his is just the first part of it. now we'll go into deliberations and provide a product to the president that everyone on this task force has worked hard to do, they'll be proud of. but we know regardless of where we ultimately end up in this nation with regard to the amount of police departments, we still have an obligation right here right now to not only come up with this product but to deliver it, sell it improve it implement it for the 18,000 agencies that are there. we're going to have to come up with a strategy for that working together. so i have good news and bad news for the task force. the good news is we're getting very close to presenting the report to the president.çn i &háhp &hc% the bad news is if you think this is the last time we're going to call on 3md we have to implement to 18,000 departments so you have much workú g ahead. it's been one of my greatest professional privileges to work with this great team to see these professionals, these great americans come together in such a manner that it is something that i will look back 20 years from now and be proud of and tell the kids and the grandkids what a good time this was to

actually participate and make the changes. a lot of work ahead. i really want to thank the co-chairs from a team point of view. when they added this last panel i'm thinking another facility, work behind us, my team is going to kill me what are we doing. quite frankly this was brilliance at its best to be able to wrap it up put a bow on it as we go into deliberations, as we close this public part for the community, as far as the hearing listening session i think there's no better way to start the next chapter. so thank you for your leadership. with that, i think we're ready to close. madam chair and mr. chairman, i turn it back over to you. >> i think with that we again thank our panel and thank our listeners and thank our task force. >> let's give them all a round of applause. we are officially adjourned. thank you. coming up live later today here on c-span 3, the

president's national security advisor, susan rice, and senator robert menendez will be speaking at apack's u.s. israel policy conference live at 6:00 p.m. eastern time. tomorrow israeli prime minister benjamin netanyahu addresses a house conference. he was invited by john boehner. this morning the prime minister spoke about his appearance before congress tomorrow. >> you may not have heard, i'll be speaking in congress tomorrow.

>> you know never has so much been written about a speech that hasn't been given. i'm not going to speak today about the content of that speech, but i do want to say a few words about the purpose of that speech. first, let me clarify what is not the purpose of that speech. my speech is not intended to show any disrespect to president obama or the esteemed office that he holds. i have great respect for both. [ applause ] i deeply appreciate all that president obama has done for israel, security cooperation, intelligence sharing, support of the u.n., and much more, some

things that i, as prime minister of israel cannot even divulge to you. i am deeply grateful for this support and so should you be. we'll bring you the prime minister's speech before congress scheduled to start at 11:00 a.m. eastern time. the hill reports 42 house democrats and five senators say they plan on boycotting the speech. live coverage from the house chamber will be on our companion network samantha power and her remarks earlier. she said the united states of america will not allow iran to obtain a nuclear weapon. she spoke during standing ovations in which she said diplomacy is the preferred

route. also tomorrow the new secretary of defense, ashton carter, will be making his first appearance on capitol hill since he was sworn into the pentagon's top job. he and joint chiefs of staff general martin dempsey will appear before the senate armed services committee to talk about the defense department budget request. live coverage starting at 2:30 eastern time here on c-span 3. the secretary of health and human services testified last month before a house energy and commerce subcommittee on her department's fiscal 2016 budget request. she answered several questions on the supreme court's expected decision on king versus burrwell which challenged the u.s. irs rule authorizing tax credits for purchasing health insurance and federal exchangers. >> the subcommittee will come to order. the chair will recognize himself for an opening statement. i would like to thank secretary

burrwell for appearing before the subcommittee to discuss the budget request for the department of health and human services. earlier this year you stated that, quote, the hallmark of effective leadership is instilling a culture of transparency ownership and accountability, end quote. these are all laudable goals and i appreciate your verbal commitment to these principles. however, your department's actions have failed to adhere to the statement standard. for example, we have only heard silence from the white house on how the administration is preparing for an adverse ruling in king v. burrwell. we did receive a reply from you and i thank you for that courtesy. but your letter contained no substantive answers to our questions. during your testimony to the senate finance committee you

were again asked about the administration's plans, and again you repeatedly declined to provide a direct answer. this is not the transparency that we had hoped for. understandably, we were very frustrated with the administration witnesses artfully dodging the questions that we asked here. and so i'm asking you today, please let your guard down a little and give us direct and complete answers to our questions. in 2009, the president correctly said, quote, the real problem with our long-term deficit actually has to do with our entitlement obligations, end quote. since then we've had the simpson-bowles commission, a super committee sequestration and a government shutdown, and never once in all this time did the administration propose a

plan to get the nation's fiscal house in order by recommending reforms to entitlements. the 2014 medicare trusties report which you signed tells us that medicare will be bankrupt very soon. we recently had senator joe lean leanerman and they told us much the same. and we stand ready to do the hard work of saving and strengthening medicare, but we need a willing partner. once again the president's budget fails to propose serious entitledment reform. the amount related to medicaid amount to saving just 15 days of programming spending over the next ten years. the plan apparently is to let medicare expenditures continue to grow without the structural reforms needed to save and strengthen this critical program, and this is not taking

ownership. if we're going to save and strengthen our safety net programs for the most vulnerable, we have to do better than the president's budget. both parties have to work together. you, we, the president need to work together to save our entitlement programs and make them sustainable, so we ask that you please work with us. on another subject you may also remember that in early november of last year, we spoke on the phone about why hhs has so far failed to hold california accountable under federal law. as you know, on august 22nd 2014 the california department of managed healthcare the mhc, issued a directive mandating that all plans under authority immediately include coverage for all legal abortions. this is in direct violation of the amendment, a civil rights statute that prohibits federal taxpayer funding for state and

local governments that discriminate because a healthcare entity does not pay for, provide coverage of, or refer for abortions. what california is doing is clearly isllegal and is morally wrong and violates the amendments that our country is founded on. it is your job to stop them and so far it hasn't happened. we look forward to your testimony. we hope that you will stay to answer all of our questions with only five minutes of questions per member and we respectfully ask that you keep your answers concise and to the point. dr. burgess, do you want the remaining time? >> thank you, mr. chairman. that's kind of you. secretary, thank you for coming to our humble little subcommittee. i am frustrated over the administration's lack of transparency and the ability for

congress to get information that realistly we've been asking for for four or five years but specifically around aca created entities, the center for medicare and medicaid innovation, the office of consumer information oversight, and the center for outcomes and research initiative. year after year they have failed to achieve their mission of reducing healthcare costs and improving quality. we can't hold them accountable if we don't know how you're spending the dollars. i do look forward to your responses in being able to finally get that information regarding those agencies. >> now recognize ranking member mr. green. five minutes for opening statement. >> good morning, and thank you, secretary, for being here today to discuss the president's fy 16 budget proposal for the department of health and human

sfgsz. a budget is more than a line of items on a page. it's a reflection of the priorities of our country. our commitment must be to protect the progress that we've made and make strategic investments. this year marks the 50th anniversary of the creation of medicare and medicaid. since the children's health insurance program was created to ensure america's children have insurance, most e recently congress passed the affordable care act dramatically expanding access to health coverage and care. the affordable care act took steps ford laying the foundation for a better healthcare system. in expanding access to cover millions of americans for whom it was previously out of reach. it also took important steps to restore the fiscal solvesy of our healthcare system. according to the most recent estimates, the affordable care act will reduce the deficit by more than $100 billion for the first decade and by more than a trillion in the second decade.

as we have seen through the second enrollment period the affordable care act has already succeeded in ensuring every american can have access to high quality, affordable coverage. thanks to the aca nearly 30 million americans got covered. these are people who would otherwise be uninsured. we have made great progress but the work is not done. i thank the agency for implementing a landmark health reform law and continuing to work with us to build on these successes. in addition to prioritizing essential services and programs, i was pleased to see that the budget makes strategic investments to improve our healthcare system and clear the way for the progress into the future. this includes funding to support training of the next generation of healthcare providers national preparedness against threats to public health, biomedical research, drug safety and mental services. the budget supports the care that provides for 22 million patients. in their role, they're providing accessible reliable source of

primary care in underserved communities. health centers will continue to be a critical element. the president's proposal includes four years of funding for the children's healthcare insurance program. currently more than 10 million children get health insurance through chip. in additional funding for chip must be authorized so there is no disruption in coverage and the states are able to continue operating their programs. the budget proposes the increase in ih funding. for the past decade it has suffered inadequate funding. without significant funding increases the u.s. will lose its status as a global leader in science and innovation. the budget proposal strengthens

national preparedness including threats and deliberate attacks and includes funding our nation's ability to move quickly to detect infectious disease outbreaks through a detection initiative maintaining strong expertise at the centers of disease control and prevention. these are> thank you very much. i appreciate the goals of the president and you have laid forth in the fiscal budget 2016 department of hhs services budget. we are seeking to move our nation's health system by rewarding volume and forgetting about the waste business.

