immigrants with criminal convictions. that comes from an end of year weekly departures and detention board. how do you reconcile, mr. secretary, what the president said, with the actions of the agency? >> well, with regard to those who are released from immigration detention, this is something i've worked on myself. first of all, there is a supreme court case, savadas versus davis which you may have heard of, which mandates that after six months, if the person is not going to be repatriated in the foreseeable future, we have to let them go. >> so why aren't we repatriating these people? >> well, that's something that requires a willing partner on the other end. which i've had conversations with the state department about to further encourage countries to take these people back faster. >> and we had a hearing in the foreign affairs committee about that last week and those countries should take these.

i mean they're required to take these back. i didn't enter -- >> may i finish my sentence. yeah, thank you. a number of releases are mandated by law and supreme court jurisprudence. a number of releases are ordered by an immigration judge. with regard to the instances where an immigration official who works for me releases somebody with a criminal regard, what i've recently directed is that the approval for that be at a higher level of the i.c.e. field officer. i want to know that we're applying a consistent standard to those circumstances, because they jeopardize public safety, and i've also directed that a person should not be released because of reasons for fiscal constraint, which is what we faced when we had sequestration in fy-13. we will find a way to pay for it if we believe somebody should not be released for reasons -- >> i think some reports came out, mr. secretary, that sequestration really had nothing

to do with the release of folks last year. i could go back and find the documents. let me ask you this. at the end of the year of 2014, how many criminal aliens have been released? what will your year-end weekly departures and depension report show for 2014? >> i believe it's less than fy-13. fy-13 i believe was 36,000. i think the number for fy-30 will be about 30. and i think it should be lower. >> so about 30,000, plus or minus criminal aliens have been released? >> pursuant to legal requirements, orders of a judge, i believe it should be lower. which is why i've enhanced the approval authority. i've raised the approval authority for that. >> i think the -- one of the biggest problems with getting any kind of immigration issues passed through the united states congress is a lack of trust of the american people in the administration to enforce the laws. they have told me, and i know my colleagues have heard it on both sides of the aisles, why would you pass another law when the administration fails to enforce the current laws that are on the

books? why pass another one that's not going to be enforced either? and then, you hear about 68,000 illegal -- criminal illegal aliens that have been released. that further erodes the trust of the american people. the american people want to see border security. they want to see deportations. they want to see enforcement of the law. and when they see that 50%, 50%, 49% i'll give you that, of the illegals in this country are visa overstays, these are people that we're not chasing a footprint in the desert, we know who they are. we've got their name. they've had an interview at a consulate or an embassy, they came here on a visa. we know who they are. that's low-hanging fruit for enforcement. so i ask you how many of the visa overstays are granted immunity through the president's action? any? >> offhand i don't know. i don't know the answer to that. congressman, i will say this, though, i'd like to see a -- i'd like to see this congress pass a bill. i'd like to work with congress

on passing a bill. the president has said that would be his preference. the problem is we have no partner -- >> i think congress can pass a bill when the american people start regaining trust in the administration to actually do their job and enforce the laws that are already on the books. and i yield back. >> chair recognizes mr. o'rourke from texas. >> thank you, mr. chairman. mr. secretary, i want to begin by thanking you for your accountability. you mentioned you've been before congress 13 times in the 12 months you've been here, five times before this committee. your responsiveness to our requests, and the questions and your commitment to transparency, i think there's a long way to go still within the department, but in the last 12 months we've seen more transparency than we've seen in years. and so i really appreciate that. and through you, i want to thank the president for this very difficult decision that he made, a very imperfect decision by its very nature. a temporary way to address some of the fundamental problems that require a legislative response.

but i think the status quo is untenable. as you and others have said, it tantamount -- it amounted to effective amnesty, and we're going to gain some accountability. and we're going to bring families and people who are working in our communities out of the shadows, and a community like mine, el paso, where 25% of the population are immigrants, more than 40% of the kids who live in my community are raised by parents who are immigrants, this is going to be a boom. it's going to make us more secure. a city that's already the safest city in america today, and i tell people not in spite of the number of immigrants who are there, but in large part because of them. so on behalf of the people i represent, i want to thank you, and i want to thank the president. i do, however, want to address an issue that congressman smith and duncan brought up, and that is the release of convicted criminals, senator cornyn and i

wrote a letter to i.c.e. and have yet to receive a response, almost a month ago, with important questions about the status of those who have been released, where they are, how we improve our working with local law enforcement so that our police and sheriff's departments know when these criminals are released and are able to track them and account for them. so we just appreciate your commitment to getting me and senator cornyn response to that. >> part of the -- one of the things i've directed when it comes to releases of those with criminal records is that we notify local law enforcement when that happens. that's part of -- that should be done. i will personally look for your letter from you and senator cornyn and make sure it's responded to promptly. if it hasn't been already, i will look. to make sure we have a general rule of responding within 14 days to members of congress. >> and mr. secretary, i'd like to -- to make a point, and try

to turn it into a question about the president's response to the immigration system thus far. i feel like there's been this implicit political bargain where there's going to be stepped-up enforcement and deportations. i believe this president has deported more people from this country than any president prior, 2 million at this point. and unfortunately, many cases that's breaking up families. which this current action, i think, will help reduce. and i think the bargain was that, in return we were going to be able to gain the trust of both parties in congress and be able to pass meaningful immigration reform. now that obviously has not happened. and so, i'm concerned about some comments that you've made, and the president has made, about stepping up border security about prioritizing the deportation of recent arrivals. i spent some time in artesia at

the deportation center there -- i'm sorry the family detention center there which has really effectively become a deportation machine. i think we are shortcutting due process, and i think we threaten to return families and have returned families and children into some very dangerous situations. certainly there are those who should be deported. but certainly there are those who qualify for asylum in our country, and i think we need to honor that process, so, when you mention the facility in dilley, texas, i want to make sure that in our effort to satisfy security concerns, we don't shorten due process for those. when it comes to border security you and others have said the border has never been more secure. we're spending $18 billion a year, 20,000 border patrol agents. in the el paso sector the average agent apprehends 4.5 people a year. not in a week, not in a month, but for the entire year. so when we talk about stepping up border enforcement, and this

southern border campaign strategy, i'd like to know what that means for my community. is that simply repositioning resources along the border, as my colleague congressman barber said, moving the border patrol up to the line of the border? instead of being set back. or are you asking for ultimately more border patrol agents, more walls, more of these militarization measures which i think show us that you have a problem with diminishing returns right now. you mention 1.6 million apprehended in 2000. not even 500,000 this year. at what point do we have enough security on the border? >> first of all, i've been to artesia myself. that facility there. it's being closed. i want to make sure we have adequate ability for effective

attorney/client communications. we've made some enhancements there. but it's being closed in lieu of a larger facility in dilley, texas, as i mentioned earl yerp. i want to make sure that the conditions of detention there are adequate, and meet the appropriate standards. i believe that added detention capability on the southern border, and some disagree with me, is essential to border security. and it's essential to border security going forward in the future. it is correct that apprehensions are way down from where they were 15 years ago. resources are way up. but i believe we can do better. and so, i'm not going to sit here and declare we have a secure border. we can do better. and i think we know how to do better. and the congress and the executive branch together can

spend the time and effort to do better on border security. we've made great strides but there is more to do. our border -- southern border campaign plan is not simply repositioning assets. it is to bring a more strategic, consolidated approach toward how we secure our border, bringing to bear the assets across my department. not in a stovepipe fashion, but in a more coordinated way, region by region, so that there is one person in the southwest who is responsible for bringing to bear all of the assets of my department on border security in arizona, new mexico, and in texas. >> gentleman's time expired. chair now recognizes the incoming chairman of government reform and oversight mr. chaffetz. >> thank you for holding this hearing. mr. secretary thank you for being here. i hope you're able to convey the love and gratitude for the men and women who serve in the customs and border patrol, the

i.c.e. agents who put their lives on the line every day for this country, we thank them for their service. my question for you mr. secretary is what do you say to someone who believes the president took action to change the law? >> we did not change the law. we acted within the law. >> can you play the clip. this is from november 25th. this is the president in nevada. talking about this. >> but what you're not paying attention to is the fact that i just took an action to change the law. >> so you say he didn't change the law. but the president says he changed the law. >> he acted within existing law. he acted within our existing legal authority. listen, i've been a lawyer 30 years. somebody plays me an eight-word excerpt from a broader speech i know it to be suspicious. okay.

