telehealth. i think the dod has done good work. private health care providers are expanding their services. it's a way to improve clinical outcomes and also a way to save money in systems. and i just wan to know what medicare in particular is doing. what you think you can do additionally within the confines of 1834 m and whatever statutory restrictions you may have, and could you divide your question into those two categories. where you think the the law needs to be changed and you're stuck, and what you think you could be doing within the confines of the statute that you're not quite doing yet. >> so i think the places where we can do more are in the innovation center. so the funding we received for the innovation, and that was part of the affordable care act that we've been given. there we are seeing and doing a number of projects that are including telehealth. that's one place where we're acting. we have several things we funded that include telehealth components that we think are

important. and i think you know the statutory requirements with regard for meeting success are very high. so it will take time and measurement to get there and prove that. so we want to get there and hit those measures because that's when we can scale those. we have to be able to show you asked us to show quality and cost. so we have to get there and do that. the other place in terms of the authorities we currently have have to do with the aco work we're doing. pioneer acos and others. we actually just recently, accountable care organizations, we just recently put out a version 2.0 and telamadison was increased in that. with regard to the statutory issues, there are some places and i think we need to have the places about are those places that we can talk about where there might be changes that would free us to do more telehealth, and that is on the medicare payment side. >> right. okay. so let's do two things. first of all, let's work together, and i know senator wicker as the chairman of the sub committee on telecommunications had a really good bipartisan hearing on the potential for tele health.

i think there were 17 members that attended. i want to work with him. i know a lot of other members are anxious to get going in that space, and i think he's going to work on legislation to introduce in this conversation and that space. so first of all we have to work on whatever changes in the law are necessary. i would also encourage you, because during that hearing, the national organization for telehealth, i think that's what they're called, but in any case the national organization that advocates in this space thinks that you can be doing more, even within the constraints of 1834m. i know you did the nextgen aco but some of my staff and others are saying you could move a little quicker in other areas. so i'm anxious to i know you believe in this. i know the administration believes in this. and i know there are other

executive branch agencies moving faster. now some of that is because of the law itself but some of it may not be. but if you can check with with your stuff to see that we're doing absolutely everything that we can possibly be doing to advance the ball on this nour one of the biggest payers around. so on this committee, a lot of questions were logistical and clinical in setting up markets and the rest of it, and in my view a lot of the problems downstream get solved if the payer comes to the table. that all gets settled because there will be a built-in market. andty think you can make some additional incremental progress as we work on legislation together. >> that's great. i think you know the payment has to do with is it something that exists, or does it have certain proof point that is -- you know to this those are the places where there is troom to push the authority. if you all have ideas we welcome that. >> thank you very much. zblf senator caputo. >> thank you mr. chairman.

and if it's not lost on anybody in the committee to know we are both daughters of west virginia and i'm very proud of the secretary. she does a great job representing our state and our nation. it's an honor for me to be here with you for the first hearing. the question i had specifically, and we were talking about the back loan clinics. hrsa made a change in their allocations to cap it at 900,000, which actually costs west virginia some federal dollars trying to make sure we meet the challenge of ridding ourselves and treating black lung disease, which unfortunately we have. what's the rational before this program cap? is this going to continue? we were able to sort of recover a little bit through another grant process, but i am concerned about this because of the deep need that we have in the state, our home state. >> so following our conversation, had some conversations about why the changes were made, and the

changes were made in the program to make sure -- i think there was questions about whether or not we were fulfilling the statutory obligations with regard to the quality of grant making. i think that was a very large portion. there were two elements. one, the question of making sure we are getting to quality. but the second issue was getting closer to the communities. when all of the money was being if you believed through mainly state grantees, there were also other grantees in states that were actually serving communities as well. so opening the door for others to serve as well. i know i went to look at our state to see what had happened. and i think in the year before the state, the department in terms of the government received the grant of 1.4 and in the end was two grantees. one was the state and another player came to. and so it was a $200,000 reduction in terms of what the state received. but the objections were to try to improve quality and get some

grantees closer to the local communities. >> is the interpretation that i'm making that the $900,000 cap is just the cap to go to the state government, and if there's others you can apply to this. >> that's right. and in west virginia we did. we were very fortunate. didn't know. i actually -- someone had also raised this last year with me and i had actually asked could the the states still, and another grantee came forward in the state. >> okay. >> and the quality issue i understand. >> and i did follow up on that issue, too. because i did ask them about the question in need. everything from our type of coal to the population we have would be greater need. >> right. >> and so one of the things is there is difficulty in measurement, and we do need to work and get people to a standard where they're able to measure these things, so that we can make decisions better based on that. >> sounds good. sounds good. thank you. we'll be following up on that.

>> and that is a place where we may need the measurement. >> and you mentioned the the opiate addiction and what you're doing in that area again all across many america, but we seem to be having a difficult problem with illegal prescription drug abuse and heroin. the rise in heroin and poisonings and deaths per population. help me out here. how can we stop this? what are you doing within the the department? >> so building on the work that had been done but being very focused about since i arrived in last june june 9th, this is one of the the first things i asked the team to come together. many things going on in the department. made that to a consolidated strategy with three priorities. we need to be focused with you all, the congress and you all the governors. the first is prescribing. that's where much of this starts. and that's the only one that addresses prescription opiates and not heroin. we need to get to a better place in terms of prescribing. there is over prescription

occurring and that's driving a large part of it. we need to make sure doctors have the right guidance speaking with me about this issue at the sgr events in terms of they need the right guidance. but prescribing number one. number two is access to -- that's an important part of the budget conversation that we're having right now because we need to give the states the money to access it. >> our state just passeded a state law to allow them to carry that. >> west virginia is good. massachusetts -- i'm doing an event next week with the the new republican governor in massachusetts who made this a big priority and is state of the state, and we're going to do an event together. we have good things going there. and the third thing has to do with medicated assisted treatment. because sadly for both heroin and opiotes we are going to have to use medication as part of the treatment. those are the priorities we all need to work on together. it's abdomen funding in terms of the conversation we're having. it's also about something called -- which is also part of treatment. and how we prescribe and how we