so what we try to do is working to achieve the triple aim in healthcare -- better care, better outcomes and reduced costs. we do this by making health insurance more affordable, emphasize prevention and public health encouraging scientific and clinical research, take advantage of the benefits of technology and building up our nation's mental health system. many of the proposals in the budget find savings in the medicare and medicaid programs by streamlining processes and realigning systems to assure that patients get the right service at the right time. the budget would make the fix permanent which we need to do to provide stability for doctors and serves and people with disabilities in medicare. the budget would expand chip that provides much needed pediatric coverage to our nation's children. to conclude, i want to emphasize the affordable care act is working. over 11 million americans signed up this year including 500,000 in california alone.

the administration just announced that since the law was enact in 2010, 9.4 million people with medicare have saved over $15 billion in prescription drugs. this is what we set out to do and i appreciate working with you as we movean forward. thank you. yield back. >>"%(x chair now recognizes mr. upton. five minutes. >> thank you, mr. chairman. secretary burrwell welcome. today marks your first official appearance but i know this is not your first time in this room our roundtables last year and we very much appreciate that participation. your testimony does come at a pivotal point to next week's supreme court oral arguments. we look forward to hearing the administration's perspective on the many important issues facing the american people. you have said that transparency

ownership and accountability are important values for the department to demonstrate which we certainly welcome. in that spirit we look forward to gaining straight forward answers here today about implementation of the president's healthcare law. there has been quite a few red flags raised in recent weeks on the continued struggles to implement key pieces of that health law. just in the last week, 800,000 households learned that key tax forms sent out by the administration contained major errors. those americans were asked to delay tax filing, therefore also delaying their refunds. a recent analysis from h and r block estimates that the majority of obamacare customers are being forced to pay back some of those subsidies. millions of americans are also learning about the laws irs fines for failing to comply with the individual mandate. the backlash has been to intense that the administration has resorted to yet another special enrollment period to quell some of the anger of those who are just coming to learn about the

individual4"ñ mandate penalty. in this last week the healthcare.gov ceo suggested that the back end functions of the exchange would undergo a two-year development plan. that means that this key part of the law will not be fully complete until president obama leaves the white house. collectively, these revelations suggest that the healthcare law is still not working. our constituents deserve better, we know that, that's why i've worked on introducing the patient care act, a healthcare reform blueprint, with my colleagues in the senate. i look forward to working with my colleagues about these ideas to improve healthcare in america by empowering states and families not washington. yes, we have concerns with the president's signature law but there are other important healthcare areas that we believe are fertile for collaboration. for the past year almost year and a half, this committee has undertaken the bipartisan 21 century cures initiative to accelerate the pace of the

discovery, development, and delivery of new treatments and cures for american patients. i would like to thank you for your personal engagement on the 21st century cures initiative. as you know this is a top priority for our committee this year. patients and families in my district in michigan as well as across the country are looking for hope and that's what we seek to instill. this effort is important to many job creators as well as whether it be pfizer in southwest mish msh. i want to thank the staff throughout the administration, particularly the fda and the nih for their work and time in an effort to improve our ideas. we've established a very good foundation i think for bipartisan success and i will yield to other republican members on this side. yield back. >> the chair thanks the gentleman and recognize the ranking member of the committee.

>> thank you chairman. today for being with us today. today we're going to hear about the president's fiscal year 2016 health and human services budget proposal and there are many important provisions that we in congress must work to support. i was pleased to see that the budget proposed air funding increase of $1 billion. it's one of the most promising ways that we can accelerate the discovery of new treatments and cures. support for nih is critical to building our economy. every dollar of funding generates over $2 in local economic growth, yet we have let nih purchase power decline by over 20% since 2003. that's why it will be my top priority as the 21st century initiative continues. i was pleased to see that the budget funds chip. we must act on this proposal immediately with more than

four-fifths of state legislators adjourning by june it makes it virtually impossible. chip always has had strong bipartisan support so extending chip funding should be the top priority of this committee for the millions of children who depend on this program. i think we can all agree that no child should be left worse off because of the actions or lack thereof of congress. i believe that because the sustainable growth rate is the result of a budget gimmick, that off sets those health programs are not necessary. if we must include offsets the war savings could be used. i know some of the other side of the aisle don't share this view. i hope that we can agree that

first sgr should be paid off -- should not be paid off for the facts of the beneficiaries. beneficiaries will already pay for their cost of sgr repeal through higher premiums and half live on less than $23,500 per year. that's why the president's budget concerns me. it proposes to further increase part b and d premiums increase the apartment b deductible for new enrollees and impose a new surcharge for beneficiaries with certain policies and institutes a $100 co payment. this increases out of pocket costs on beneficiaries. we've seen enough of that. beneficiaries may forego necessary services and use more high cost acute care services and such policies will disproportionally affect lower and middle income beneficiaries who are not poor enough for

medicaid nor have access to employer sponsored healthcare. i urge my colleagues to be conscious and consider the impact on our seniors. first i want to commend you, secretary, for your agent a se hard work. because of your efforts, 19 million uninsured americans will be covered in this year 2015. i recognize the challenge your agency faces. however, despite what i call republican obstructionism, the affordable care act is working. in sum, i think this is a sound budget and i look forward to hearing from you today. i would yield the remainder ofqft÷ my time to the gentle woman;te4 from florida. >> i thank the ranking member for yielding time. i welcome secretary iqwburrwell. we're very excited to hear about thefr medical research and children's

health insurance improvements in medicare and the centers for disease control but i couldn't help but ask mr. pa loan for a minute to highlight the florida enrollment numbers under the aca. it's remarkable. i know you've seen them and we've talked about it. as of february 15th over 1.6 million floridians have signed up for health insurance in the federally facilitated marketplace. we were surprised. this exceeded all of our expectations to bead california, texas, especially in a state that had many fits and starts over whether to assist our neighbors in signing up. i wanted to highlight a couple of stories. a 27-year-old third year law student at the university of south florida got assistance from a navigator. his income is about $16,000 a year in scholarships. he was able to find insurance for approximately $10 a month zero deductible.

it's his second year enrolling in the marketplace. he's very happy with his coverage. there are stories like that again and again. i look forward to talking about it. thank you. >> that concludes the oral opening statements. as usual all the written opening statements will be made a part of the record. so we'll go now to secretary burrwell. first muchof all, thank you for appearing before us today. you'll be given five minutes to summarize your testimony. we appreciate you being here this morning. you're recognized for five minutes. >> thank you chairman, ranking member palone and green. i appreciate the invitation to be here today. thank you for the opportunity to discuss the president's budget for the department of health and human services. i believe firmly that we all share common interests and therefore we have a number of

opportunities for common ground. from preventing and treating substance abuse to advancing the promise of precision medicine to building on innovation economy and strengthening the american middle class. the budget before you makes critical investments in healthcare, science, innovation and human services. it strengthens our work together with the congress to prepare our nation for key challenges both at home and abroad. for hhs it proposes $83.8 billion in discretionary budget authority. this is a $4.8 billion increase which will allow our department to deliver impact today and lay a strong foundation for tomorrow. it's a fiscally responsible budget which in tandem with the legislative proposals would save taxpayers an estimated $250 billion over the next decade. it is projected to continue slowing the growth of medicare.

it could secure $423 billion in savings as we build a smarter, better system. in terms of providing all americans to quality affordable healthcare, it builds upon our historic progress in reducing the number of uninsured and improving coverage for families who already have insurance. we saw a recent example of this progress with the about 11.4 million americans who either signed up or reenrolled in this past open enrollment. it extends chip for four years. it covers newly eligible adults in the 28 states plus d.c. which have expanded medicaid. it improves access to health for native americans. it invests $4.2 billion in health centers. it affords more than 50,000

national health core clinicians, serving nearly 16 million patients in high need areas across the country. with health center mandatory funding ending in 2016, we estimate that more than 7 million americans may lose access to essential cost effective primary care, and this could result in 40,000 jobs lost. to advance our common interest in building a better, smarter healthier delivery system the budget supports improvements to the way care is delivered providers are paid, and information is distributed. on an issue for which there is bipartisan agreement it replaces medicare's flawed sustainable growth rate formula and supports a long-term policy solution. the administration supports the type of bipartisan bicameral efforts that the congress took last year. to advance our shared vision for leading the world in science and innovation, it increases funding for the nih by 1 billion dollars

to advance biomedical and behavioral research. in addition, it invests $215 million for the precision medicine initiative, an effort to focus on developing treatments diagnostics and prevention strategies tailored to individual genetic characteristics. this budget outlines an ambitious plan to make affordable quality child care available to every working middle class family. to keep americans healthy, the budget strengthens our public health infrastructure with $975 million for domestic and international preparedness including critical funds to the global health security agenda. the budget will support cdc's infrastructure and research to facilitate rapid response to public health emergencies and other public health threats like