that was very nice. >> it says, i'm going to read it back. now you're absolutely right that there have been significant number of deportations, that's true. but what you're not paying attention to is the fact i just took action to change the law. so that's point number one. point number two, the way the change in the law works, and he goes on. he's pretty clear, and he is the president of the united states. i -- this is why we have a hard time believing that homeland security is doing the right thing. i think the gentleman from south carolina made a very good point. let me move to something else real quickly. you and i had an interaction last time you were here about the poor people with ties to a terrorist organization were caught illegally crossing the border into texas in september. you said they would be deported. did you deport them? >> no. not at this point. >> what is the disposition of those four people?

>> two are detain ed. the two others were released by the judge, not my preference, they were released by the judge, and they fled to canada. and they are seeking asylum in canada. >> so, you told the world that you were going to deport these four people with ties to a terrorist organization. that's not what happened. two of them were released -- >> they were in deportation proceedings. an immigration judge released two of the four. and they fled to canada. my intent is that they be deported. but two of them are in canada seeking asylum. >> where did these two wshs where were they anticipated going and where did they actually go? >> i'm not sure of there exact whereabouts, sir. >> but they're currently being held in canada? >> that is my understanding. >> are you going to ask that

they be brought back to the united states? >> i don't generally get involved in individual immigration cases. >> but these people had ties to a terrorist organization. >> i think as we talked about this last time, there's some question about whether their affiliation is with what one should consider a terrorist organization. >> it is a terrorist organization designated by the state department, correct? >> they are or were a member of the kurdish workers party. >> that is designated by the state department as a terrorist organization, correct? >> i refer you to the state department. >> and that is the accurate statement. mr. secretary, this is the problem. you come and you say -- you tell the world you're -- that you're going to deport these four people tied to terror -- these are terrorists. and you don't. they get released! they go to, my understanding is they go to arizona. they go to the state of washington. they cross illegally into

canada. they each put up $25,000 bond. doesn't that beg a lot of questions about what you're doing in deporting criminals? these people have terrorist ties. and i'm getting tired of the democrats with this righteous indignation saying that we can't find a congress we can work with. well the first two years of the obama administration the democrats had the house, the senate, and the presidency. and they did nothing on immigration. i sat on the subcommittee. they brought stephen colbert in to testify. that's how bad it was. so the country made a change. we actually passed immigration bill. it was my bill. nearly 390 people voted for it. it's as bipartisan as it gets. worked on high skilled immigrants, dealt with family based visas, took the per country cap from 7% to 15%. it went to the united states senate under harry reid, it had nothing happen to it. nothing. so i want to continue to work with this administration. there is common ground that can be had. but the president and the record

is clear. when they had the chance with the house, the senate and the presidency, they didn't even introduce a bill in to the committee, let alone bring it through the process. i appreciate the time. yield back. >> chair recognizes mr. -- >> chairman, may i offer something into the record? >> yes. gentle lady is recognized. >> thank you, mr. chairman. there are three articles or letters or statements emphasizing the approach of the president in deporting felons and not families. one is from the national immigrant justice center, dated december 2nd, 2014. from the american immigration lawyers association, dated december 2nd, 2014. and from the southern border communities coalition, aclu, dated december 2nd, 2014, ask unanimous consent to submit these statements into the record. >> without objection so ordered. i want to remind the members of this committee that the secretary has 30 minutes left. so if you can keep your remarks

as short as possible. with that. >> mr. secretary if i'd known we could have played clips that i was reminded of the scene from cheech and chong with the background music coming to america. if anybody has interest they can probably find it on youtube. but i, too, want to thank you for your accessibility since having taken office. and i just want to say that since we've been dealing with you and your staff, we've seen marked changes in progress between communications between this committee and yours. i think with respect to the idea of border security, the fact that you were asked about metrics. the fact is, is that this committee, in a fully bipartisan fashion, almost a year ago, passed a border security bill that would have established those metrics, and we've yet to see it on the house floor. we had two weeks left before the end of the year. if that bill was brought to the house floor, you'd have a border

security bill by the end of the year. with respect to the issue of a permanent solution -- and as -- in the context of immigration, the fact of the matter is, is our choices are very stark in my view. there are those who believe that of the millions of people who have been working here in our construction sites, our hotels, our restaurants, and all across this country, that what we ought to do is rope them up and send them back. and there are those who believe that we ought to develop a pathway to citizenship, and a legalization process. what i strongly object to, and remember that i agree we need border security. that's why i voted on the bill that passed this committee, what i strongly object to is the idea that the legalization process ought to be conditioned on border security. because to me, if you define border security as making sure that we prevent people from coming here in the future, i

don't see what that has to do with the people that are already here. i also cringe when i hear the word border crisis because in my view, what we're talking about is three separate crises that are interrelated. that is the crises of drug smuggling, human smuggling and illegal migration. the fact is that those are crises that do not end or begin at the border. they begin with conditions, economic conditions in mexico and central america, and issues of cartel violence in central america and mexico, as well. and they end with our demand for drugs on this side of the border, as well as the fact that when you consider the fact that over 1,000 cities across this country, the fbi statistics shows that there is a cartel presence. so i really believe that if we're ever going to really address the root causes of those three issues, that we really have to start talking about the issues of economic development in mexico and central america,

and addressing cartel violence. and in that -- with that in mind, what i would ask, and this may be coming from left field because i know it's more of a department of justice matter, in the last year, the former governor of mexico indicted in the southern district of texas and an extradition order has been issued by the federal judge down in brownsville, and i would just ask that you do whatever you can with respect to the other department heads to see if we cannot bring this gentleman to justice. because when we talk about drug smuggling, we talk about human smuggling, the fact of the matter is, it's not that they're making the money, it's the people at the top. i yield the rest of my time. >> congressman, may i respond? >> yes, sir. just briefly. i have this thought listening to

you, congressman. negotiating and arriving at an acceptable piece of legislation that addresses our immigration system in a comprehensive way in my judgment should not be that hard. i have in my private law practice negotiated the most complex civil settlements ever on wall street. i believe that if we could just strip away the emotion, and the politics, on this issue, and you brought me the right group of members of the house of representatives, i could negotiate a bill with you. and i'm offering -- i'm issuing that invitation again. i believe we could do it. it should not be that difficult. >> thank you. chair now recognize -- >> thank you mr. chair. mr. secretary, some people say that our economic security is national security. nearly 20 million americans woke up this morning, either

unemployed or underemployed. now the president didn't mention these americans when he announced his plan to grant de facto amnesty and work permits to up to 5 million illegal immigrants. he didn't discuss the competition this would create for them. or the impact it would have on their pocketbooks. and your series of memoranda outlining this policy for him, didn't mention them either. to address this problem and protect the american worker i introduced legislation prior to the president's announcement that would make clear that illegal immigrants benefiting from his executive amnesty are not authorized to work in the united states. when it comes to illegal immigration, the conversation is always about the illegal immigrant. not about the people that it will affect. and you see, mr. secretary, i don't think it's fair, especially around the holidays, to put illegal immigrants ahead