control prescribinging, but i think hat this point in time there's general agreement it's a little too controlled, but the changes we need to make i think we need to make in conjunction with the congress. the other thing is working with the states and making sure that they have the prescription drug monitoring plans pdmps is what they're referred to, put in place and they're strong and eventually we need to make sure those plans are going across states. you know, kentucky to us and west virginia, the border is porous. if we can't know what that person in pike county is prescribing in mingo county people are going across. those are the ep steps we need to take. >> thank you. >> thank you, mr. chairman and ranking member. i am going to follow on senator caputo's questions in a moment. before i do, i want to thank you secretary burwell for being here and share with the committee that i'm hopeful that we can find relief from the budget control act to allow this sub

committee to draft pa bill that provides the funding that we need for the critical programs and to carry out its mission and serve the very people that we all represent in our home states. and as another side note, as someone raised by an nih funded scientist, my grandfather, i am certainly a strong supporter of our research and nih budget but in particular, knowing the impact that our scarce funding has had on young researchers, i'm especially concern that had the budget control act continues to put our next generation of researchers at risk. but as i said i want to focus in on the prescription initiatives that are in your budget. and this is an issue that obviously impacts many of our

states. i would dare say all of our states. and so i'm interested in hearing a little bit more about the cdc's plan to develop prescribing guidelines and in particular, i want to ask some specific questions about that. number one we've seen in wisconsin some particularly tragic cases involving our v.a. system. a number of deaths of tragic deaths of patients who were treated at our v.a. center in toma. so part of the question is will the guidelines be applicable to systems like the va system. and then secondly guidelines are just that, they're not mandates. and so we've had challenges when best practice is when guidelines are articulated before in getting the widespread adoption of those in our medical and

prescribing community. please speak to that too. zbr and so with regard to the guidelines, we think it is one of the things i think people feel is that they do need more clarity, because there are important issues of pain that need to be treated, and treated with the types of drugs that we're talking about. and so we don't want to deny those who their daily limit is depend. so getting clarity in the guidelines, cdc will work with with fda, with nih, with all the other parts to provide those guidelines. with regard to the issue you just articulated with guidelines, this is another space that i actually think we may need to have a conversation about potential legislative health. and that has to do with training. because even if we put the guidelines out the questions of whether or not those existing physicians and even those coming through will be trained in the mechanisms and trained in the guidelines is a question that is extremely important one. and so how that and where that occurs may be a conversation

that we need to continue as we have put together the places and spaces where we think, you know, legislative, states and what prescribe prescribers and others need to do. that's how we thought about the the strategy. that's a very specific issue that is on our list to continue to have a dialogue and conversation with you all about. >> well i would welcome the follow-up. because the tragedies we have seen in our states that i have seen in my own state deserve a response of the utmost seriousness. and in fact, i think we're coming very late to this issue. and your secretary highlights that in 2009 total drug overdoses overtook every other cause of injury death in the united states. and yet we have yet to implement a comprehensive strategy.

so in addition to working together on future perhaps legislative measures, what i want to ask you is, how will the administration's proposed initiatives to address the growing nationwide emergency be impacted if your budget request is not funded? >> it will be extremely important. the funding is very important to the states. that's one of the most important parts of this. because it is implemented on the ground. and so the funding goes to cdc and those are the place where is the money is going directly to the states. and so having that money available for the purchase and use of it and the training and they are providing the legislation so more and more people can use it. there was a question of what type of emt did you have to be to use it in a number of states, and that's prohibiting in numbers. but west virginia, massachusetts, kentucky, there are places making good progress. but even when they make the

progress, there are funding issues. so it becomes very important that we make progress this year on these issues. and i also think it's important to reflect that this is done completely in coordination with ondcp, the office of national drug coordinator in the white house. that is our policy counsel for purpose of these issues to make sure that we are coordinated. hhs, dhs and department of justice. it's mainly us and justice are the two places that interact. because it's many law enforcement officials who are the people who need to know how to apply. they are the person on the scene when there's a drug overdose. and so we need to make sure we're closely tied and the funds are a part of that. >> on your thoughts about legislative health there for connecting these people and places and spaces with what they need to know. you think you need more authorizing language or is this the kind of help you asked for in the appropriating budget? >> i think we may need

further -- it's not just money. it's other questions about how people are willing to implement the guidelines and make sure that people are trained. the question of continuing medical education and how this touches upon that are the kinds of questions that we need to talk about. i think, you know i've spoken -- i think the ama and others are thinking through this, and so let's understand. but i think it's important enough issue that we as a nation at this particular point in time need to make sure if we have the guidelines that people are being educated. >> chairman cochran. >> mr. chairman, even though i know in p question has already been asked by one of our members, it relates to the immunization program and funds are provided in all states to help provide vaccines and to those who are not able to buy because of their own difficult

economic challenges and there is a majority of funds available for childhood vaccination and our state has to win the prize as the highest childhood vaccination rate in the country. we are proud of that because a lot of people spend a lot of time and effort in making that possible. but it all depends on funding from the program, and so in looking at the budget requests, we're disturbeded that over $50 million in advanced funding is recommended. to ruse funding for that amount would be devastating, we think to the affordable care act. what's your react to that and do you have any thoughts about what we can do. ? >> well, what we have tried to do is design a vaccine budget that included both the children's vaccine and immunization, which actually

increased well over -- it's close to i think 70 million. the increases of the childrens vaccine fund that we do were greater than the decreases in 317, which is the place for the decreases. so net-net, it was about a $50 million increase. and so what we were trying to do is make sure the places we did decreases were funding rerp doing for those underinsured. and those underinsured because of the affordable care act, that's not occurring because it is covered. if you have insurance now, there's not an underinsurance where you would have to pay a copay for your child's vaccination. and so that's where we were. the cost of the vaccines we were purchasing for use in the facilities that we were talking ability, that's what has been reduced. and that's because we believe because of the affordable care act, that's being taken care of, actually through private insurance now. in terms of people who are insured. is we tried to implement a

policy that decreases overall but decreases it because of the affordable care act. those people underinsured had insurance but it didn't pay for this. it now does. that's the objective of the policy that we're trying. >> okay. thank you. >> thank you, mr. chairman. >> thank you very much mr. chair, and thank you madame secretary for your testimony and as i read your testimony, the number that was higher than i had seen before was the 16 .4 million americans previously uninsured have now gained health insurance coverage through the different facets of the acas. am i interpreting that correctly? >> because i always want to be careful with numbers. that number includes -- wily the the vast majority improves the revisions. but the economy has recovered so some of those people may be because they have gained jobs that have insurance. i think the vast majority, and we know that because of the marketplace, but a portion could