the recent measles outbreak. it also invests in behavioral health sciences and substance use prevention. finally, as we look to leave our department stronger the budget invests in our shared priorities of cracking down on waste, fraud, and abuse initiatives and are projected t yield $22 million in savings. we're addressing our backlog with a variety of approaches and investing in cyber security. i want to make one final point and that is that i am committed to answering your questions. i will respond promptly and thoroughly and work with you as we can. i also just want to take a moment to thank the hhs employees for all their work on ebola and children and all the other issues. with that i look forward to your questions. >> thank you madam secretary. i will begin the questioning and recognize myself, five minutes

for that purpose. let me start with king v. burrwell. in a few short days the supreme court will be hearing oral arguments in the king v. burrwell case that could have a major impact on obamacare. in january we sent you a letter asking for any actions, analysis and/or contingency plans that hhs has undertaken to prepare if the irs rule is overturned. while we received a letter from you earlier this week, your response failed to actually answer our question. the letter simply stated that you believe no administrative action by hhs could reverse the effects of a decision in favor of the plaintiffs. madam secretary, your statement of opinion in the letter does not answer our simple question, so let me ask you the question this way. have you or senior department officials instructed counselors within hhs to prepare any

potential actions or approaches if the supreme court rules against the irs? >> with regard to what's in the letter, one of the things that's important to reflect is the analysis of what would happen. that's a part of the letter. in terms of what would happen and i should state we believe that the court will decide in the favor of the position we hold. we believe that this law says that people have traveled across the country, people in texas should have the same subsidies as people in new york. important starting point. with regard to what happened because i think that's an important part of answering the question. first, what would happen, when those subsidies go away, 11.4 million people as of january 30th when we did our most recent analysis 87% of the individuals in the marketplace are eligible for subsidies. those subsidies are on average estimated to be $268 per

individual per month. those subsidies number one would go away. that would lead to -- >> madam secretary, i understand that. i'm asking if you know of any plan to respond to approaches if the supreme court rules against the irs. has the white house, has omb or other administration officials directed or asked you about any approaches in response to king v. burrwell or work with the treasury department on potential responses. that's my question. >> in order to respond to the question, mr. chairman, in order to think about the question of a plan, one needs to i think analyze the problem which is what i was articulating in terms of the three major things that would occur if the court decides with the plaintiffs. >> let me ask it a different way. i would like to provide you some more information.

that's why we expect an answer from you today. the committee received recently specifically information from a source within your department about the existence of an approximately 100-page document related to potential actions hhs may take if the supreme court rules against the administration in king v. burrwell. are you or senior staff at hhs aware of this document? >> mr. chairman, this is a document i'm not aware of. with regard to the question that you have asked, as i said in the letter, we believe -- and i think it's very important to understand the damage because it is related to the answer. the damage comes in the number of uninsured that would occur. it occurs in what happens in the individual marketplace where a group of less healthy individuals come in and that drives premiums up in that marketplace. number three. the indigent care in those

states and those economies those are the ramifications. with regard to those things which we believe are the damage as i state in the letter, we believe we do not have any administrative actions and therefore there is not. >> let me go into another issue. i, as you know, as we discussed over the phone i'm deeply concerned about the lack of hhs action regarding california and the dmhc authority to immediately include coverage for abortion. this mandate, california mandate, is a clear violation of the welden amendment which prohibits funding to government entities discriminating against healthcare for following their conscience. do you agree that the welden amendment prohibits funding for states that mandate abortion coverage in insurance plans? >> we take the welden amendment very seriously. since you spoke with me mr.

chairman, and we received those letters, we have opened an investigation in the office of civil rights at hhs to investigate the concerns that you and others have articulated. we take this seriously and are frying to move through that investigation. >> can you project a date by which you expect the violation to be stopped? >> with regard to the issue of the investigation, mr. chairman that's not something i need to let the investigation go and i have asked the team to make sure they do it as expeditiously as possible. in order that i stay away from the investigation in terms of my interference, i want to let them go forward but i have asked for due speed. >> we'll follow up. thank you. the chair recognizes the ranking member for questioning. >> thank you, mr. chairman. madam secretary, it's been almost five years since the affordable care act was passed and i have yet to see any legislation produced by my

republican colleagues to replace the affordable care act, even though we've had at least 56 votes on the house floor to repeal it. given all this talk of repealing the affordable care act, are you aware of any requests for assistance from republicans that will replace the affordable care act with a credible proposal that would provide comprehensive healthcare coverage? >> i'm not aware of those request. >> if the millions of americans who receive financial help through the affordable care act would lose them are you aware of any republican legislative proposals that would provide millions of americans with the financial assistance to help them with affordable healthcare coverage? >> i am not aware. >> i want to get your input on an issue that i know you're concerned and i appreciate you addressing in your opening remarks that myself and a lot of members of our committee, there's a funding clift that's facing our community health

centers. health centers serve nearly 22 million patients and are projected to serve 28.6 million patients in over 9,000 locations across the country in the fiscal year 2016. because of the current demographics to local underserved areas, health centers are well positioned to provide healthcare service to millions of newly insured americans. they're particularly important in our district which is federally designated underserved community in houston, texas. i was pleased to see the budget included mandatory funding for health centers. as you know, the health centers patients face a major loss of access in a few months if we don't act or prevent the funding cliff caused by the expiration of the mandatory funding at the end of the fiscal year. can you speak about the importance of community health centers within our health system as we look at the issues of access quality and cost.

>> we believe they are a fundamental underpinning not just in terms of healthcare communities but they are an important part of the economies of communities when you think about the fact that we could lose up to 40000 jobs if we don't extend. think about the numbers think about one in 15 americans actually are served by these health centers, how integral they are to providing primary care throughout the country. we think it's extremely important to continue that so that we can as we have reduced the number of uninsured we want to make sure that those people are having care and those that had care before still have access to that care, especially in our underserved communities across the country. >> can you comment on the impact the funding cuts would have on patients access to care and estimate how many fewer people would be able to receive service at our local centers? >> our estimates are that it could be up to 7 million patients who would no longer have access to that care.

we estimate that perhaps over 2,000 of the centers would shut down without that, and then there are the patients who would not be served because people would have to scale back with reduced funding. >> in those 2,000 centers, do you know how many jobs will be lost? >> the estimates are up to 40,000. >> thank you. the health center is a crucial part of our nation's primary care infrastructure for 50 years and have long had a truly bipartisan support. last year along with my colleagues on both sides including representative lance reiterating our support for health centers in calling for a bipartisan solution we had 250 co-signers including 31 members of our committee. the senate gained 66 votes and more than 100 national organizations have called for a fix. consensus is something that must be done and we have to act as soon as possible. this issue is a top priority of mine and i know a lot of other members, literally republicans and democrats across the

country, who look forward to working with you and our colleagues to avert that funding cliff. mr. chairman, i have 4 3 seconds left and i'd like to yield to somebody for that 43 seconds. anybody want about 30 seconds now? mr. chairman i yield back. >> thank you. the chair recognizes the chairman of the committee for five minutes for questions. >> thank you again, mr. chairman. there are a number of healthcare law implementation issues that continue to trouble us. in the interest of time i'd ask that you submit answers to the following questions in writing within two weeks. the ceo of healthcare.gov recently stated there's a two-year development plan for the back end of the healthcare.gov. if you could provide us an estimate of when the back end will finally be fully automated,

would be great. the second one is hhs recently announced that 800,000 americans enrolled in coverage through healthcare.gov received inaccurate tax forms under the aca. we would like a detailed assessment on when the department expects these taxpayers will have accurate information in hand so they can file their taxes. third, many americans were automatically reenrolled in exchange plans, raising concerns that individuals and families may be getting unexpected premium bills or inaccurate exchange subsidies in 2015. we would ask that you submit specific data on the number of americans who have been automatically reenrolled in those exchange plans. that would be helpful. >> be happy to. >> now i'll return to 21 century cures. i appreciate your personal assistance with this. ford i want to thank dr. collins dr. woodcock and dr. sheren for the

help on 21st century cures. because of that participation and participation of folks across the country we've been able to learn more about the status of innovation in this country and we hear about ways to accelerate the discovery development, and delivery of cures and treatments for patients. as we heard in our first roundtable, there are over 10,000 diseases and we have only cures and treatments for about 500, so we have a great deal of work ahead. we released a discussion document last month and have been working with the congress woman to get. members of our committee on both sides of the aisle we want to improve that document. one area that includes a place holder is precision medicine, something the president talked about in the state of the union address and a white house visit a couple weeks ago. we did put that place holder into the draft and look forward to continuing to work with you and the white house, the administration, on that

important issue. could you give us some background on the administration's precision medicine policy and what we should look for. >> thank you. and thank you for the partnership as we work through these issues together. it's exciting to have the energy around these issues including the precision medicine which is a subset of the broader éé issue. it's $215 million as we think from a budget perspective but thinking about it from the pieces and what it's doing it's creating a very large database but we'll access that through other channels so we're drawing from existing databases to get the information we need. what this is precision medicine or personalized medicine is getting the information so we can do treatments so the individual. i was at nih recently and had the opportunity to meet a cancer patient where he had had a group of tumors removed and they came