of the american worker. secretary johnson, the president keeps saying that his executive action will boost the economy. so tell me, how will adding at least 5 million new competitors to the workforce make it easier for the unemployed americans to find a job? >> congressman, the fact is, as i'm sure you know, that we have lots of undocumented in this country working off the books. and if that's not apparent, then i suggest you spend some time in a restaurant here in the washington, d.c. area and see for yourself. what we want to do is encourage those people to get on the books, and i will provide them a work authorization so that they may legally continue in the -- >> how does that make it easier for the american worker? we keep talking about the illegal immigrant. here we go again talking about the illegal immigrant and how we can make it easier for them. how does this help the american

worker who can't find work and can't provide for his family? who's fighting for them? why don't we talk about the american worker and what this will do to them, not what it will do for the illegal immigrant? >> well, the economy is getting better. as i'm sure you know. and the question of u.s. jobs, american jobs, is, in my view, a separate issue. what i would -- >> well adding 5 million more competitors for these jobs will make it easier -- >> if i may finish my sentence. the estimate is that the potential class is up to 4 million, not all of those will apply. the goal is to encourage these people, who are now working off the books, and we do have undocumented immigrants in this country working off the books, to get on the books, pay taxes, into the federal treasury, pursuant to a work authorization. the assessment is that that will not impinge upon american jobs with american workers. >> mr. secretary, is it true

that the illegal immigrants who are granted amnesty will not need to comply with the affordable care act? >> the -- those who are candidates for and are accepted into the deferred action program will not be eligible for -- >> so therefore an employer -- >> company -- >> so therefore an employer may have a decision to make, do i keep the american worker and provide health insurance, or pay a $3,000 fine? or do i get rid of the american worker, and hire someone who i do not have to provide health insurance and i won't get fined? is that a possibility? >> i don't see it that way. >> i don't think any employers will see it that way? >> i don't think -- i don't think i see it that way. no, no, sir. >> poll loeg the 9/11 commission report the commission staff issued a report on terrorist travel that made connections between enforcement of our immigration laws and national security. on page 98 of that report, it describes how terrorists would benefit from any form of amnesty.

the report recognized that terrorists in the '90s, as well as the september 11th hijackers needed to find a way to stay in or embed themselves in the united states if their operational plans were to come to fruition. this tells us what we all know, that terrorists want two things. they want to get into this country. and then they want to stay here. mr. secretary, does the president's executive actions facilitate just that by not heeding the advice of the 9/11 commission and its staff? and how can this administration justify its executive actions on immigration when it directly contradicts their findings? >> the reality is that we have an estimated 11.3 million undocumented in this country. for my homeland security perspective, and from the perspective of someone whose principle mission is counterterrorism, i want to see those people come out of the shadows. i want to encourage people -- >> but you did testify at the last hearing -- >> if i may finish my sentence. i want people to submit to criminal background checks, and

come out of the shadows. the problem we have right now is we have 11 million people in this country, and we do not know who they are. from the perspective of what you just read from that 9/11 commission report, we are vulnerable. i want people to come out of the shadows -- >> mr. secretary you testified at the last hearing and you agreed with me, and your words were, most criminals do not subject themselves to criminal background checks. >> i want as many as possible to submit to criminal background checks. >> thank you, mr. chairman. >> thank you. >> let me just say to the remaining members, due to the time constraints, and the secretary, we're going to limit questioning to three minutes. by unanimous consent. without objection so ordered. the chair now recognizes mr. swallow from california. >> mr. secretary does the number 2,577,516 mean anything to you? >> sounds familiar. i'm not sure why it sounds familiar. >> would it surprise you to

learn that according to the american immigration council, this is the number of immigrants granted temporary relief by republican presidents over the last 50 years? >> that's news to me. >> would it surprise you -- >> that's a big number. >> would you surprise you that not a single person who has sat on this dais with me, particularly among my gop colleagues, made a single public statement criticizing any executive actions taken by any republican presidents with respect to immigration? >> i'm not sure what to say. >> you know, our chair has brought up a number of times that we have a bipartisan bill, something that i admire that he was able to shepherd through this committee. yet it has not come to the floor for a vote. and it's frustrating to me that we are bringing you here to criticize the president's actions, yet speaker boehner has a bill that addresses border

security that has not been brought to the floor. and i believe that in many ways, by silencing both sides of this issue, by not allowing the vote, the speaker, in many ways, has taken his own executive action. that refuses to allow people who oppose immigration reform and those who support it to even be a voice of their district, and take a vote. and so with that in mind, i want to know, among the 11.3 million undocumented immigrants, do you know, mr. secretary, how prioritizing felons over families for deportation, what that will do to make us safer as opposed to what we've been doing prior? >> well, the guidance that i issued is guidance in clearer terms that spells out exactly the types of offenses that are priority ones, priority twos.

when we did our review. we found that there was a fair amount of ambiguity in the existing guidance that needed to be cleaned up. because there was a lot of misunderstanding in the field, that led to some of the cases of heartache that we all hear about. so the guidance is clearer. with that is a restart of secure communities programs. secure communities is supposed -- is intended to get at criminals who are undocumented in jail. but there's a lot of resistance now to security communities. so an integral part of this promoting public safety is a fresh start on the secure communities program. last thing i'll say is, when we talk about a bill, i believe the speaker's desire for comprehensive immigration reform is genuine. and i'll say again that i'm interested in working with members of this committee, members of the house of representatives, on -- on a piece of legislation or pieces

of legislation that addresses our system in a comprehensive way, in a way that our executive actions cannot reach. >> time of the gentleman has expired. the gentleman from florida, mr. clawson. >> thank you, mr. chairman. thank you for coming today. mr. secretary. i'm not going to harangue you or badger you and i'll ask you to be quick with me so we can get right to what i want to know, in all sincerity. in previous meetings that i've been here i've been told a little bit of what you've said today, which we need more resources. $8 billion is the backlog of cap-ex for reports and so forth as i understand. going to spend $800 million on newports in the next five years some of the border folks have told us. but when we ask for operational data to know what the bang for the buck is for the taxpayer, we really get very little data. if i was a board member and you and i were back in our previous

lives, we would say, i would say how can i say okay to more resources, and more effort, more taxpayer involvement, when i don't know the return on investment for the cap-ex, and i don't know what the operational effectiveness is other than really macro data. can you shed any light on that? am i -- and am i missing the boat here? >> i'll shed light on my commitment to more transparency. i think part of the problem we have is lack of coherent data. and so one of the things i directed in the executive actions that we issued week before last is i directed the office of immigration statistics to create the capacity to collect, maintain and report to the secretary data reflecting the numbers of those apprehended, removed, returned or otherwise rerate rated by any component of dhs. i also intend that this data be part of a package of data released by dhs to the public

annually. so, i'm sympathetic to what you're saying. and i would like to see us, in addition to this, develop metrics for how we define border security so that the congress and the public understands what we're driving for. >> but i just don't know how much bang for the buck we're getting for the taxpayer dollar. so in addition to how many people we are capturing and how many are getting through, what the return on investment for the money we are spending. is there a way -- >> i would -- it's hard for me to say yes or no to what's being asked if i don't know how well we're spending the current money, and the money that's been -- >> i would encourage you, if you haven't already, to look at the speech i gave on border security in october. to a think tank calls csis where i laid out a lot of the investment and a lot of the data concerning illegal apprehensions of illegal immigrants to get at a clearer picture of what you're