be something that have employer based care. >> and so you go onto have numbers at 11.2 million are now additionally. and 11.5 million are folks who previously did not have insurance in ballpark numbers? >> yes. those have to be derived, because we don't ask anyone when they come in because there are no preexisting conditions anything. >> is that roughly the right ballpark of your estimates? >> i don't think we have put out a number of exactly the number in the marketplace that are uninsured. >> let me continue then. i was very st struck by the statement and the the testimony that eight out of ten of those who go after tax credits get health insurance for less than $100 per month. >> that's correct. >> that's autoout of 11 million. >> are eligible can find a plan $100 or less. >> well, it's been a huge change

in the uninsurance rate in oregon. our hospitals are seeing a dramatic drop in the coverage of the uninsured, zblrks which gives them more dollars to provide hns and stops the transition of folks who had insurance didn't have to pay for their rates. i want to turn to another area that i have concern about. a year ago when the commissioner was testifying i raised the issue here of concern over the explosion in the use of e-cigarettes or vaping these are the electronic devices that vaporize liquid nicotine that comes in little bottles like this. and i showed the same two bottles. su j juice, scooby snacks label. and j juice gummy bears.

this now has changed dramatically in a single year. we have a new report from the cdc. e-gret use trips among middle and high school students in just one year. and from high schoolers it's gone from 4.5% to 13.4. so almost a kwaquadrupleing for middle school. and it's very important that we regulate this. and back in 2009, congress gave power to the fda to regulate flavors and basically all aspects of tobacco products. so now we're here six years later and we don't have the regulations yet. and i very much appreciated your call to update me on the process. the process goes from fda, and

then it goes to omb, and as has that transition occurred yet? is omb now reviewing in in has fda shift the draft final regulation? >> we are still reviewing the comments at our end. >> at? >> at hhs, i'm sorry. >> at hhs. so it hads yet to go to the final review within omb, or is that simultaneous? >> that's correct. no, we complete the process of the review. >> and you know i was going to ask you about this, but when do you anticipate that will be completed. >> so the question is the overall process of the rule making, and everyone knows we have a rule making that we have in the middle of receiving comments on, and that will then finalize the deeming for these products err some other products as well. it's our hope that at some point this summer we will get to a final stage. >> well i -- i hope that it's

more than hope. i hope it's a reality. and i appreciate your personal efforts to accelerate this process, but i still am deeply disturbed by the fact it has taken this long. had this taken two years less, four years instead of six years and i don't think anybody thought it needed to take four years, we would have many thousands high school and middle school students who are not being basically brought into the nicotine addiction world through the flavors designed specifically to appeal to children. i mean, you have chocolate and you have strawberry and you have gum gummy bear and you have scooby do. the statistics show 90% of smokers first began smoking, and i'm including vaping in this as teens. and three out of fourteen teen smokers continue smoking as adults.

the industry understands it's in childhood, the teenage years you must secure the addiction, which then has huge consequences for the quality of life of the next generation, and huge consequences for the cost of the health care system. so this is one of those opportunities to make a dramatic improvement that make a tremendous amount of sense from every direction, and for every month of delay, it's additional americans who are damaged. and it's not just in smoking. it's also in the poisonings. the poisonings have exploded in the space of time since 2011 until now it's a 14-fold increase in the poisonings because these little things -- jars look very appealing. they look very appealing. and they're labeled juice and they're called gummy bear. it must be something good to drink. do you consider it irresponsible that people are making these things and not putting them in

child proof bottles? >> with regard to that, i think the question of how everything will be regulated once we g et to the deeming, i think those are the questions we'll have to work to answer and answer quickly. >> well. >> am i over time? >> yeah, you are. >> thank you very much. >> mr. chairman thank you. congratulations to you and senator murray for your leadership on this sub committee and secretary burwell welcome. thank you for reaching out to me this week to see we had a conversation on the fwoen. it's my fault it didn't happen. ch i'm very appreciative of the efforts you make to stay in touch and have conversations. i think i'll have time for a couple of questions. let me ask first an early childhood collection. ch this committee allocated $500 million to expand access to infant toddler services through early head start. and the goal was to expand child care partnerships. my question is tell me about

implementation and particularly assure me that rural communities where licensed child care is a rare commodity, that they are being considered appropriately for those services. >> the issue of -- we have worked towards implementation, and i think because the program had both early headstart and child care partnerships that expanded our ability to serve where various types of care would be provided. we want to make sure we're meeting standards in terms of the the conversation we had earlier. the issue of rural america and the issues of rural access to these types of programs are something i think you probably know deeply important to me, as someone who participated in head start many, many years ago, i understand the congresswomens of the limited access that anyone has to quality early education. so issues we are working towards. if there are things you are hearing that are not consistent with that could you please make sure we know. we vice president heard this

issue, so if there's something you have heard from your state, i would really like to know about it. >> what is the status of implementation? >> grant making is occurring. i would have to check exactly what stage of the grant making we're in. i can remember the point that the announcements went out to solicit the grants but i'm not sure where exactly we are in the process. but we can get back to you on that. >> i would welcome that. and let me change topics now and talk to you about dietary guidelines. you and secretary vilsack, secretary offing ary agriculture vilsack are charged with guidelines. and you have an advisory committee, the dietary guidelines advisory committee. they've issued a report and at least to many of us, it's a very controversial report. because it includes in their recommendations, and they admit they're taking into account topics outside nutrition and

diet, and specifically considering environmental sustainability. so dietary guidelines, which in h it of themselves are hard to determine what the right answers are, at least by your advisory committee is now being expanded to include consideration of sustainability. contrary to the statutory framework by which you and secretary vilsack are making the guidelines. i've had conversations with secretary vilsack in person in any office as well as in the hearing on agriculture, in which he indicated to me that he will color within the lines. be that, i assume he's assuring me that he's going toe a abide by the statutory framework for those guidelines and i'll also ask if he had conversations with you about this topic and what

interface is occurring and my impression is at this point that's probably not occurring at least at the secretarial level. and so my question to you is the same as to the department of alry culture. i want to make certain that you agree with the sentiment expressed by the secretary of agriculture. i want you to assure me you intend to in developing the final guidelines that you will disregard areas that are outside your instructions in developing died tear guidelines, that you will stay true to the issues of diet and nutritional science, and not expand the dietary guidelines to something beyond its intended scope. >> so actually secretary and i have spoken. it was an issue. he spoke with me and then i received your letter after, and the letter is signed by many folks in terms of -- two different letters, and we extended the period of kmebt.