back. but then using precision medicine which meant looking specifically at the genetic makeup of his tumors to be treated in a different way. i met him. that happened months ago and now the patient was there discussing with me and is a very different place. so one, that large database. two, specifically focusing on the area of cancer because we already are seeing some progress there and we believe that place is ripe for it. the other thing we need to do is fda, make sure that as we think about precision medicine we regulate and think about how to improve these things in ways of a different type of medicine. finally, we need the health records, the office of national coordinator for electronic health records to be a part of making sure this will do with payments and how clinicians will use. those are the elements. >> that's very helpful and we're excited as well. though i've been out to the nih a number of times in the past number of years, i want to

remind members here that we have got a committee trip invited, i think, all the members on this subcommittee to go out to the nih next monday morning. dr. collins has been very interested in having us out to kick the tires like you saw yourself. i know that because we have votes tomorrow and friday and again on monday and perhaps over the weekend there may be more of us here over the weekend than originally thought, so i want to remind members that they're invited to join with us and not miss votes come monday on a trip there. i yield back. thank you very much. >> now recognize the ranking member of the committee, mr. palone. five minutes for questions. >> secretary burrwell, i'm sure you can sense that i'm very proud of the affordable care act and concerned about republican efforts to repeal it or now take it to court in the case of king versus burrwell.

are you aware of any republican bill that would reduce the number of uninsured in this country by 11 million people -- i said 11. it's actually 19 million people, the way that the affordable care act does? obviously i'm saying this because i don't see them coming up with any alternative. >> we haven't and i think it's important to reflect historically. when one looks at the history and i've gone back to teddy roosevelt and the quotations. we see whether it was president bush president nixon republican and democrat president clinton, the conversation about how we make this next step forward with regard to reducing uninsured is something that we've struggled with as a nation. this is the first time and someone reflected on the anniversary of medicare and that 50-year anniversary this is the first time we've seen that. the plan that we have in place the implementation of the

affordable care act, has done that, but we have not seen any alternatives. >> about chip, all the democrats on the committee recently introduced a bill to extend the chip program. i want to emphasize that we have to act on this legislation immediately when we consider sgr which expires at the end of march. while funding e until the end of september for chip. in fact, 20 states will finish their legislative sessions by the end of april and more than half by june 1st so it's clear that congress needs to act swiftly to ensure states can budget appropriately for chip and to avoid any disruption in children's coverage. given the bipartisan history of this program, i see no reason why congress can't act very soon. can you comment on the impact on states if the chip funding isn't extended soon. >> i would comment from two previouses. perspectives. the issues of funding and the ability to manage, for the states to be able to do that,

this is important. when we've had predictability we've seen the benefits of that throughout the past two years. having just spent a lot of time with the up to this is a very important issue to them. we've seen that letter that 40 governors have signed with regard to knowing that they have that predictability of a program ha is providing great benefits to the children in their states. >> the senate and house republicans have released a chip proposal this week. however, this proposal would institute a 12-month waiting period. needlessly forces low-income children off of medicaid and on to chip and reduces or completely discontinues coverage for children above 250% of the federal poverty level despite the choice of 28 states around our nation to cover those kids. can you discuss the impact of policies like this on some of our most vulnerable children? >> we think that the chip program is a program bipartisan program and a program working

and delivering results in terms of quality health care for those children. has worked. we believe it is in our budget a four-year extension of the program. it is a very important thing and we need to do that in a timely fashion to both make sure those children are covered and receive care that they need but also to have the predictability for states especially those in their legislative process right now. >> you mentioned the four-year extension. budget includes a four-year extension of the chip program. can you talk about why that full extension of four years is so critical for kids that depend on this health coverage and maybe also mention as part of the extension the budget includes a permanent extension of express lane eligibility. talk about the success of express lane eligibility. >> those issues we -- folks ask us to try and figure out ways to makes things easier. that's making things easier in two kwazways.

it is about both the customer in terms of when they came in as well as the states. we believe this is a program that's been successful in getting to the simplicity and that often be can work to create better quality or lower cost. why think that's important. we believe four years is the right amount of time for us to do this extension. there will be interaction with the affordable care act. we believe the four-year period is the right period for us to understand and look at that. >> thank you. i'd like to submit for the record two articles. the first an op sed-ed published discussing long term bipartisan history of the program and importance of a four-year extension. the second article was published in the "new york times" last month showing how health coverage for children pays for itself and all the research showing that when children have health coverage future earnings are boosted. >> without objection. >> thank you.

>> gentleman yields back. chair now recognize the chair emeritus of the full committee. five minutes for questioning. >> thank you mr. chairman. thank you for being here. as i have talked to you before there are lots of problems that we have to deal with, you in your position and the committee in our position. but there are some opportunities for bipartisanship. one of them is a piece of legislation that we call the ace kids act. the original co-sponsors are miss caster of florida i think miss he shall shueschew of california, mr. green on texas, myself on the republican side along with several other members of this committee on the majority side. you said in your opening statement that medicaid is going to be about $345 billion this year, an increase i believe of

over $16 billion. where there is one legislation we can pass on a bipartisan basis would save money in medicaid and that's the ace kids act. it creates a home for families that have medically complex children based on an anchor hospital concept with the major children's hospitals in america. i think there are about 60 of them. so if a parent has a child that's medically complex and qualifies for the program, that child gets access to the network on kind of a one-stop shop. all the specialties, all the various procedures are provided. medicaid is billed one time. we think there are about 12 million children that would qualify for the program. and we believe that it will save billions of dollars over a

ten-year period. it's been introduced in the senate the identical bill with three republican co-sponsors, three democratic co-sponsors. here is a rare piece of legislation that both sides of the aisle support. republican leadership supports it, chairman upton supports it chairman pitts supports it. does your department have a position on the bill and if so could you explain to the committee what. that position is? >> with regard to the specific legislation, i don't think we as an administration have issued and s.o.p. the idea that we can improve both quality and cost for these children who are very complex and who are moving state to state and the current system doesn't afford us the opportunity both with regard to making sure we don't have duplicative payments. we obviously do not want that from a fiscal responsibility. and we want that ease that the parent can have the child at the right place with the right care

even if it is across state lines. i would just say we look forward to working with you. welcome the opportunity if there are questions and ways that we can provide technical assistance and other things as part of this. we welcome that opportunity because we agree with the fundamental of what we are trying to do here and believe this is something that can improve both cost and quality. >> i would encourage you and your department to take a look at the bill. it's not illegal or immoral for the administration to issue a letter of support. and this is one that i think with chairman upton and chairman pitts, ranking member of the full smith and subcommittee on both sides of the aisle, this bill could go. could be part of chairman upton's 21st century effort or it could be a stand-alone bill. i also in the brief time i have want to concur with what ranking member green said about community health centers. i hope we can work together in a

bipartisan fashion to find an answer to keep those funded. i know there is a funding issue this year that we need to address and reauthorize a program. i have a in um ber of those health centers in my congressional district and they are very helpful providing indigent care. finally, i wasn't going to ask this question but i'm a little bit puzzled. when chairman pitts asked you the question about this report that deals with planning in case the health exchanges at the state level under the affordable care act are found to not be legal the way they're currently funded, if there was a plan and if you had seen the plan, i take you at your word that you haven't seen the plan. but don't you think it is prudent that there should be a plan? i mean i hope i don't have a primary opponent. i hope i don't have a general location opponent but i have a plan in case i do. i know you hope the court

upholds your position but shouldn't the administration and your agency have a plan in case it fails? >> congressman, what we state in the letter and what we believe is, if the court decides -- which we don't believe they will. but if the court decides on behalf of the plaintiffs, if the supreme court of the united states says that the subsidies are not available to the people of texas, we don't have an administrative action that we could take. so the question of having a plan, we don't have an administrative action that we believe can undo the damage. that's why when i was answering the chairman i think it is important to understand what the damage is. because tlen ithen it comes to the question of we don't believe we have any administrative -- >> so my time is expired but if the court strikes it down the administration's just going to hold up your hands and say "we surrender"? >> what we believe is we believe the law as it stands is how it should be implemented. >> i understand.