getting on the return trip on your investment. >> and any data that would help us understand how well the department is working will make it easier for us to be open-minded to working to the as you say. >> thank you. >> there's a misapprehension that things are as worse as they've ever been. in fact, illegal -- the apprehensions of illegal immigrants is a fraction of what it used to be. in large part because of the investment that this congress has made in border security. we are seeing a return on investment. i think we can do better. but we've invested a lot in surveillance, personnel, as the chairman knows, and others, over the last 15 years. and we have seen a return on investment. apprehension used to be 1.6 million. they're now down to between 300,000 and 500,000. but i believe we can do better. >> time of the gentleman has expired. gentle lady from california is recognized. >> thank you, mr. chairman. and thank you, secretary for being before us. had the pleasure of working with you when you were over at the defense department, and i'm glad

you -- you're staying on at homeland. because, this is a very, very critical time. i'm worried, being double-hatte and homeland i'm worried about threats from isis and terrorists and coming into our country or being embedded in our country or some would say mentoring candidate or what have you. here we are. we are here to protect america and to protect americans. thank you for the work that you and all the people who work in your department do on your behalf. i want to go back to something that you said, the whole issue of having background checks on people. i live in california. we have a lot of people there who for whatever reason don't have the right documents to be in our country. some actually would qualify and have qualified under our

programs but if they have to wait ten years away from a loved one because they have to wait outside of the country they have probably broken that and they have decided to stay and live those ten years here with their loved one or their child rather than do what we do to them which is to push them out for ten years. there are people who just it has taken too long. the back log is so long for some people to get through the process. i am thrilled that we are going to get good people who are deacons in our churches, they are pta moms, to come forward and give us data and finger prints and say let us work and go on with our lives here, especially if they have usa-born children or legal residents. i'm thrilled that the president understands that. i'm even more thrilled about it because that allows these

limited resources that we have to be trained on the people that i really want to go after and that is the terrorists and these threats to our country. and a lot of people say you are hispanic, loretta, so you care about the hispanic community. i have one of the largest asian communities in the country. many of them working, some of them paying taxes, but many of them working and wanting to get on an even footing here in the united states. i just want to thank you, mr. secretary, because i know that you have sat down and you took a look and you used your lawyer skills and everybody else's skills to sit down and figure out how do we make sure that the limited resources we have are trained on the bad guys, not on the people who are really part of our american family.

so i just want to thank you. >> time of the gentle lady is expired. gentleman from south carolina. >> thank you, mr. chairman. secretary, delighted to be with you again. i'm going to try to ask three quick questions. first question is fundamentally a question about fairness which is i think one of the things a lot of people struggle with on the notion of the president's executive and unilateral action is that it will put a lot of families from around the world in essence in a second class bus. my question to you would be, is it fair to the families who have been waiting in the queue in terms of immigration to go behind a bunch of folks that innein essence will get favorable status based on executive action? >> that's not what we have done. through executive action we

cannot grant citizenship. we cannot put somebody in the head of the line for citizenship. deferred action is simply for a period of time a determination that someone should be lawfully present in the country which is a significantly lower form status. >> they are able to live here, work here, raise families here. i will go on to the second question. >> in fact, they already are. >> they are, but they don't have the legal claim to our entitlement system that they now will. if you look at our entitlement system it is $18 trillion in the hole and most of them are based on being lawfully present in the country to be eligible for entitlements. so how do you say to that family in mississippi who has been struggling to make it you get to retirement age and then you begin to collect, what do you say to that family, your

retirement system and your health care system as provided by government will be less financially solvent then it would have been based on this unilateral action? >> i would say the people we are talking about are already here, they have been here for years and become integrated members of society. >> they are not going to collect social security. >> and contribute to the tax base. >> do you get more than you give. "wall street journal" had a very interesting editorial on that point. last question is in your opening statements a lot of the attributes that you defined could be handled perfectly by work permits. why not just do work permits rather than this defacto quasi-citizenship that comes with this executive action? >> work authorization is something the secretary of homeland security has the

authority to give by statute to someone granted deferred action. so that is what we did. >> i see i have three seconds. i would go for a second question but don't have it. >> you guys speak more slowly than we do. thank you, mr. chairman. there was a statement made earlier from the gentleman from south carolina that i know was a gross generalization about the american people as it relates to the executive order issue by president obama. so for the record, overwhelmingly the americans in my district laud and support what president obama has done and they have your back. i want to ask, secretary johnson, the president's executive action was certainly a step in the right direction and for many it speaks to the moral, social and family related reasons that will have a

positive effect on our civil society. however, i want to get to the economics of this because it has been raised by a number of colleagues and particularly mr. barletta. it was estimated recently by the center for american progress that this executive action will raise an additional $3 billion in payroll taxes in the first year alone and $22.6 billion over five years as workers and employers get on the books and begin paying taxes for the first time, even individual states will gain from this. do you believe that the economic factors like these should play a role in determining our immigration policy? and secondly, the issue of securing the cities. the program finger prints individuals booked in state and local jails and submitted electronically and allows to

remove potentially criminal individual. the program has been controversial legally and politically as you know. it is my understanding that the priority enforcement program which will replace securing the city's under the administration's plan will rely on the same technology as securing cities but will focus on individuals in state and local custody convicted of felonies and significant misdemeanors. please explain how it will explain while also addressing important concerns raised by courts, advocates and local communities about securing the cities. >> you characterized it accurately. and to address the legal concerns that are arising in litigation we are no longer going to be putting detainers on people. we will have requests for notification. a detainer in litigation has

often led to court determines that state and local law enforcement did not have the legal authority to hold that person simply because of a detainer when they would have otherwise released them. in place of that we are going to have request for notification so we are notified before the individual is released unless we have probable cause to tell the nypd that the person is undocumented and will be removed, for example. i agree with your question about should economics play a role in immigration policy. i'm not an economist. i will refer you to the president's council of economic advisers analysis which was issued week before last on the impact of our executive actions on the economy. >> the time of the gentle lady is expired. secretary, it is good to see you today. thank you for being here. let me begin my questioning on a positive note. i was at a meeting the other night with a number of republicans from new york who

strongly oppose the executive order. several went out of the way to say they dealt with you as a lawyer and highly regard you. >> it goes down hill from here, thank you. >> we can discuss the legal merits of it, but i'm influenced greatly by in the case where justice jackson where the court struck down executive action by president truman. saying that executive action in questionable cases must be scrutinized with caution because what is at state is the -- american people have faith in the government. in this case we have the president time and again saying he did not have the time to do this. the fact that anytime the

president could have issued the executive order. the fact that he did not issue until after the elections were over. if the president felt there was a consensus among the american people this should have been part of the campaign debates. the fact is virtually silent on the issue throughout the campaign. campaign is over. republicans win both houses and then the president issues this order. i would say if the president is sincere about wanting legislation and he believes he has the right to issue the order why didn't he realize things changed in the congress and disagrees that the house did or did not act and set a deadline of july 1 and we can take what action we want against it whether legislative or appropriations. during that six month the president would have an opportunity to frame the national debate on trying to come to an immigration bill and focus attention on it and then you would have seen republicans

in the house and senate being in a position to deal with the president. if july 1 comes along -- it's an arbitrary date, could be any date. the american people can decide who is right and wrong and congress take whatever action it felt it had to. i just feel and i use the words that there was bad faith in issuing the executive order at this time. if we are trying to get to the american people's confidence this is not the way to do it. >> i guess in response we did do that. we did exactly that. we said we were going to do this in the spring and the president decided to wait over the summer to see whether the congress would act. the speaker whose desire for immigration reform i believe is genuine had hoped he could get immigration reform through the house of representatives. that did not happen. the president said he would

wait. speaker told him we are not going to get a bill. then he decided to wait until after the mid terms. we have done a lot of waiting. >> i think the president's executive order trying to undo the impact of the election he should have issued it before the campaign. my time is expired. now my friend from new jersey. >> thank you, mr. chairman. mr. secretary, always a pleasure to see you here. i want to say that i'm also delighted that you will be staying on at homeland security. i think that you in your time there have brought that organization together, tighter and more efficient. for that i thank you. it is my understanding that this executive order, this executive action will only last for two years under the obama administration and it's not

clear what will happen to the millions who are affected when the administration is over. this creates a lot of uncertainty in my opinion and under scores the need for congressional action to clear up and fix this broken immigration system. in your opinion what will happen to the children and parents who are being encouraged now to come out of the shadows in two years if nothing happens? >> well, the nature of executive action is that the next executive can undo it. i would hope that would not happen here. administration to administration we do thoughttypically undo administrative actions, executive orders particularly where you are affecting in what i think would be a rather harsh manner the lives of people who are here in this country.