because right now we are in a period where it has been put out. >> thank you for that. >> and i have talked to the secretary. he said on the first issue that faced us the process issue, he and i have had the chance to talk about it, agree and, extend it by 30 days, for the reasons you have stated that we want to see what the comments are and we want to see what we get back. when the process comes to hhs, we receive what the advisory committee does. nih, cdc, fda, we'll have the full spectrum of our health as well as the surgeon general be a part of the conversation as we develop with usda what will be the final, as with any issue, i will always want to abide by the statute, and as we work to implement that that's what we will do. >> i give you too easy of an out. of course you would say you would want to abide by the statute that would govern your actions. so the follow-up question would be do you share my view, or let me say it this way. do you share the view that the

dietary guidelines are to be developed around dietary and nutritional science or nothing more? >> i have to be honest and say i have not reviewed the statute closely enough to comment on that. with regard to this the people i was indicating. the people involved in terms of our issues around science and health, fda and nih those are our players. that's where our sweet spot is. >> does that suggest you're going to color within the lines? >> it suggests that i need to read the statute because i shouldn't answer a question, i apologize, until i know what the statute says. i do want to abide by the statute. that's something in this process, i apologize, i haven't gotten to. i hear and understand that's something you will follow up on. >> thank you secretary. >> thank you, madame secretary,

for being here. >> as we delay this implementation of deeming as to e-cigarettes, more and more children are getting addicted. it is time. i know where this has come to a halt. whether in your agency or omb or some other place, but i'm going to try to find out and move it along. i met with dr. francis kol lins a couple years ago. i said to him, we can't aspire, sadly, to the glory days when harkin inspector and porter doubled the the budget but what can we do to make a difference? he said i will tell you 5% growth for ten years. we'll light up the scoreboard. we'll provide cures that more than pay for the the cost of this research. and alleviate the human suffering involved. so i've been watching that standard. and i have to tell you that we

are following short of it. over the last ten years we've fallen short by 23% of keeping up with inflation and so the number of grants that have been awarded have been cut in half. and that has discouraged researchers from staying. when i look at the president's budget request for nih and cdc, i find for each of them, roughly 3% increase over last year. if you assume 2% inflation, and i understand omb no longer assumes inflation, but if you assume 2% inflation, you can see the minuscule amount that we're increasing. i won't ever quote, and i rarely ever praise newt gingrich, but i'm going to. he ends up writing in the nooim thais this week what are we thinking? we're spending a fortune on all the medical care associated with illness disease and not putting money in the research to alleviate it as we should.

he fell short of suggesting how we would pay for that, which would be the important ending to a story. i would like to i i've spoken to senator murray senator blunt and others about this. i think it's time for us to step us as a congress and do something truly bipartisan the american people will applaud and say we're going to start a commitment of 5% plus inplace to key medical research, and we're going to do it on a bipartisan basis. no ifs, ands or butts about it. and i would just say for the record, if there's going to be a conversation about the rescue of the pentagon, i want to be part of the conversation too. but i want to stick to the basic rules that paul ryan and patty murray came up. that we make sure there's money coming bag in that is so

important to labor h. i hope if we we can find the money, i'm all for that. let us not do that at the expense of non-defense. and i hope that we can come to a conclusion that we're going to make our mark in bipartisanship when it comes to biomedical research. i open that to any comments you would like to make. >> i will just make two. one is that we, too, believe in terms of the numbers and investments and trade-offs and choices that we need to make those in terms of getting the nation to function but preparing for the future to get the nation to function. and i would also repeat what you just said is with regard to the match of increases in defense spending and nondefense spending. in terms of the health and security of our nation, i think we saw what happens to is when ebola comes our border. that's funded on the nondefense

discretionary side. making sure we keep these two things moving and moving together issing this swe think is extremely important. >> one other unrelated issue. the program, i believe in it. i hope we can find ways to expand on it make it better. do you have any idea what the eligible income is for qualifying for wick in the state of iowa? >> no. i do not. >> $90,000 a year. it turns out when we coordinated the eligibility for medicaid and wick, there's a great disparity among the states as to whether or not you qualify for wick. and i would like to suggest that the statutory standard we used to have is swrr near 45,000 that you could kwch for wick. and because of this coordination of the medicaid eligibility and is wick eligibility, there appears to be groes disparities in some of the states. would you look at that?

>> happy to. we worked with secretariville sax on these issues and you no don't see that, but certainly this is a number i've never seen so i want to look into it and we'll understand it. >> thank you. >> thank you. we've got a little more time on the vote than we thought we would have. so there's time for a second round here. and 11:55 is the time for the scheduled vote. so hopefully we can work with that time. on the issue of dietary standards that nart brought up he brought up the same issue at the fda hearing. she said she didn't have a role in this and she was an adviser. today you stated you hadn't really looked at the law yet. it seems like there's a certain running for the hills here. secretary vilsack said that sustainability falls outside the guidelines. so the one person we've talked

to who looked at the law appears to think sustainability is not an issue. all you have to do is change the the law for that to happen. not add it to the the law. so we'll be watching that. i'm sure. i've got a question on this -- i've got a couple of questions for the record. on risk corridor. the risk corridor program secretary, the affordable care act or at least last april let me be sure i'm right here. the department released guidance stating the risk corridor program would be implemented in a budget neutral manner. my impression from what -- the discussions i'm hearing now that somehow the risk corridor program would find revenues somewhere else to make up the difference. is that your view? >> with regard to i think the guidance that was put out at

that point in time and i think that -- i'm trying to remember. i was at that point in time going between but with regard to risk corridors. a program about making sure that we have premium control and put downward pressure on premiums which we all think is important. with regard to the program we think it will be budget neutral. the question i think your follow-up question will be, what if it is not and at this point in time, what we have said is it will be budget neutral. it should be budget neutral, and certainly in this year what would happen if it weren't is it would be -- fall over into the the next year in terms of the payments that come in to pay that. and so we're clear when the end is, it's 2017. if there were any issues i think the insurers believe that commitments have been made. and at that point one would have to find appropriated funds.