>> and with regard to when the supreme court speaks if the supreme court speaks to this issue, we do not believe that there is an administrative authority that we have in our power to undo it. and so that's something we don't believe we have. >> that's puzzling but i accept it. thank you, mr. chairman, for your courtesy in the minority for letting me have extra time. >> chair now recognizes the gentleman from new york, mr. engle. five minutes for questions. >> thank you very much, mr. chairman. and welcome, secretary burwell. let me piggyback on back-up plan. i was part of this committee. i participated in months and months. deliberations for the affordable health care act. we had weeks of mark-ups. this committee did. and not once was there mention of subsidies not being able to individuals in states that did not set up their own exchanges. i've heard a lot of complaints on the other side of the aisle

about the law but never was this issue discussed inuntil they lost at the supreme court in 2012. some of my friends sign on to amicus briefs and wasting incredible time forcing votes on the floor, for repeal of the law, yet they are upset the administration doesn't have a back-up plan for 8.6 million americans. i think it is somewhat ironic that my republican friends are demanding that this administration fix problems that they themselves created and have shown zero interest in fixing. should republicans get what they want and the supreme court rules in favor of king i would urge my colleagues if that should happen to pass legislation to ensure that americans have continued access to affordable coverage for the federally facilitated exchanges just as democrats intended. next month the affordable care act will have been the law of the land for five years. it is not a perfect law and there are issues that need to be changed with it. but i would like to see those

issues addressed and unless unless both of us in a bipartisan way turn our focus to improving the law an enabling more quality coverage options for our constituents instead of trying to kill it, repeal it, take it to court and things like that. i just want to say that i'm sure that you agree with what i just said. >> we look forward to moving want and we do want to make improvements where we can. >> i want to use my home state of new york as a great example of what's possible when the federal government has a willing and enthusiastic partner in the affordable health care implementation. as a result of our successful exchange and medicaid expansion, more than 2.1 million new yorkers have quality health carebñgx coverage. our state's uninsured rate has droptd to only 10%. there is clear evidence we are reaching the right people since 88% of people who obtain coverage through the exchange reported being uninsured is at the time they enrolled. so it is really working in new

york and the health insurance options available for new york state of health are, on average 50% cheaper than the comparable coverage available before the exchange was established. so i want you to know -- i'm slur you sure you know it -- the aca is working well and working well inñ11ç new york. that's why i think it is terrible that i've been forced to take more than 50 votes to repeal some or all of this law. we should fix what's wrong but in my state, wits's really been a tremendous success. >> fortunately i've had the opportunity to travel the country and see the individuals. those are the numbers and the individuals and whether it is laura in florida, 26 years old married to someone who is a truck driver who does not have coverage. she's training to be an x-ray tech. they have two children. they did not have insurance. she now has insurance with a premium of $41 a month. or a woman who had ms in the state of texas and for 17 years she had not had health

insurance. and so how people go about -- she treated her ms through the emergency room and she has four children and she works. so whether it would get bad enough, that's what she would do. the stories of what it means to people in terms of their financial and health security i think numbers are important, but it is those stories which really make this real. >> secretary burwell, i understand that we have seen robust exchange enrollment nax wide even in states where republican governors refuse to set up a state exchange or expand their medicaid programs. isn't this true? >> so the numbers -- i spoke to this yesterday when we've looked at numbers. 53% of the enrollees in the marketplace in year, in the federal marketplace are new enrollments. so i think that is indicating the demand for the product and the need for the product. >> thank you. i want to second mr. palone's positive discussions about clip. i've always been a strong supporter.

as of july 2014 an estimated 476,000 children were enrolled in this affordable coverage option for their care in new york. so i think that that is really really important. i was pleased therefore, to see with the budget proposal for fy 2016 included funding for chip for the next four > we believe one of the things in trying to be fiscally responsible and indicating how we are paying for things we believe this is a legitimate way to pay for things especially in the context of we are providing health care and something that will hopefully create a deterrent and help health care in the issue of a tobacco tax. as one analyzes across the department and whether it is at cms or cdc the impact that tobacco has on health in our

nation and the cost of health care in our nation is one that we think is a fair place to go to pay for this care for the children. >> i agree with you. and finally, i want to talk about graduate medical education. i was concerned that the administration's proposal to cut indirect gme funding, 1 in 6 fisz physicians obtains training in my home state of new york and we have some of the finest academic centers in the country. so it requires significant funding and time to develop the infrastructure and expertise necessary to insure quality care is availability. how do we insure stability for these academic medical centers and patients they serve if we put gme funding at risk? >> we believe and hope that our proposal does not do that and meets the objectives of making sure we are training appropriate physicians for both primary care and specialties where we don't have as many as we should. at the same time making sure we target it. there is $100 million for

pediatric and a wider pool for competition. we want to meet the same objectives at the same time doing it in a fiscally responsible way. >> thank you. >>. mr. guthrie, five minutes for questioning. >> thank you madam secretary, for coming. i look forward to the next years as vice chair. first directing your attention to the cost share reduction program contained in the aca. sections 1402 and 1412. does any part of this budget that we are talking about today request any new authority including any transfer authority to pay insurers under the cost share reduction program? >> with regard to the program which is a program as you know is about making sure that the cost of health care to those individuals that are coming into the marketplace is something that they afford. that's what it is about. we believe that we do have the authorities to do the cost slayering. >> is there any new authority requested from this budget? >> no new language. >> we do know it is up and

running. i think we went $3 billion already on the cost share reduction program. the budget estimated is estimates 1 $1.2 billion over 2015-2016. cbo says $175 billion over the next ten years is what they estimate. could you site where the appropriations authorities is? i said you do believe you have the authority. >> we do believe we do. right now this is an issue that is under litigation and a court case that's been brought. so with regard to that that is an issue that i will let our colleagues at the justice department speak to because of the place it is in litigation. >> i understand that. but we're doing oversight here. i'm not an attorney. when you were at omb in 2014 there actually was a request in the 2014 budget for direct appropriation and that didn't happen for whatever reason but we're spending money. whether we spend a penny, this is $175 billion over ten-year

bram. we feel like this is oversight hearing. so we feel like it is our responsibility to make sure to our taxpayers that we have good answers on where this is coming from. we're just asking for where the appropriation comes from. >> i understand and appreciate the question and i'm sorry that it is in litigation. i wish we weren't in a place where we are in litigation. but when issing is entered into that place it does create a difficult circumstance. i respect the issue of oversight because the litigation has been brought by the house on this issue, we're in a place where i think that is the appropriate place for this conversation. >> i'm just not aware of any pending litigation exception in oversight hearing questions. is it like a legal case or authority or did the justice department tell you -- >> with regard to issues that are being litigated generally those are matters that we refer and let the justice department continue on. >> we've never been able to get an answer from the administration for where the language -- nobody's ever been

able to point us to where that appropriation language comes from. and you previously had requested appropriation. let me ask you another question. recently you received 18 employer groups sent you a letter urging small groups be plain tand at 50 employees citing actuarial analysis showing when they go from 50 to 51 analysis estimated that two-thirds of the members said they'd receive an increase of 18%. i just don't believe that these small employers, 51 to 100 employees can accept an 18% increase in their premiums. also the promise that if you like the plan you can keep it because if they -- if the 51 to 100 have to go into the new plan they'll have to meet the requirements of the health care law that essential benefits and other things that have caused other people to lose the plans this they liked if they can keep. due to this impact would you

support allowing states to keep their market at 50 or below, not go to the 51 to 1 00? >> this is and issue that we are looking at and examining because we have had a number of comments on it. i welcome the opportunity to see the piece of work you are referring to so that we can see and understand that. we want to understand the facts around this type of thing so i'd welcome the opportunity to see this study and piece of work that you are articulating. >> my understanding it's been submitted a letter from these 18 employers but we'll make sure that's -- thank you, mr. chairman. i yield back. >> gentle lady from illinois. five minutes for questions. >> thank you, mr. chair. thank you, madam secretary for being here today. i wanted to ask you if tu are aware of any republican legislative proposal that would keep insurance companies from denying coverage from people are pre-existing conditions like cancer or dropping someone from

coverage because they got in an accident or got sick. >> i'm not aware of a piece of legislation that would take care of that issue. >> are you aware of any republican legislative proposal that would provide access to preventive services like cancer screenings, yearly wellness examples, and do that at no additional out-of-pocket costs to consumers? >> i am not aware of a piece of legislation that would do that in the way the aca does. >> i want to talk a little bit about something that's a growing concern, and that's alzheimer's disease and the cost that it is in our personal lives and also in funding. so scores of public agencies, including many hhs agencies, as well as numerous private and non-profit organizations, are trying to address this challenge of preventing alzheimer's serving those who have dementia today, finding a cure.

shouldn't the federal government be coordinating a plan on alzheimer's? >> in terms of the issue of koord that igs, there is a body and advisory group that includes both people from the federal government as well as external folks to be a part of putting together our thoughts an straejz. it has informed the way that we are doing investments. there are members of the federal government across the government as well as external bodies that are a part of that. with regard to the work at the department, the work cuts across a number of different areas. nih and research is generally what comes to mind for most people but where the biggest dollars are spent is actually in cms and making sure we think through the issues that and in that space because that's where the dollars -- the other thing is the administration for community living is where we work on and think about things like those that are care gives and those that are going through that process of dementia and how they deal with it. so as a department we work through all of those. there is this overall advisory group that we have externally and includes internal members.