so my hope is first over the next two years there is legislation that in effect addresses the same phenomenon in the same way, but in the absence of that my hope is that these executive actions are sustained as good government policy. going forward i want to emphasize this. going forward those apprehended who came here illegally january 1, 2014 are policy for removal. there is a clear demarcation between those who have been here for years and those who would think to come here in the future illegally. those people will be priorities. >> and how could congress help ensure that these millions of people are not encouraged to go back into the shadows in two years? >> support us through

legislation. >> so it's really time congress stood up and helped fix this problem rather than throwing darts at the administration. >> that is my hope. and i believe that it is a solvable problem legislatively. and i believe that if we can remove the emotion and the politics we can achieve it. there are several members of this committee who i believe i could work with on a comprehensive solution legislatively. >> thank you, mr. secretary. i yield back. thank you, mr. chairman. thank you secretary for being here. you know i have a great deal of respect for you. you are an attorney. i have some fundamental disagreements with a couple of points made and i need your articulation on this. you are the one who said what you are doing is creating an opportunity for them to lawfully

be here in the country. i think it is an unquestioned point that as the law stands today anybody who illegally enters the united states is a deportable alien. that is the congressional intent. what has happened by this directive is the president has stepped into the authority of congress, the constitutional authority to determine it under the existing law of you have identified somebody will lawfully be here so long as they are using prosecutorial discretion. they won't be deported if they are not a threat to national security, aren't a threat to public safety or border security. how can you create a class of people who are beyond prosecution and not be violating the constitutional separation of power in which congress has articulated its intent? >> first, during the period of

deferred action you can lose membership in that program if you commit a crime, for example. >> but you can also have a lawfully articulated ability under the president's directive to be here if you don't. and that is an expression of a constitutional protection that does not exist except for the president's overreach of prosecutorial discretion. >> this type of action has existed in one form or another going back decades. it was exercised in the reagan and bush administrations. >> i will not allow you to go there. it was after authorized activity by the congress. >> to protect the class of people that the congress did not. >> but the congress already clearly articulated an intent to include those. there was the fulfilling of congressional intent. here you have created a class of people in contra vention of congressional intent.

>> an assessment of deferred action will be made on a case by case basis. the way i look at it is this and i know you will appreciate this. when i was an assistant united states attorney we used to -- and i'm sure this is true in your office as u.s. attorney. we used to enter into deferred prosecution agreements with individuals. you committed a crime or may have committed a crime and have been charged but if you behave for the next six months to a year we will defer prosecution. >> i understand. my time is -- we all understand prosecutorial discretion. this changes that, however, which creates a class of people despite prosecutorial discretion who may be here because the president created that category, not congress. that is a clear violation of the constitutional principles apart from our desire to work together

he is acting in the capacity beyond where he has the ability to do so. >> sir, i respectfully disagree. >> on what basis? >> they are lawfully present. >> how are they lawfully here when the intention of congress was clear, they can be deportable. it doesn't mean they will be deported. >> the congress has not given me the resources to deport 11 million people. that does not exist and they are here. >> that is prosecutorial discretion. we are choosing but we can't stop everyone but that doesn't mean that they are not going over the speed limit. your level says there is no speed limit. >> if i may finish my sentence. they are here and for my homeland security perspective i want them to come forward and get on the books and receive a work authorization. >> they are here but you said they were lawfully here and under congressional intent they are not lawfully here and yet

the president has created that category out of -- >> this is a form of executive action that was not invented in this administration. it goes back decades. >> secretary, it was. i'm sorry to disagree with you. i will work with you but i disagree with you. >> thank you, mr. chairman, mr. secretary i appreciate your service. is there a forged document system present that allows illegal immigrants to avoid the law? is there a forged document system present around the border where people come here illegally obtain social security numbers and other documents that provide them access? >> a criminal network that provides -- >> whatever you want to call it, is there one present? >> i would imagine there is. >> is using forged documents to gain access, is that what we consider lawful.

>> i do not believe so. >> what is the estimate for those here illegally including those with terrorist affiliations or motives who have used falsified documentation to gain access to our nation and other things i described? >> i don't have that number off hand but i can get it for you. >> you have a number? >> if there is an estimate i will undertake to get it to you. >> i'm sure there is just an estimate because they are unlawful. i would also say we have written your office on several occasions requesting information and have not gotten answers so i'm just concerned about the ability or your willingness to give us those answers. let me cite a couple of examples for you. we have major league baseball players who have become mvps and after the fact we found out as americans they were not here lawfully and used forged documents. an individual in california

deported three times, came back on the fourth time and shot a police officer dead. we have an individual that was residing in north carolina came up to baltimore, kidnapped a 13-year-old girl and raped her and that person was here illegally and deported and used falsified documents. to that end, mr. secretary, my question is how will your department screen these folks including background checks to ensure the security of the citizens of america especially when people that don't -- that don't recognize or respect the law, terrorist ties and affiliations or motives that won't use proper documentation and won't come forward? how can we as american citizens be confident that this plan to screen up to 5 million people that came here knowingly unlawfully in many cases, how can we have confidence based on the examples that i have already

cited, confidence that your agency and this policy is going to work? >> excuse me. based on the experience that we had with the program two years ago i believe that we will be vigilant in terms of looking for fraud in the application process. the other part of my answer to your question, sir, is through our reprioritization i want to get at the criminals. i want clearer guidance so that our ero enforcement workforce has the ability and the capability and the resources and the time to go after the type of individuals that you cite. >> we want that, too. with all due respect, mr. chairman, i have no confidence and i don't think the american people have confidence that that is going to work. we appreciate your hope. we appreciate that with the resources being targeted to those individuals maybe it could be better, but i see no plan and

you have given me no plan at this point with any specific metrics or anything like that. we have been working on this for years. none of us want these people in our community. i have two daughters. heaven forbid one of them falls prey to something like this and i say what did you do about it and you say we hoped for better. that is not an adequate answer. >> that is not an accurate characterization of my answer. i am happy to brief you and other members of the committee on the implementation plan put together. we spent considerable time on it. if you let me know the last time you sent me a letter that was unanswered and the date i will be sure that it is answered. >> thank you, mr. secretary. let me just say that i don't envy your position right now. it has been a productive hearing. i think you have been forth right in your answers. it is a very emotional, divisive

issue that i hope we can resolve in the congress. i can tell you this committee and i think the ranking member feels the same way, we are committed to passing in the next congress a border security bill and we look forward to working with you on that. >> thank you. this hearing stands adjourned.

we just saw homeland security secretary testifying for two hours. that allows nearly 5 million undocumented immigrants to stay in the u.s. temporarily. we have been getting your thoughts on president obama's action on immigration on twitter and from facebook. one says the president's executive order is a breath of fresh air compared to the stagnation in congress. it heightens security, provides compassionate relief to millions and is ultimately pragmatic and progressive.