>> and 2017 is the end of the program. >> yes. these are -- >> and by then insurance should have figured out how to set up the structure of the marketplace and profile. >> that's correct. and so with regard to the three rs. and risk adjustment, two of those go away on the timetable. and one was based on what we used to medicare part requests "d that didn't go away in that short time frame. but yes, by that time, people understand the marketplace well enough to get this. >> well, money from discretionary dollars, if that's necessary, would be something we talk about next year. >> the question of whether or not -- i think the question is, do you need appropriate rated dollars. and i don't know that we're going to have any signals. we certainly won't have a anythingal about this year until about the send of the summer.

right now all the data is starting to come in. >> designeded in the scoring of the affordable care act, not to cost money. >> correct. budget neutral is where it has been at this point in time. >> we will see. on iraq audits. i think what i meard you say is one of the things you were looking at is the incentive structure to bring these cases? >> yes. what we're looking at in terms of the structure to bring the cases and to bring any case that you wouldn't win. so if you bring a case you're not going to win you're not getting anything. and if you bring a case you can't get done in a set period of time, you don't get anything either. so changing those structures is important. i think the other things in terms of the increase that occurred in cases, we kind of didn't get into this because he

distinguished between the lack long issue. part of that occurs because there's no real cost for a provider to pring all their cases, to appeal so many. there's no up side as a provider. o making sure we have any size and amount, i mean, the the cut-off is very low. we need to look at what should the cutoff be for how little money you can appeal for because of the question of the processing, and then the second question is, what are the steps for you, and is there any bar in terms of you appealing everything? so there's the issue of the racks. there's the issue of the providers and the issue of the processing. and i think all three of those things we can put in place improvements, to both reduce the backlog, which is essential and have been working with the congress and working with others about in a bipartisan wake to make the improvements. the funding will be important from the perspective of this committee. funding additional ability to review those cases because i

think you know, it's a judicial process, and so we have to have a certain type of judge, an appeals judge that can review. and so we have a strategy that'se inging administrative actions, things to get rid of the backlog, additional hires we need to do to process the cases that are before us, and creating prevention in the pipeline so that people aren't as encouraged to do certain types of things, some f it related to racks, to come into the system. >> are you allowing new cases to be brought while you've got this huge backlog out there? >> the issue is how the cases get brought in terms of the racks. it's divided in terms of the way the legislation was passed and what it bans that they could do. there's a time limitation. so some things are coming through, but portions are not. >> senator murray. >> thank you. as you know, this year marks the 50th anniversary of headstart, which is very exciting and i'm

really pleased to see the administration's request for a significant investment to make sure that kids get access to full-day, full year programs. some of the early childhood research on this incredible that an extended learning day is strongly suggesting the current minimum of three and a half hours days is inadequate. this is really an important step in making sure headstart prepares our children for success in kindergarten and later in life. i wanted to ask you, what is the administration doing to improve quality and make headsteart more effective? >> the the quality progress has been over a number of years and part of it is that we are requiring that certain grantees there would be automatic renewal. but we are reviewing with regards to certain quality. but weem will have to reapply. we've seen that happen across the country in terms of those

not meeting the standards so we are enforcing the quality standards. that's in the headstart sfas. . the work that you all did thank you, in terms of the authorization last year has also given us guy dins in that space as well. >> one of the things i'm hearing in washington state is the lack of getting and retaining quality teachers. is what is the department doing to deal with that? >> right now, that is actually a part of the quality standards in terms of what types of degrees and training that teachers do have, and that is a part of what we are trying to do and we are seeing some increase, in terms of measurement of quality. in terms of educational background of teachers. i know that's not the only measure of quality, but we are seeing progress in that number. >> i think that's important. my last question and one that's important important is the 2015 omnibest represented the first time they utilized the budget control act cap adjustment to

fight fraud and abuse in medicare and medicaid. current data indicates for every dollar spent to address fraud, $7.67 is recovered by treasury. so utilizing that cap adjustment, this should create $5 billion in deficit reduction. i think that's a goal we all think is critically important. i don't understand anyone who wants to cut the deficit would oppose additional dollars for that fund. i know neither the house nor senate budget resolution included funds for that. you did. can you talk about how you can use these targeted resources to help us save money? >>. >> so we put in the budget based on the return that we have been seeing. it would be about $22 billion in terms of the proposal from the president. in terms of the savings, if we continue on a path that we're seeing in terms of medicare

issues, and as i mentioned to you all before we came in, having seen and having the privilege to the awards for public servants across the entire federal government, when those awards went to the people who were -- it was called the miami heat. the heat task force across the department of justice, as well as hhs, pursuing this fraud, when we can see that success, that cross government work, we want to do more of it. and we also know the issues of fraud and improper payments in medicare, you know it is a large portion of what we see in the entire government. having come from my omb hat and having spent lots of times on this issues, i'm happy to be at a place where we can can hopefully bear down and make progress. >> sko if the cap adjustment is not allowed to be utilized, we'll see an increase in spending. >> well, we won't see the benefits that we would have gotten, and we see those benefits coming every year. the numbers we did, we report the numbers every year. it was one to eight ratio last

year. this past year. it's been almost a 1.7 racial owe in terms of the reports that we're getting. >> thank you, mr. chairman. i had an additional question. in your statement you talk about the aca provides full funding in the the medicaid area all the if way through 2016, and then in 2017, the state share then goes to 90% or less, no 10% or less. the state of west virginia, the legislature this h year before the expansion had to fill an $80 million hole in their medicaid budget this year. with no cost of the 140,000 new expansion medicaid recipients. i raise this question when this was going through -- when we were voting on this, when it was

passed. how are the states, my state our state, going to be able to meet these budgetary expansions that they have taken on themselves because they've expanded medicaid by 140,000 people when they're already short 80 million this year without expansion? >> i think two things are -- as we think about the answer to that question of how do you financially do the medicaid expansion in the state. the first is when -- in kentucky they did a baseline study before brashears expanded medicaid. he did a followup study with deloitte and the university of louisville. it was about three months ago in terms of what happened with medicaid expansion and in the state of kentucky, there would be 40,000 more jobs and $30 billion to the state's coffers in terms of what the medicaid expansion would result in in terms of the economic growth. i think that's one part of the

question. the other part of the question which is an important one has to do with delivery system reform. that has to do with why we are so deeply focused on changing the way that care is delivered and the quality of that care. you and i talked about one of the thing that drives this is emergency room use. and while the analytic are not strong enough yet, we are starting to see the indications where people who -- some of the places that are ahead that we decrease that. i think what we're trying to do to make sure we get to the place where people are not using the most expensive care and using the care in ways that we can save and have quality prevention is dow jones average care. that is an effort -- that is coverage of care. that is an effort we're focused on with cms and moving people to understand, new people who have never been insured before not understanding except to go to the emergency room how to use the care in ways that, one, they understand how to access the care, two, they understand how to read their bills, and three,