>> so the population is aging rapidly, obviously. alzheimer's is taking a much bigger toll on families, on health care systems, on people who have the disease and the number of people living with dementia will continue to grow as baby boomers age. so you had mentioned the research that's going on. what is hhs, nih doing to find a cure? >> in this budget you see a 24% increase to funding for alzheimer's which is much greater than the percentage increase even within the other nih. so focusing deeply on doing that. it is also part of the brain initiative. as we think through there are specific issues. but we are also making progress on something which is a protein that is indicative of alzheimer's. that's one of the pieces of research that's going on. if we can make progress there, the other piece of research is seeing if there are ways that we can slow the progression by understanding how the neuro

channels move and what's happening in the disease. those are pieces of resenkarch that we're starting. we believe that with the funding we are asking for that we can move that research we can broaden it and we can make it faster. >> so dementia is a major focus of work in the united kingdom and other developed countries. are we keeping up with the rest of the world in research activities and investments? >> no. we believe that we are with regard to that. i have been in touch with my colleagues and the secretary -- or minister in the uk and continue to have those conversations so we make sure that we are learning and staying connected to our colleagues. that's a particular example where i have been in touch and will continue to do that to make sure we learn everything we can from our colleagues and in places where we can work together see if we can leverage

going on in each much our countries. >> who is on the alzheimer's advisory committee? i im i'm asking because shouldn't there be a person with alzheimer's on the group? >> i'll get back to you directly but it is my understanding that there is a person. there is a slot and either there is or will be a person that does have, that that is part of the committee. i'll get back to you on that though specifically. >> i want to thank you for the focus. as the co-chair of the seniors task force of the democratic caucus, i really want to work with you on that because this is a problem affecting so many families and individuals. i appreciate it and yield back. >> chair now recognizes gentleman from kentucky mr. whitfield, five minutes for questions. >> secretary burwell thank you for being with us today. i want to follow up on my colleague's question. we are concerned about this cost reduction program because cost -- cost sharing program because it is $170-some-billion

over a number of years. we understand that's one of the issues involved in the lawsuit. but all we're asking you is, since you a you will are dis. percent dispersing the money, what is your opinion as to where the appropriationdispersing the money, what is your opinion as to where the appropriation is dez nail thesignated that you are working from? >> i understand the question. we believe we have the authorities. with regard to the specifics of that, because we are in litigation -- >> but you can't tell us where the mrnoney is come being from? were you instructed by doj not to answer that question? >> with regard to that specific issue, that is at the root of the litigation. >> were you instructed by doj not to answer the question? >> with regard to when there are issues of litigation like this this is our standard practice. >> well, yesterday, we had gina

mccarthy here we had 111d before the supreme court right now and she gave us her theory of why she thought she was right. we're not saying we're right or you're right we're simply asking what is your theory, where does the money come from in your view? >> that is something, as i said -- why don't i work to get back to you on where we feel comfortable with regard to where the litigation is. i'd like to come back on that. >> i must say i have been impressed with your facility to use numbers. you're really tuned in to the budget, responding to mr. pitts responding to mr. green about the community health centers. i was at a rotary club meeting recently and i was asked the question, they said congressman, can you tell us what dollar amount has been incurred by the federal government as a result rf state expansion of medicaid programs pursuant to the affordable care

act. because we picked up a larger percentage of the normal cost. and i would ask you that question. i didn't know the answer. but could you tell me what is the total dollar amount incurred by the federal government by the expansion of the state medicaid programs as a result of the affordable care act? >> that -- in terms of the federal dollars versus state dollars? >> yeah. just the additional dollar amount incurred by us. >> let me go back and look. because the question of being able to disaggregate whether a person came in because of expansion or were under the old rules. i would want to make sure that we can understand -- >> you don't have a dollar amount for that? >> i don't know -- i will check with the department if we do. one thing -- >> you would think that you all would definitely know that. because that -- we can all talk about the advantages and disadvantages of this program but there is a big additional cost to the federal government and we're simply asking -- i'm asking what is that total dollar amount incurred?

>> i think the question that i am not sure is how one breaks out the actual number from expansion. because when people come through -- >> let me ask you this question. the states were encouraged to expand medicaid which is fine, because the federal government's picking up more of that dollar amount. but at someq9ñ point in the future the federal government's not going to be picking up those additional costs. what year is that? >> what year that is is the federal government never goes below 90% of the payment of the additional. so -- >> until when? >> 2020. 2016 is the year through which there is 1 00%. >> do you have any projected cost over that period of time for the federal government? >> we do have those incorporated into our budgets. but one of the things in terms of these cost issues that i think are important in the state of kentucky -- >> okay. well, that's okay. listen, you can't answer the question. but i appreciate it anyway. let me ask you this. i notice that you all made $2.5

million in loans in the co-ops. kentucky has a good co-op program as well. we sent a letter last year around we were concerned about the sol vensy of some of these co-ops. federal government has loaned in iowa and nebraska those co-ops are in bankruptcy. have you all done any aem sis to project -- are therer in 80s sta there is a chance that these co-ops will go into bankruptcy? are you looking at that? >> we are looking at the co-ops. one thing i think is very important to note is the deep cuts in the funding for co-ops. when the funding was originally designed and passage cht ageage of affordable care ability occurred, the states in which it was felt to make a difference, those monies were cut as part of sequestration. they were cut in '11 '12 and

'13. >> so are you saying that bankruptcy occurred because of sequestration? >> what i am saying is had we had more funding in order to provide additional loans to the co-ops, it could have made a difference. with regard to the fundamental of your question, which is are we looking at the co-ops, and there are two things that we want to do. understand whether they are stable and then the second is where we can provide technical assistance. >> well, those questions that you couldn't answer or were not familiar with, i do hope that you'll get back with us with throws answers. >> be happy to. >>. within seven days, if possible. thanks you. >> want to make sure that we will get back as quickly -- >> i've got to be back at rotary club next week. >> as a neighboring state i appreciate that. >> gentleman yields back. >> madam secretary, thank you again for -- on belaughhalf of the

1.6 million floridians able to buy health insurance in our exchange. i'll give you due credit and to everyone at hhs but i think real credit goes to our terrific navigators that were on the ground, hospitals across the state of florida, community health centers and family members that probably put in a good word for their sons and daughters or aunts and uncles to sign up. you probably want to give them a pat on the back yourself this morning. i encourage you to do that. >> i do. i want to expression appreciation. i've seen the local stake holders and met with them across this country. and it was the communities coming together. it was individuals. it was people in the community health centers. as was mentioned. it was business people. it was everyone when i would visit the hospitals would be there, everyone would be around the table working on this issue together. it was that kind of work and then the individuals that i visited on second sunday and in texas actually was given the opportunity to speak at one of the churches. it was all of that coming

together to give this information to people so that they could make choices and have that financial and health >> so in florida we have the very competitive marketplace as well. consumers could choose from 14 different issuers in the marketplace this year. that was up from last year where we had 11. florida consumers could choose from an average of 42 health plans in their county for 2015 coverage. so with $1.6 million now enrolled it really demonstrates the high stakes involved with the supreme court case that the court will hear next week. i cannot imagine that the court would rule to take that away from over 1 1/2 million floridians, then millions more all across the country. just like representative engle said i was here during the hearings in advance of the affordable care act adoption, during the mark-up, during the

amendment process, during negotiations with the united states senate. never in those discussions was there any dichotomy between a state exchange and a federal exchange and the availability of tax credits. have you seen any evidence to the contrary in your review of the record and the case that's before the supreme court? >> with regard -- i would let the justice department who has reviewed everything. but the thing that i agree with is we don't think that that was -- we just don't believe that that's what the law says or what was intended by the law either. >> yeah. i can say straightforwardly, as a member of this committee, what the legislative intent was. it was for those tax credits to be available to every american no matter if they're in the state marketplace or a federal marketplace. but i would say, if the court rules otherwise, they are going to create chaos and they're

going to strike right at the heart of the sxhik security of so economically of so many of my neighbors in florida and so many americans. i know they'll study the legislative intent. i hope they rule the right way and we don't have to address that chaotic situation. but i think with the affordable care act the real untold story is what has happened to people who have insurance. i can cheer on the million and a half floridians that now have it, but most of my neighbors already had insurance private insurance or medicare. i notice some more good news that was announced this week for my neighbors that rely on medicare. just in florida alone floridians have afdsaved almost $1 billion since the aca's doughnut hole discount. almost 350,000 beneficiaries saw savings in 2014 to the tune of about $300 million last year. the average discount for -- per

beneficiary was $884. then for private insurance, how come we haven't been able to get the word out on how much better an insurance policy is? a consumer can't be kicked off if they get sick. in florida alone over 200,000 young adults can stay on their parents' plan. floridians have received millions of dollars in rebates because the law says you have new rights and protections and insurance companies cannot spend that money on profits. it has to go to -- it can't spend the profits on salaries and excessive profit. it has to go to health care. what else can the administration do to tell this good news story? >> i think we can do a better job of making sure people do know. another area is the issue of preventative care abdz the importance of the fact that your childhood visits and those things are no longer requiring