one writes the money for immigration needs to be redirected to the african-american community. you can weigh in as well and read more comments, facebook.com/c-span. we will be hearing from nfl executive troy vincent and others. we will have that live at 2:30 eastern here on c-span 3. and president obama in washington, d.c. today scheduled to visit soldiers at walter reed medical center as well as visiting the national institutes of health to meet with researchers trying to develop an ebola vaccine. we will be streaming that live on c-span.org. the c-span cities tour takes book tv and american history tv on the road traveling to u.s. cities to learn about their

history and literary life. this weekend we partnered with time warner cable for a visit to waco, texas. >> as we began to receive the vinyl to be digitized and saved we began turning over the b sides of the 45s that we received. first off, gospel music was not widely heard in the white community. it would only be the hits if that. the b or flip side would be heard even less. what we discovered was how many of the b side songs were directly related to the civil rights movement. since there are few databases and none of them are complete on all gospel music we didn't know that. we didn't know the sheer number of songs like "there ain't no segregation in heaven." at a time when possessing one of the songs much less singing it was a dangerous thing in the deep south. singing that sort of song out

loud that's a risk. >> the texas ranger hall of fame was set up in 1976 for the 175th anniversary of the rangers and honors at this point 30 rangers who have made major contributions to the service or gave lives under heroic circumstances. we have paintings or portraits of all of the rangers. they really begin with steven s. austin. austin was very successful with his rangers. they fought and not only managed to make the region safe for settlement from indian raids. when the texas war for independence broke out the rangers played a major role in texas gaining independence by saving off the mexican army long enough to allow the colonists to build their own army and develop a strategy. as a result texas became its own independent nation, the republic of texas for about ten years. >> watch all of our events from

waco saturday at noon eastern on c-span 2's book tv and sunday afternoon at 2:00 on c-span 3. we heard recently from health care providers and consumer advocates about how data is released from medicare and medicaid and ways for making the data more user friendly. the discussion was hosted by the brookings institution and ran for about two hours. we are going to go ahead and get started. i know folks are probably going to be trickling in. i am one of the fellows and managing directors here at the brookings institution. we are really glad all of you could join us today. we have a packed agenda so i'm going to keep things short and simple. we have folks in the room and i wanted to acknowledge a number of people watching via web cast.

because we have video recording i want to make sure we have a couple of items. we will have a full recording on our website on the event page in the coming days. if you do have questions or comments in the room or on the website go ahead and actually wait until we have an open floor for questions and answers. so hold time until we have a question and answer session. since we are using a web and tv monitoring we will ask everyone to use a microphone and have mics available during q&a. we have the ability to submit questions via twitter. you will see the hash tag for this event is health data. you can also tweet brookings medin case any of you would rather use different media to get the questions. if you are viewing online you can immediately download a couple of resources that i wanted to point you to and once

i finish this house keeping we will get to kind of why we are all here today. the two items that we have that are also available in the room if you are in person are first issue brief that is also on the commonwealth fund website as well as ours regarding the cms medicare physician payment data and the topic we are discussing in part today. and then also something that i want to thank katlyn brant who helped with this effort. once we had talked to so many of you we learned there were so many tools around transparency that even to us who talk about this on a daily basis it became overwhelming. we decided to just at least for the sake of today's conversation and hopefully in the spirit of moving forward put together an online list. we would love feedback on this and we encourage you to send us feedback through the website or through the twitter feed so we can get your real world take on how valuable some of the

resources are. those are also available through the website and the link below. with that i want to just kind of start things off. i will be moderating the first panel. i will do a little bit of kind of intro and stage setting at that time. i wanted to actually ask one of the vice presidents of the commonwealth fund to give us some of his thoughts. this work wouldn't have been possible without support from the commonwealth fund. i will say the work that they have been doing on transparency and delivery system reform has been instrumental in helping us to get to today and hopefully to get past today into what i hope is health care of the future. stew, some comments and then we will start. thank you. thanks. on behalf of the commonwealth fund i would like to thank everybody for showing up here and everybody who is watching online. i just have a couple of thoughts to kind of set the stage.

we talk about transparency -- lately i find myself asking the question what does that really mean? and back when we first started talking about transparency it really kind of caught on especially in washington and policymakers. i got this image that we were really talking about putting the preverbial black box and calling it transparency but nobody could figure out what was going on. you could just see the outside of the black box better. so what do we mean by real transparency? i think the folks here today will help address that. it's great to have a lot of data but what we really want is information. and so we need to have data in usable form. we need to have data at the right time and we need to have it in the right context. that is it needs to be provided to the folks who can use it the way they need to use it

effectively. and we are talking about consumers and about researchers, about payers and policymakers. and i'm hopeful that the topic we'll be addressing today in these panels will begin to give us some insight as to how we can use all of the data available to good use and make better policy and make better decisions both in what we produce in the health care system and what we consume and how we consume it. i won't hold up the show any longer, but thanks again. i look forward to the discussions. >> with that let's go ahead to get to our first panel. if i could have chuck, charlie and nile come up so that we can mic you. and let's have you kind of go -- chuck, if you don't mind we will

kind of go in order. and then charlie and then nile and then me. that way you guys can get micced up. good. perfect. so we have -- let me just for the sake of getting us started, make sure that i get introductions kind of from me

going all the way to my left. this is nile brennan from the centers for medicare and medicaid services, chief data officer. charlie orensteen and dr. cutler. we have extensive bios for these esteemed individuals in the packets that are available in person as well as biographies online. sufficient to say the goal of this first panel was to really offer perspectives from exactly what started a lot of this which was data release that came out earlier this year 2014 on physician payments. that was the motivation that i wanted to explore and understand what does it mean for patients. i will tell you we are going to get into deeper discussion around this topic. this hit home not only from when i looked myself up which all of you can do online and nile can

tell you more about how to access that information but even more importantly in real patient care i had a 61-year-old woman who came in with what she thought was a cracked rib after picking up her grandchildren who were pretty heavy at the time and she is kind of a small woman. she said i think i cracked a rib. i said that is a little unusual. long story short found out she had what was most likely lung cancer. not sure how it started but she asked me an important question, who are the best doctors for me to see. i pointed her to some of charlie's resources and then i went through the difficult conversation of how so much of american medicine is not transparent. she said well i will talk to a friend who is a doctor. ultimately when really important decisions get made we cobble together a lot of these resources. yet i think all of us in this

panel as well as the future panels today would tell you that we can do better. so i'm going to leave it at that and hopefully through each of our expert panelists as well as your own discussion we can get into this a little bit more and probe how what we have started and i think nile can speak hopefully more about what cms and the administration did, what we have started is really just the beginning. i'm going to ask you first to kind of give us a little bit of background on what has been done and then also a little bit about what you are hoping the future can hold with regard to data transparency. >> sounds great. thank you. it's great to be here especially so as i'm an alum. >> you have gone a long way. >> so i think how you have to view our various data releases and exercises in transparency is that it's been an ever-evolving

journey really dating back to 2010 and 2011, one of the first things the president did upon entering office was to sign an executive order in open government. so todd park then cpo of hhs enthusiastically embraced that charge across the entire department and not just cms and worked with folks to identify a whole range of available data that was either already being released and maybe not getting the attention or publicity it deserved or that could easily be released in a machine readable format. i think those first couple of years were an interesting process because the commitment to transparency was definitely there but some of the resulting data sets, they were good but i

think they left people wanting more. so there was a lot of facility level data, machine readable hospital compare data, geographic variation data. that is not at all to diminish or demean those data releases. the geographic variation data you had dartmouth historically releasing data. that is the first time cms laid the books open and said when you compare this is what it looks like and this is in very granular ways that can help people. what are county level trends in er visits, imaging use, et cetera. i think where it started to get interesting, if you will, was about 2 1/2 years ago when we

were trying to figure out where we could move next with our transparency effort and the decision was made to release hospital charge data. again, some folks may remember the release of that data. it was for 3,000 hospitals and the top 100. it highlighted massive variation in hospital charges for the same procedure often times in the same geographic area and certainly nationally. and you know i think it really resonated with people. frankly i think more than we thought that it would. i know that certain health economists when the release initially happened said nobody pays charges anymore. but to a certain extent charges are often what people are exposed to particularly if you

are not insured. i think to a certain extent the release of that data was a deliberate step but the reaction took us a little bit by surprise and took a lot of people looking at health data and talking about charges and costs took them a little bit by surprise, as well. obviously, with the release of hospital data there was a desire to keep building on this whole effort. the issue with releasing physician data was that we were legally prohibited from releasing any data that would allow anybody to identify the total amount of the physician's medicare reimbursement. that was a legal prohibition that stemmed back to the 1970s in data geek speak known as the florida injunction.