they understand that there are tools to keep them healthy. the diabetes numbers that we're seeing out of the states that have expanded, it's increasing. what that means is they're actually getting the care and hopefully that's going to drive down part of the cost. >> i would say that that all sounds like it aeps's going to solve the problem, but this is on the horizon. an $80 million budget hole shortfall already without the expansion, you know, you're talking about changing behaviors. and we know it's not going to take a year. it's probably going to -- five ten-year kind of thing. with the creation of 40,000 jobs i wish i saw jobs growing in our state. but unfortunately, that's not happening. we've got more people unemployed in higher areas, andy you know what i'm talking about. we've got a real problem here. i'm concerned about that. by this time the president and you will be gone, by 2017, and we'll have a new governor.

and that's going to be a difficult challenge for that governor. last question -- this should be a simple answer, and i think i'm not seeing the numbers correct. if you expand medicaid which we have in west virginia, and you've asked for an increase in budget and children's health insurance program with -- sizable sizable, $3.9 billion if i'm reading the numbers right -- somebody asked me this, i thought it was a great question, i didn't have the answer. if you're expanding medicaid pulling in families and children, wouldn't the cost of the children's health insurance program go down because a lot of those children are being pulled into medicaid expansion? >> so the children covered by c.h.i.p. are saying in c.h.i.p. and that was part of what the sgr bill did. those children are actually not moving over. that's why. >> so they're not required, if you're in c.h.i.p. and your family goes into medicaid, your mom and dad go into medicaid you're not required to pull that child in with you? you stay in the c.h.i.p. program? >> that's correct.

>> i worked on the c.h.i.p. program as a state representative. i've a believer and voted for expansions of it because it is important in our stated. i guess you answered my question. i guess my followup question would be from an economic standpoint is it more beneficial to the state and federal government to keep that child in c.h.i.p. -- financially, i'm not talking about quality of care and all that because i believe in that -- or to go into the medicaid program? what's less costly? >> that is a piece of work that i think actually is coming out in the next weeks in terms of an analysis that we have been asked to do with regard to the question of does c.h.i.p. -- i think the basic of your question is -- does c.h.i.p. cost more or medicaid cost more. that's coming out in the next few weeks as part -- it is part of the followup to the aca and the reports we've been -- >> i'll look forward to seeing the report. >> want to make sure we -- >> thank you. >> one last question, and then there will be questions for the record. i'll have them and others will

as well. my next thing is a meeting of senators who are talking about what to do based on the result of king v. burr well. in the past you said you were not looking at options if the court rules that the subsidies aren't valid in a number of states s. that still your position? >> what i have said is that the three things -- i think it's important for me to state, we believe we would win the case and that based on both the letter and the intent as well as cbo scoring over the periods of time in terms of the interpretation of the law that we hold the correct position. but with regard to if the court would decide and decide against and for the plaintiffs, at that point the court will have said that we cannot provide those subsidies. and the point at which that happens, our ability to have authorities to do the subsidies is not something that exists. so the real problem which is

people lose subsidies they then become uninsured because they were insured because of the affordability. the question of a spiral in the marketplace because now sicker people are in drives premiums up. and then the question of how that affects states in terms of costs. some of the issues we were talking about with the senator. all three of those thing result from the loss of subsidy. that's the problem we're trying to solve. and the question is, if the court says we don't have the authority, the question of a plan for me to have an authority that if the court says i don't. so that's why when asked about the question of a plan to resolve the massive damage, that's not itsly something -- if the court makes that kind of decision that we believe or have seen that we have an authority. >> we'll see what the law says. there will be -- the record will stay open for the court says. the record will stay open for one week for additional questions. the subcommittee stands in recess until 10:00 a.m. thursday, april 30th. thanks, secretary. >> thank you, mr. chairman.

>> this senate appropriations subcommittee's wrapping up its hearing on the 2016 health and human services budget with secretary sylvia burwell. you can watch this and congressional budget hearing coverage at cspan.org. over to the u.s. senate and a live look as senators are voting on whether to advance the nomination of loretta lynch to

be attorney general. if the nomination moves on a confirmation vote may take place around 2:00 p.m. eastern. slonchlg on live coverage is on c-span2, and a live debate tonight on the c-span networks. tonight, first ladies lives and public images, carl anthony carl cannon, ed that medford and carissa thompson participate live at 7:00 p.m. eastern. she was considered modern for her time called mrs. president by her detractors and was outspoken about her views on slavery and women's rights. as one of the most prolific writers of any first lady, she provides a unique window into colonial america and her personal life. abigail adams. sunday night at 8:00 p.m. eastern on c-span's original series "first ladies: influence & image." examining the public and private lives of the women who filled the position of first lady and their influence on the presidency from martha washington to michelle obama.

supposeds at 8:00 p.m. eastern -- sundays at 8:00 p.m. eastern on american history tv and c-span3. as a complement "first ladies: presidential historians on the lives of 45 iconic american women," is available. providing lively stories of these fascinating women, creating an illuminating entertaining, and inspiring read. it's available as a hard cover or ebook through your favorite book store or online bookseller. with live coverage of the u.s. house on swrks span and the senate on c-span2, here on c-span3, we complement that coverage that by showing the most relevant congressional hearings and public affairs events. then on weekends c-span3 is the home to american history tv with programs that tell our nation's story, including six unique series. the civil war's 150th anniversary, visiting battlefields and key events. american artifacts, touring museums and historic sites to discover what artifacts reveal

about america's past. history bookshelf, the best-known american history writers. the presidency looking at the policies and legacies of our nation's commanders in chief. lectures and history, what top college professors delving into america's past. and our new series, real america, featuring archival government and educational films from the 1930s through the 1970s. c-span3, created by the cable tv industry and funded by your local cable or satellite provider. watch us in h.d., like us on facebook, and follow us on twitter. next, yesterday's senate finance committee markup for trade-related measures including fast track trade promotion authority that would give the president broad powers when negotiating trade agreements and would require congress to consider treaties with an up or down vote without amending them. coverage starts after the committee reconvened following a long recesstude an objection to the meeting by senator bernie

sanders. >> please call to order. i will now recognize any senators who want to give opening statements. i would urge you not to give them. [ laughter ] >> but if you feel like it, i urge you to give it. that would be fine with me. but i hope the most senators will choose not to give statement at this time which would allow us to move more quickly to the business at hand. that said, for any senator who does want to give an opening statement, we would ask they limit their comments to three minutes. is there any desire to give any opening statements? then we'll -- you're recognized senator. >> thank you, mr. chairman. i know others gave statements earlier.