co-pays or cost sharing in terms of when you go in for that or measles. an important thing i think right now and timely thing. i think we need to do a better job of making sure people know about those improvements to quality. >> thank you. i yield back. >> chair now recognizes gentleman from illinois. five minutes for questions. >> thank you. i talked to your staff prior. i appreciate your outreach trying to tall. it was a crazy day. . >> this happy talk about how great health care is and the affordable health care is moderated by real concerns out there. remember the bill that passed signed into law we had nothing to do with on the house side. it was a senate health bill that came over to us that we passed. so that is the health care law that we have today. the language of the law is pretty clear. i am concerned also that supreme

court will rule that the federal exchanges in states are not authorized to receive subsidies. we just need to be prepared for that here. i would hope the administration would be, too. i promised two ladies from my congressional district i'd mention their names. angie esker who is a pro-life strong family and she cannot buy a policy that does not have abortion coverage. for millions of americans this is a really important issue. this is an emotional -- just like on the other side. you no he how this debate is. i think part of the agreement from some of my pro-life democrats was to ensure that that option would be available. it is just not for her. the other one is debbie mckinney

huff from a town kildcalled highland. her premiums went up astronomically last year. this year they've gone up with a $10,000 deductible. she can't afford it. for all the happy dancers there are challenges out there that we don't do our constituents service if we don't understand that there's problems that have to be resolved. there's some budget requests that i want to talk about so i move forward. i'm a big supporter of medicare advantage. i was here when we passed it. seniors didn't have any prescription drug coverage. been very successful, been very popular. the budget request makes the reduction again in that where the enrollment is going up. favorables are high. and 670,000 people weren't able

to access medicaid advantage. if you're from rural parts of this country, that option is very limited. if not or it doesn't exist. so i would ask that we relook at that so that seniors who want to have the option can choose that. and our concern is your budget hurts the ability for that to happen. >> with regard to the first issue in terms of your two constituents, want to make sure we understand that. on the issue of the question of abortion and that -- >> let's just answer this question. >> i'll focus on the medicare advantage issue. we want to make sure the program during the period of changes that we have had we've sent a large increase in the number of people in medicare advantage plans. i with a'nt to understand your $670,000. 90% of beneficiaries have access to ma plans. i'd like to understand that 670

better. we know those number of plans that have gone from four stars -- gone to the higher ratings, we've gone from 67% in the two highest rating category. we're improving quality, there is premium control. understand the $670,000. we alter our plans as we hear concerns. that's why i want to understand that 670. we believe that we can continue making these changes. some of the points the chairman raised with regard to deficits and making sure we are responsible. >> are you aware of any efforts to accelerate the next round of user fee negotiations? our concern is if they are and they're not doing due diligence about the fees and the return on investment, we would hope that they would not accelerate it until due diligence is done. the last thing i wanted to address was the biologic price

competition innovation act. stakeholders have to be involved in that. that's really part of this 21st century cures debate. not just having bureaucrat's panels.z2,ç

>> as we look at this we have to also look at seniors. that's really why when we look at this, i know you seek to increase the skin if the game for medicare beneficiaries. however, i would argue that seniors already have a lot of skin in the game and medicare and that additional cost sharing will not bring down the costs in the program. as you know, if they have increased costs, you look at most of them as supported by social security, then that -- what they do is shift over the cover the to pay for their health care from social security. so i think it is something we really ohave to look at wholistically. so thank you very much.

>> now recognize the gentleman from pennsylvania, dr. murphy for five minutes of question. >> appreciate being here. py also i in a related area, we've had a number of hearings regarding mental health and one is substance abuse among the mental health service administration. we've asked for information for almost a year for getting some records. chairman upton and i have not gotten those documents. we are concerned about their delays. i wonder if you could help us get some assurance we'll get those documents? >> as why had the opportunity to discuss, i'm hopeful very soon you'll have some of those documents and we'll continue to work with you on it. >> i appreciate your team work on this. another question, when we pass the sgr patch last year there was also a demo project which is what miss matsui is also

referring to for behavioral health clinics to improve access. as part of this we attached something for outpatient assisted treatment for counties and communities who also have access to some grants to facilitate that as long as those communities -- behavioral health clinics could get those to offer help for those cycling through, whether as a result of violence prison homelessness, et cetera. that small 1% of 1% who are persistent chronic and mentally ill going through the system. i want to make sure from you, the way this was designed only those counties who really have aot would be eligible for those grant programs if they're going to attach those to those community health centers. is that something you are aware of and could you work with us to make sure those grant programs were available in that sense? >> we do want to work with you on that. yes, we are working on that and would like to work with you to make sure we do have those standards in place. >> another one has to do with a

program that was discussed called icare which is to help with those going into emergency rooms to deal with those in crisis. one concern i have and certainly we have seen headlines, tragic sad cases such as that cases, there are just not enough psychiatric hospital beds. people languish in a emergency rooms often in a five-point tiedown given sedatives. we wouldn't have this problem if we had more psyche beds. i'm hoping since the demand for psychiatric beds exceeds current demand you can work with legislation to say there should be a place where people can go, not languish in a jail cell or sit in an emergency room.

>> yes. >> another issue then related to the assisted outpatient grant program is a stand-alone thing. i think i have a poster. this comes out of a duke university study. when you have assisted outpatient treatment -- working with someone from the courts, working with a person saying you need to stand treatment for a number of months, outpatient treatment -- not inpatient -- take your medication, see this person and report back, they saw an 87% reduction in incarcerations. 83% reduction in arrests. 77% reduction psychiatric in-patient hospitalization and 33% reduction in er hospitalizations. i just want to show you that, too. by the way costs are cut in half for these folks too. a in working with issues of cbo scoring, we're going to have to team up together on this and say there ought to be options for people to be in outpatient care.

psychology, psychiatry, peer supports, people helping with job training housing, all those things together but there has to be this coordination of brams programs. >> i think it is part of the broader issue of how we deliver quality. when we look at diabetes and clinics we visited across the country, when we get these adherence numbers up and people participate in that that usually has to do with coordinated care and the type of interaction and communication you are talking about.get adherence. we get lower costs because of the things that happen when we have the bad things that go wrong when people aren'ted a here aide adheres. >> gmo said 112 federal agencies and programs scattered across eight departments that deal with mental illness. they said the interagency

coordination programs supporting individuals with serious mental illness is lacking. it was really to me a really dizzying and sad description of the process here. i hope you will also work to coordinate those programs andky have that assurance from you as well? >> we will and we do coordinate. we coordinate from across the overarching issue then within areas like veterans homelessness and issues that relate. i want to have the conversation about how we think about where we can strengthen those things. >> thank you. i yield back. zblrm the gentleman from . >> the gentleman from oregon. >> thank you for being here, madam secretary. last year health care spending grew at the slowest rate on record since 1960. health care price inflation is at its lowest rate in 50 years. and aca's gotten a lot of attribution by cbo for making a big difference in that result. have you seen a republican

legislative language that would give us that same result? >> we haven't seen a proposal that would continue us on our path with regard to some of the changes we've got in place. >> seniors have also benefited dramatically from the aca. prescription drug costs are a big issue for them. over 8 million seniors have actually benefited from and saved over 11 billion dollars. is there a republican proposal out there that does a similar thing? >> we haven't a proposal that would take care of the issue of the doughnut hole. on tuesday we actually were able to update our numbers in that space and it is now $15 billion in terms of the savings. on average in the country, that's about $1,600. >> i found that ironic that my colleagues on this side of the aisle keep asking for contingency plan from this administration on this bogus lawsuit.

yet, as a firm believer in article 1, legislative supremacy, with all due respect madam secretary, i think it is our responsibility and majority party controls both chambers. where the heck is their contingency plan? that's a rhetorical question madam secretary. one of the things that's been really good i think in my state is the expansion of the affordable care act, medicaid population into the private sector. we've had some unqualified success. emergency room visits are down like 21%. we've actually got lyly gotten complications from diabetes alone down 1 1%. copd, hospital stays down almost 50%. are you getting any of the same -- those same type of results from other states? >> so we are. recently in the last two weeks out of the state of kentucky we have seen a piece of analysis done by the university of louisville and deloitte.