and about a little over a year ago a florida judge overruled or overturned that injunction or aspects of that injunction that allowed us from a policy perspective to begin considering the release of that data. and we tried to do it as deliberative and transparent way as possible. we asked for public comment and it took all of the public comment on board. in april i think the open data entered the big data phase or the quasi-data phase with the release of detailed utilization information on almost 900,000 providers and over 9 million records, i think, in the data set. so that's sort of the story of how we got from there to here. it has been a very interesting journey. i think we have shown our commitment to this over the past few years.

obviously as a bureaucrat i can't get into specific predictions of what is coming next but i would say look at our track record over the last four years and i think it is highly unlikely that we wouldn't continue to build on that. >> this was just before we moved to charlie just to be clear. this is not just the florida injunction but internally there have been discussions prior to even your time in the administration about whether the data should be released at all. this is not just a couple of years in the making. this sounds like it has been decades to try to think about this. >> this was a 20 to 30 year process. >> real accomplishment but acknowledgment. your title as data officer is a nod to the notion that more work needs to be done. as part of that are you increasing capacity within cms to kind of explore the use of

not just these data sets but kind of the transparency movement, as well? is that part of what you will be doing now? >> the new role is really you can -- little tag line is maximizing cms data for internal and external uses. that manifests in a number of different ways and transparency and making data available whether publicly or innovative ways to access more control data in a secure manner that respects and maintains. >> as part of the work we have been doing one of the comments and feedback we have received is trying to find ways to help work whether we call it public or private partnerships, finding ways to help capitalize on what you have been doing but also almost crowd sourcing allf these different tools and private sector as well as public sector opportunities. with that you already got the

pointer. if you want to stay there and i know you had slides but i wanted to first say that before we even spoke to charles i think all of us in the room would agree that it has done one of the best jobs trying to offer a way for that 61-year-old patient when i told her to go to a website i pointed her to yours to be perfectly honest. i said it is easier to use this website plus it gives you context for understanding. i encourage many of you. we have your website in our resource and i know you are going to go through some of this. as an investigator, journalist and i put you in the category of a researcher, as well, because some of the analysis you did was research on the public data sets, it would be great to hear some of your perspectives and without all of this seeming like this is rosy, some of the limitations of what we have seen to date. i know you're working hard to lead the effort on future

transparency releases both from medicare as well as from the private sector. thank you. >> thanks. i think that one of the unfortunate things for nile is the more data that comes out there the more data you want out there. they open one door and then there are seven more we want to open. that is one of the challenges here. i would argue it is more than just patients that want access to this information. i have gone and talks to physicians all across the country one of the things i have been surprised about is how little physicians know about how their own practice of medicine and prescribing of drugs compares to others. they think they are doing it right and sort of benchmarking by word of mouth. when it comes to looking at it there have been no tools that have been really available. they may get one report card saying they are doing one and one from blue cross saying they are in the middle. i thought it would be helpful to show the real importance of

putting caveats and comparisons to things. i think putting out raw data can be misleading and confusing. that is one of the pushback on the part b media release is a lot regurgitated what the government put out. so even before, well before cms put out its data on medicare fee for service the amount that doctors are paid in medicare thought cms is limited. they can't release information about how much doctors are paid. when it comes to prescribing drugs doctors are catalysts. they are not paid for what they prescribed, the pharmacy is paid. we can get around this by requesting what doctors prescribed and what patients filled at the pharmacy. after a lengthy negotiation thanks to niles' advocacy on our behalf cms released data about

what doctors prescribed in the medicare part b. it looked like this which is a lot of rows and a lot of codes. doctors and drugs they prescribed in numbers. can you imagine opening this to patients and say take a look? it doesn't mean anything to them. why would you want information about what your doctor prescribes? one, if your doctor is recommending a drug for you and you want to see does your doctor have experience prescribing this drug? if your doctor doesn't have much experience prescribing the drug is that the doctor you want prescribing you the drug or if the doctor has a lot of experience that may be worth while. with the plethora of data about financial relationships between doctors and drug companies having access to is a doctor prescribing more of a particular drug made by a company he or she is doing speaking that could be

cruseful. we created a tool which allowed folks to access things from various portals of interest. don't assume you know how somebody wants to access data. people want to access data in a lot of different ways. you need to give them the tools to do it. we let you access it by drug, by state, by specialty, by doctor name. you can look at it through any of these portals to get to results that show you the top prescribers within a specialty within a state, top prescribers of a particular medication or just your doctor's prescribing. instead of just releasing when you click on your doctor we have sort of what we call our dashboard which shows how similar or dissimilar your doctor is to other doctors in their specialty and state. why do we choose their specialty and state? we didn't think it was fair to compare. each are going to have different ways of prescribing. if you just release it just in total and let folks swim through

it that can be confusing. we show you the percentage of a doctor's patient who gets market narcotics. if you are a pain medicine doctor that brings the specialty up. how the doctor compares to that. we have a mathematical formula that takes into account the doctor's selection of drugs and then volume of the drugs they prescribe and puts them on a line of bars where you can see that if a doctor is on the far right they are practicing in a different way than other doctors are practicing. >> you can see a list of the doctor's drugs and what it ranks for that doctor so the doctor's number one drug and how it ranks for other doctors in the same specialty and state so you are able to compare the doctors. one of the things we did with medicare part b data this is what medicare released which is a long list of each procedure. the media wrote about medicare's millionaires and how much money people got from medicare.

that was pretty unfair because doctors are spending a lot on in-office drugs. is it fair to say they are millionaires? if they treat a lot of medicare patients is it fair to put them head to head? not necessarily. we created a tool called treatment tracker. our tool lets you see this in context. we compared people within their same specialty and same state. you could see, for example, the number of services per patient and how that compared. when you see the red marks you see the doctors in the top 10% of specialty and state. you are able to see who is a real outliar compared to who has a big number attached to their name. the amount paid per service and patient. so you are able to get a sense of the doctor and comparison to peers trying to level out based

on the volume of services. finally -- take aways we have from this data and the prescription data is right now with the information medicare is putting out it is a lot easier to find doctors who are off who seem to have questionable practices than it is to find doctors who are good whose practices you want to emulate. there are too many variables that we don't know for now. that is the next stage. right now we have what doctors perform in their office. if a doctor gives a referral to their pal down the hall then the doctor may be incurring medical costs but you may not see the other doctor's profile. we think the next level of information is things the doctors referral for. and you are able to look at a doctor's totality of what they are controlling in terms of health care services so you are able to see the doctor's complete picture in context and comparing it to others like