first, i'm pleased we're moving ahead with this debate today because as you know experts are incredibly important to our economy -- exports are incredibly important to our economy in ohio. 40% of factory worth depend on export. i want to congratulate you and senator widen for getting us to this point. as you and i know because we've talked about there a lot ohioans are equally concerned that we level the playing field. in other words that american manufacturers, worker, farmers, service providers who are facing illegally subsidized and undersold imports have a chance to compete and compete fairly. i've got a number of priorities that will be considered that focus on supporting good paying jobs in ohio by growing exports while also putting our competitors' feet to the fire so they play by the rules. i want to quickly mention through priorities i understand have been adopted into the trade package. first i'm pleased to learn that an amendment crucial for the american steel manufacturers and steel workers has been adopted and is in the customs bill. this amendment will help ensure that american steel workers can remain globally competitive. it's ape tough time for the

industry now. the last thing they need is additional unfair competition. and this helps with regard to the material injury standard to make it easier to use for steel companies. when competitors cheat, they need to be held accountable, and this bipartisan measure will do just that. it's backed by the united steel workers but companies like u.s. steel and newcor and others. all of whom have a strong presence in my home state of ohio. unfortunately, some of our competitors don't play by the rules sometimes. that's why i've worked with senator wyden to crack down on countries that evade duties through evasion schemes that can be addressed through what's called the enforce act which i support and am pleased it's in the customs bill. i congratulate senator wyden for debting that done. i'm pleased to see trade adjustment assistance will extend the health care issues that we've talking about in this committee. the hctc health coverage tax credit. this is important to workers and families in youngstown ohio, downtown an sandusky, including

5,000 delphi retirees in ohio along with hundreds of united steel worker retirees. i offered the bill, and it's a key priority. i appreciate it being in the legislation. with regard to trade promotion authority, our goal, of course should be to ensure that our trade negotiators get the best possible deal at the negotiating table for american workers. and i want to be clear as i have been in the past that tpa needs to address issues that tilt the playing field away from workers in ohio and other states such as currency manipulation. we all seem to agree that currency manipulation is a bad idea. we all want to prohibit it, stop it. and all we're trying to do with regard to the amendment i plan to offer later is to ensure that foreign governments are put on notice. that they enable their workers, our workers to have a fair shot. that they don't get an unfair advantage over our workers and manufacturers by manipulating their currency. by devaluing or manipulating currency so that they're weaker against the american dollar, some of our competitors china

would be an example japan in the past have made it cheaper to export their goods into the united states and third country markets at the expense of our workers. if that isn't bad enough for our workers, this scheme of course makes it more expensive for countries to import american goods that directly support good paying jobs here at home. here's a letter signed by thousands of ohio autoworkers who call currency manipulation the most critical the most critical trade barrier in the 21st century. these are the views not just of autoworkers in ohio but around the country who are concerned about this issue. i've had the chance to visit with them back home as many of you have. and this is why this amendment is so important. with so much to gain from growing u.s. exports we can't let countries take away that by gaming the system at the expense of american manufacturing. that's why i've stood side by side with ohio workers in dozens of trade enforcement cases that make sure their protected from practices including targeting

u.s. jobs ranging from working with the united steel workers on cases impacting tire workers, uncoated paper products, and of course pipe and tube where i work closely with my colleague from ohio, sherrod brown. to further grow export, i'm pleased to be joined by senators toomey, burr casey, and carper to jump-start the miscellaneous tariff bills. our bipartisan amendment will ensure an mtb can pass soon and restart the process next year. this is important, again, to a lot of our manufacturers and other companies we all represent. this bill help american manufacturers remain globally competitive by having access to needed manufacturing inputs that aren't available at home but only overseas. since the expiration manufacturer verse had to cut jobs to deal with these rising production costs. look forward to working together to pass that mtb amendment and help american manufacturers. senator cardin and i are introducing an amendment to ensure our negotiations to protect our ally israel who has been the target, unfortunately, of economic warfare really in an effort to weaken and isolate it

from the international community and international investment in trade. that's a so-called bds amendment. boycott divestment and sanctions. the issue is particularly important as we consider negotiations with the european union under the ttip and i should mention today is the historic 30th anniversary of the agreement with israel signed by brock and aerial sharon 30 years ago. again, i congratulate you, senator wyden for getting us to this point. i think all of us can agree we need to expand exports. that's good for our economy. it creates jobs and good-paying jobs. they pay on average 18% more. good benefit. this is what we should be doing. we have to ensure that the playing field is made more level. for our workers in ohio and around the country. >> thank you senator.

>> we're waiting except for senator tropical storm. if you would like to make an -- senator portman. if you would like to make an opening statement -- >> i'll make weekend. >> thank you very much i will be brief. i wanted to thank both mr. chairman yourself and our ranking member wyden for including two of my amendments in modified chairman's mark. one that creates a chief manufacturing negotiator for ustr. we have a chief agriculture negotiator but not manufacturing negotiator. we don't have an economy or

middle class unless we make things as well as grow things. that's important. the other would expand existing agriculture trade, technical assistance programs at usda and usaid. and i thank senator roberts for working with me. i also -- senator wyden, want to thank -- even though we come down on different places and i will not be supporting tpa, i do appreciate the work that you have done and transparency and enforcement. for me the bottom line is we want to export our products, not our jobs. and when we look at a global economy, we have a choice of creating a system where there's a race to the top with opportunities to strengthen not only our middle class but the middle class of those around the world or a race to the bottom in terms of lower wages and benefits environmental standards and shipping jobs overseas. i don't see the toughness that i need for a yes vote, and certainly we will talk more about currency later.