that piece of analysis showed they did it at the beginning of the expansion, then they did the analysis now. what the analysis showed is that the expansion will contribute to 40,000 jobs in the state of kentucky and will contribute to their gdp by $30 billion. that's the period of to 2021. that is over a period of time, but we are starting to see both the sxhik and job impacts as well as some of the health impacts you were describing. >> contrary to popular demagoguery on right ring radio and tv, this is a marketplace system we've set up. federal government is a facilitator in that. the state hopefully -- those are some of the state exchanges. like everyone i think here we all believe in the power of shth ma place competition. my own state for instance over the last year, instead of seeing the double-digit increases in insurance premiums on average, ours actually are decreased

slightly. that to me is a key indicator for the affordable care act. uninsured rate if had oregon went down 63%. i've had testimonials from hospitals and doctors about how people actually have health care access at this point in time. could you talk about what you've seen nationally in increased competition? >> with regard to the issue of increased competition, we saw 25% more issuers come into the marketplace this year. so more issuers means more -- >> they wouldn't be doing this if they weren't making some money and if the program weren't working. >> also with regard to the issue of competition. what we no he is in many plans that are employer-based, people do not come in and shop. they just automatically re-enroll. as you know, we had that as part of the marketplace this year but we no he -- know that the majority of people came in and shopped and that is i think related to the competition and related to a consumer that wants to make the best choice. that choice is sometimes based

on benefits, sometimes it is based on cost. cost has a number of different elements, whether that's premium or deductible. >> i'd like to call out some kudos on the gme, increase in the budget. the msh money you put in for medicare appeals. we do a lot of work with people having trouble nevada gating the system big time and the investment in primary care docs. the only thing i am a little concerned about, if we're going for bundled payments why we are handlering on the medicare advantage plans a little bit. >> as i mentioned to you ary colleague, i think what we're trying to do is balance, making sure that those plans are good and strong. we've seen that over the period of changes we've done. we try and do the changes in a measured way that gets to things that actually have to do with what we believe is strong representation of the taxpayer in terms of places where we

believe there are issues like upcoding that is occurring. and that med taxes has articulated, those and others. we always want to listen and hear and watch carefully if we see problems that occur. but to date we haven't. >> recognize the gentleman from nj emergency emergency emergency. >> thank . >> i understand you said there can be no administrative action should the plaintiff win the case. you stated that explicitly and repeatedly and that is not my question. my question relates back to the chairman who said in his opening line of questioning that that we have a specific source within the department of that there is a document should the supreme court rule against the administration. i understand that your point of view is that there can be no

administrative action. you have stated that explicitly. are you aware of any such document -- i'm not asking you about your position on administrative action. i'm asking about a and i'm not asking about your position on administrative action. i'm asking about a document in this regard. >> congressman, if there is this would certainly like to know of the document because i don't have knowledge of a 1040-page document. >> i didn't say 100-page did i. i said a document. i don't know how many pages it is. you're not aware of a document? >> as i've said there isn't administrative action, therefore there's not a plan. >> i've made that clear. i understand your point of view on that. is there a document as to a reaction from hhs should the case be won by the plaintiff in the supreme court? >> with regard to a reaction as i said because i've articulated that -- i want to be careful because i have articulated what we believe -- >> as i have tried to be

careful. >> -- the problems with regard to the question of what will happen. we know how many people are in the marketplace. >> yes, that's filler bustering. i understand that. i'm asking whether there is any document. we have a source indicating there is a document as too what might be the response from hhs. >> i'm not familiar with the document you're referring to. >> let me say that a former cms administrator, tom scully of i believen the bush administration has said ochk i had a document. he said of course they have one. they should all resign if they don't. i would hope that your department, madam secretary, would have some sort of contingency plan should the court rule for plaintiff. do you believe that the suit is bogus? >> with regard to the lawsuit, as i've said, what i believe is that the law is clear -- >> yes i understand that. do you believe the suit is bogus? >> that is a characterization

i -- my point about the suit is what i believe is that we hold the right position and that our position is correct. >> and i understand that, it will be argued next week and a decision will be made by june. formerly when i ask questions about this not by you, but regarding prior professions, there was a question that was a frivolous suit. do you believe that the suit is frivolous or bogus? >> what i believe is we should make progress for the person people -- >> i'm aware of that. do you believe the lawsuit is frivolous or bogus? >> may i finish congressman? i believe that we as the executive branch and the legislative branch should be working on three things that we agree with affordable, access and quality. >> i agree with that. >> and what i hope we can do is build on the progress that we have sean. and that progress is that 11.4 million --

>> you're claiming my time. do you believe that the supreme court is likely to rule unanimously on this decision? >> as i've indicated we believe that the court will rule in our favor. >> do you believe the suit is bogus or frivolous? >> with regard to characterization, what i think is valuable is that we believe that our position is the position that will stand and that we believe we're right. that people in the state of new jersey should not have their subsidies taken away because they do or don't have a marketplace when people across the border in new york will get those subsidyiessubsidies. >> i believe in equal justice under law as inscribed across the street in the supreme court building. i believe this is a serious case. it's closely contested. under no circumstances do i believe that plaintiff will win 9-0. i have read the briefs, all of the briefs, i've read the brief of the plaintiff. i think it's very serious case

and i you and i may disagree on the case. i respect that and i understand that. it's frustrating to me that here in washington there cannot be an intellectual argument as to pros and cons and i certainly would encourage the administration to have a contingency plan and to work with us in congress including the republican majority in both the house and the senate should the court rule for plaintiff. thank you, mr. chairman. >> congressman with regard to the question of our authorities, what you just ended with was the issue of legislation. and i want to make sure i touch on that. as we've said all along we're willing and look forward to working with the congress on any legislation that would work on those three things we talked about, afford bltdkt and access. that's how we look at legislation. we want to do that now and in any -- >> and i was part of a group that had an alternative piece of

legislation that didn't see the light of day put forth by the tuesday lunch group. i'm a member of that group. it was different from the affordable care act. it was an alternative legislation. it didn't see the light of day in any way, shape or form. >> i recognize the jen from massachusetts, mr. kennedy five minutes for questions. >> thank you very much ffr being here. you touched on a moment ago the legislation that you were eager to work with. have you seen any such legislation? >> with regard to legislation that would promote and move forward on those three things the issues of making sure we're expanding the insured population have not seen things that would work towards that. >> madam secretary, are you aware of how many bills were passed and signed -- bills were passed by the 113th congress? >> i don't know the exact number. >> give or take a few 931

ballpark sound about right? any idea how many of those were signed into law? 296 sound about right? any idea how many times in my first term in congress we repeal 0 all or part of the affordable care act? 55 sound about right? any idea how many times those were signed into law. >> none. >> none. any times are you aware of how many times we voted on some sort of replacement bill to the affordable care act that we voted to repeal 55 tames to provide americans with quality affordable access and financial assistance to access to health care that they deserved? >> none. >> i think the number is none. >> i would agree with you. so i think given all of the discussion we've had over the course of the past several hours about contingencies about other options, and the time that i have been in congress over 55 times in my first term, including another time in my second term te appeal all or

part of the affordable care act. under the time i've been here to not have a single bill that has seen the house floor to vote on an alternative to provide quality accessible health care to millions of americans i would respectfully ask, as my colleagues have, for the administration to work with democrats and republicans to work on any such legislation should they decide to bring that to the light of day. >> in our bungt we actually cohave a proposal to improve the small business provisions of the affordable care act to try and both simplify and make the tax credits better for small businesses. that's feedback we've received about that. and that is something that is included in our budget. >> now turning to a couple, i think, hopefully more substantive questions that i could get with you, i was happy to see the included in the president's budget extended the

medicaid primary care payment increase. the rate of increase that was initially included has been absolutely critical. for the last two years it's boosted payments to doctors that treat the most vulnerable population making access an attainable goal. according to a report however, the expiration of the payment bump in last year will result in medicaid payments that are going to be cut on average 43% and over 50% in some states. the impact on wait times could be drastic and immediate. i was hoping you might be able to comment on the importance of the parody between medicare and medicaid payment to our primary care providers and when they have to choose between seeing some of the most vulnerable populations, senior, pregnant women, and children, boy why would there be a reimbursement discrepancy. >> why have we proposed the continuation of the payments? we

believe it's making a difference and it's making a difference to the access in coverage that people are getting in the system. we've proposed it as a continuation and we hope that that's something that the congress will consider and support. >> thank you. the second topic i want to touch on today, actually my colleague, mr. murphy touched on it quite extensively in his comments is about substance abuse and mental health. back in massachusetts, madam secretary, i see communities on the front lines of a growing devastating opiate abuse crisis. we're looking to the federal government for support. as a prosecutor before i ran for office i saw the impacts 0 this on a daily basis not just in terms of addiction, and people needing treatment but in terms of property crimes personal crimes for folks that are looking to try to find a way to get help. but the treatment options aren't there. there are not enough doctors, not enough beds, there's not

enough wrap around services not enough care. i'm hoping you can touch on the importance of creating these incentives through medicaid to make sure the incentives are in place to allow that marketplace to provide that care. >> so the bad news as you indicate there were 259 million prescriptions for painkillers opiates during 2012. that's more than one per adult in the nation. the good news is that i believe there's bipartisan support for us to do something and i believe that's both in the executive and legislative branch here in washington, d.c. as well as with the governors who i met with over the weekend. i think with regard to payment it is an important place but there are three fundamental things we believe we need to work with the congress and governor to do. one in terms of the prescribing that's at the root of the problem. we've seen progress in states like florida where they're watching the prescribing. the plans that states can put in place to oversee