them. we think there is a huge amount of advances that are taking place just within the past couple of years but there is still a lot of work to be done. ultimately this will lead to patients who are more educated and engaged in health care decisions and doctors who are able to benchmark themselves and take initiative before a patient asks them how they compare. >> before we go to chuck, do you have a sense given all the work you have done to date and all of the conversations yo you have had you started by saying it may not be patients as the only audience. who are other people who are really interested in what you have done and your sense of who is using your database right now or the various databases you have? >> i think hospitals are, insurers. i think folks within medicare are. we heard from folks within the organization who think our interface is a lot easier to use than their own interfaces. i think you find a whole lot of folks. our databases are being accessed

a ton of times. we build products that are more than just things that are supposed to be drive by products. you get the first 48 hours of the data release. you are able to go from our page about prescribing and directly to the doctor's services. it is sort of like very easy to navigate around. as more and more information comes out that is going to be key is where people are going to be able to say this is interesting i want to check this about this doctor, too. literally so many different audiences are interested in this information. >> you mentioned about prescribing pharmaceutical relationships since we started this work on the part b data, the physician open payments database has been released and you already saw the kind of technical problems with trying to do the analysis that you have done already to date on other databases with that one particular one raising kind of a

very common logistical problem for regular folks to access the data as you showed it in its raw form. >> that's right. the assumption that just because the government releases data that it has to be 100% accurate is not necessarily the case. in the case of the open payments data which is the payments to doctors they are relying on drug and device companies to get it right in terms of what they are submitting to the government which is what they are releasing. we found there are situations where the drug companies were spelling names of the drugs wrong. they were listing drugs in multiple columns when it should have been listed in one column. they list drugs as devices and devices as drugs. we spent months trying to sort it out. it is complicated and confusing. lucky to have the resources and the interest among editors to spend the time to get it right rather than face the lock and say we need to get this out in the next 12 hours.

that is the perfect segue to dr. charles cutler who is practicing internist and has leadership experience from american college of physicians to side comment before you go. we actually -- our staff at brookings, we looked through dozens of letters that were sent to the senate finance committee when its chairman, ron wyden, senator ron wyden, asked for public comments from physician groups and physician organizations and anybody on this topic of data, kind of transparency, writ large. he was looking at this topic for a number of reasons. and the american college of physicians a long with a number of other physician organizations, sent very detailed, i think, thoughtful letters that all said probably, just to gloss over similar things. transparency is good. we know that. but huge caveats around how this data is interpreted by public is something that many physicians, especially given what charlie had pointed out with some of the

media headlines, that had really been threatened by. so, i'm going to just kind of speak to that because i had a number of conversation after some of the newspaper and radio and other media headlines went live around, i would say, the outlier reporting charges of millions of dollars and trying to understand who these doctors are and why they have millions of doctors of medicare charges, it made a lot of physicians really nervous with how people would view their own kind of charge patterns within these publicly available data sets. but i thought it raised a very important conversation amongst the physician community where in the end, everybody kind of remained kind of quietly curious as well as cautiously optimistic that this was the right direction. so, chuck, your thoughts both as a practicing physician in the data set as well as someone who's been leading some of these efforts at a national level for a physician organization. >> yeah. well, for the audience, the

american college of physicians is the largest medical specialty organization in the country. 141,000 members, internists, medical specialists, and medical students. and i did serve on the board and was chair of the board until last year. in that position, i was able to travel around the country, meet hundreds if not thousands of doctors. but my day job is a general internist. i'm in the office. in the morning i go to the hospital and see patients. and i could share with you, if you took some of my colleagues and put them in a room and said, talk about the data release for ten minutes, you might have nine minutes of silence. there are a number of medical issues from electronic health records, the affordable care act, data reporting from cms on quality parameters, budgetary

concerns about cms and whether or not they'll be able to pay the bills for doctors that i think have a much higher priority among physicians. now, having said that, data is really important. and this conversation is really important for doctors. and the example you used, kavita, is perfect. with every patient that i see as a physician, i have to make recommendations. i have to help the patient move to the next step. it may be an antibiotic, it may be an x-ray or procedure. and for my entire career, i have not been able to help patients in the area of cost. it's clear to me the right antibiotic to get you better, but if there are two antibiotics, which is the better one? if both will get you better, which is the more cost effective antibiotic to use? and you can use that example

across every recommendation that physicians make. so, what charlie has begun to put together begins to change that conversation that doctors might have from nine minutes of silence in a ten-minute period, there may be 15 minutes of conversation in a ten-minute period because it's so important for doctors to know what things cost. and we never have. now, the other part of that, and i think you've begun to touch on it, is we need outcomes, too, because we can't simply make -- i can't make recommendations as a physician to patients simply based on cost because the costs could be high, but the outcome could be even better than a low-cost procedure. and so the outcome is really important. and the comparisons really need

to be adjusted for risk because if you're a doctor -- and i think you alluded to this, charlie. if you're a doctor that takes care of a lot of sick patients, your costs may be very high but your outcomes may be very good. so, we're in our infancy here and this is great news for the profession, i think for the american college of physicians, we are really encouraged by the data release and we're even more encouraged by honing the data, making it more useful to patients and to physicians. so, i think with that maybe i'll -- >> so, chuck, one follow-up and then i have a question for all three of you. there were some people that expressed concerns, as i imagine an organization as large as the acp, you'll hear many sides of this issue. can you reflect a little bit on what some of the concerns have been from physicians about some of what's been released to date?

>> yeah. well, first of all, and i think it was touched on earlier, accuracy is really important. there is a lot of information out there, and it has to be accurate information. and physicians in the sense of fairness should have access to the data. and if it's inaccurate, there should be a way for physicians to address what they perceive as inaccurate. and make it more accurate. the usability is really important, too. we have to be able to access it in an easy fashion. the doctors have to be able to get to it and the patients have to be able to get to it. if it's complicated to access the information, it can lose its utility. so easy mechanism to get to the information is really important. one of the other concerns that the physician community has had,

and we've expressed it to cms, is that one of the deputies alluded to the fact that releasing this data might be a way to address waste, fraud and abuse. we can argue about it. simply because costs are high we have to be careful not to attribute that that's fraudulent or the utilizer is wasting services. he or she may be, but simply by having high costs, we have to be careful that there's not guilt by association. so, those are some of the things we were concerned about. >> if anyone in the room has any questions, go ahead and raise your hands so we can at least get a mike to you and then before we get to you -- while we get a mike to you, i just wanted to ask if anyone on the panel, and niall, if you can kind of

respond. as you mentioned, you can't talk about future data. you can't talk about any actions that might take place in the future. but can you give us a little bit about to date how you've seen what you've done so far on the public side have some influence on the private side? so things outside of medicare or medicaid, for example. >> so, first of all, i think charlie and chuck's comments were both excellent and added a lot of, you know, important context. my remarks were a little profit-driven, i guess. in the sense of, you know, we are in our infancy. in is a fluid area. while we tried to make it clear what the data was and what the data was not, you know, the very nature of the fact it's open data means we have very little control over how people choose to analyze it and present it. i think in terms of the effects

on the private sector, you have many hospital chains and hospital systems undertaking to be more transparent and how their charge masters are displayed. there's legislative activity in several different states seeking to address or formalize the punl indication or availability of pricing information. and i think most recently the health care cost institute, which is an agglomeration of pretty large national and some regional health plans announced a pretty large initiative that is going to kick off next year where they're going to look at the data they assembled from multiple different health plans. i don't know if the output is

going to be like what we did. i do think our actions have had a trickle down -- >> i think charlie referenced this, but it bears repeating. the commercial payers by and large are looking at parameters. the doctors aren't necessarily looking at fee-for-service, but they're insisting there's quality reporting. but the so-called quality reporting does not take consideration into cost. it's not high value care. it's measures that don't consider costs. and i think the next generation of reports that physicians are expected to turn into the payers will be high value care. good