i appreciate there is some currency language here but it is not strong enough to be enforceable. and i think it's incredibly important that whatever we do has tough enforceable standards in it going forward. so i appreciate the opportunity to say a few words and will certainly have more discussion during amendments. thank you. >> thank you. anybody else want to make an opening statement? senator? >> if we're -- all right. mr. chairman, i want to thank you and the ranking member for getting us where we are. this is both necessary and long overdue. tpa expired in 2007 without this authority which nearly every president since franklin roosevelt's had in some form. we simply will not be able to conclude trade negotiations that promise to open new markets to american exports, whether agricultural products, manufactured goods or services. the tpa bill we'll consider is updated, modernized for the 21st century global economy. and i want to mention a couple of thing. i appreciate your help in

getting those included. the legislation includes a number of important provisions. i want to highlight as i said, two in particular. one has to do with helping us to eliminate non-tariff barriers abroad that increasingly impact our agricultural exports especially crops that use biotechnology. unjustified non-science-based regulations by trading partners have become a major impediment to trade and something we need to aggressively combat. secondly the bill includes digital trade provisions that will help america maintain its competitive edge when it comes to the internet economy. the provisions such as making sure that cross border data flows are not restricted and that nations do not attempt to dictate where technology infrastructure is based are pulled from the digital trade act that senator wyden and i introduced in december of 2013. these provisions are critical if wement a trade policy updated for the digital age. additionally i want to thank the chairman and ranking member for inclusion of a number of important provisions in the customs reauthorization legislation that will also consider -- we'll also consider today. the customs bill includes a

provision from the legislation i introduced with senator wyden to update the deminimum level for imports, making easier and less burdensome for importers and america's express delivery companies. this is the first time we're updating the de minimus value in over 20 years. the chairman's modified mark adopts the amendment to senate the amendment to trading partners to follow suit in updating their deminimum levels, as well. the bill is designed to fight the transshipment of chinese honey through third countries or what some call honey laundering, an important initial my home state of of south dakota, which is a major producer of honey. i offer an amendment to ensure that customs and border protection treats our honey producers and other producers fairly as they collect duties related to certain chinese imports. i look forward to committee action and passage of these bills and consideration, i hope, soon on the senate floor. thank you, mr. chairman. >> thank you. are there -- anyone else care to make an opening statement?

senator roberts? >> mr. chairman i understand we are on sanders' eastern time, and also understand that like king tut we are pressed for time. so i have a wonderful opening statement. absolutely wonderful. but i'm going to submit it for the record at this point and just let it go. [ laughter ] come on, come on. mr. chairman? >> senator -- >> i'll follow suit. >> oh, that's good. that's really good. anybody else care to make an opening statement? we don't -- >> mr. chairman? mr. chairman? >> yes? >> if i could submit an opening statement for the record also. >> that would be fine. >> thank you. >> without objection.

>> same. >> anybody else? >> could i move that we all have the opportunity to submit our opening statements for the record? >> a wonderful thing. you have such a wonderful way of doing thing. >> thank you, mr. chairman. >> without objection, we'll certainly do that. today's first order of business is a technical document on the trade adjustment assistance enhancement act of 2015. now before we begin, i would like to put this trade adjustment assistance mark in context. what is before the committee today is a carefully negotiated compromise between ranking member wyden and house ways and means committee ryan. the chairman of the house ways and means. i do not support trade adjustment assistance but agreed to ensure that taa and trade promotion authority move in parallel form and to allow taa to come before the committee for a fair vote. i've always been willing to debate and consider taa repolice station on its own merits, and

today provides us that opportunity if anybody wants to debate the issue. so -- does anybody care to bring up anything on taa? >> mr. chairman, i'll be brief, as well. this is a critically important piece of legislation because this ensures that as the economy changes, those changes don't knock our workers off stride. this is what in effect gives them a springboard to new opportunityies in a tough global economy, new opportunities for high skill, high-wage jobs -- i hope my colleagues will support it. >> anybody else care to make a statement on this? all right. senator cardin? >> i'm sorry, mr. chairman. i was on the floor concerning

another bill. are we not making opening statements? is that -- is -- >> some have if you desire to, you certainly have a right to do so. >> i would like it make an opening statement. >> that would be great. go ahead. the senator from maryland. >> thank you, mr. chairman. i appreciate that very much. first off, i want to thank senator hatches, snared wyden for their efforts. i think they've done a really fine job. i do believe this trade promotion authority bill is a major improvement over the last tpa bill. i think the way that you've handled transparency congressional involvement, negotiating objectives including labor, environment, and good governments and human rights, and how you've dealt with enforcement is a major improvement. i want to compliment you. i also am one -- >> thank you -- >> -- who believes that we need

tpa authority to complete the tpp agreement and hope we have a successful tpp agreement. let me say though, that i hope that we'll have a chance to improve the tpa bill as we move forward through the process. let me tell you my concern. trade presents an opportunity for us to advance u.s. values. yes, economic values, but also the type of people that we are and the principles that we advance. i'm proud of our predecessors jackson bannick who against all odds were able to get a major provision included in trade that many at the time said why are you putting this in a trade issue. the united states provided leadership that brought down the apartheid flip south africa by using trade rather than bullets. trade is a very strong tool that we have in this country. yes, i am concerned that we have adequate provisions and trade agreements. that's why i have been very focused during this process on

good governance, human rights and capacity building. the legislation before us has shortcomings in that regard. i have said from the very beginning as my top prior to have enforceable negotiating objectives to accomplish good governance and human rights and capacity building. when we saw the bill for the first time, i pointed out page 32 as i was reading through that the enforcement provisions that are in the bill apply only to principal negotiating objectives. principal negotiating objective include goods, services investments, intellectual property regulation, state-owned enterprises, labor, environment, transparency et cetera, et cetera. but not good governance. and that is why i think it's critically important that the provisions included in this bill that deal with good governance

and respect for international human rights need to be a principal trade objective. i would hope as we go through this process we'll have an opportunity. i have several amendments that will point out why that was so important. and i would be glad to call my -- my colleagues' attention to the language included on page 33 of the tpa that points out very specifically that without making a principal objective the trade enforcement provisions, the -- they're not applicable to the human rights. i think we need to correct that. >> thank you, senator. we do have nine senators in attendance. i hope we can keep our senators here so that we don't waste time and that nobody will be inconvenienced because it's going to be a fairly long evening anyway, it seems to me. although i think we're getting to where it could be much shorter. if we will all work together.

the committee will walk through the mark and motivation. i recognize shane wern of our staff to do so. we also have anderson hineman of committee staff and norris tyler from the office of trade adjustment assistance, as well as terry julo from cbo. and am i pronouncing that right terry? >> it's gulo. you're close. >> close enough. i'm going to call you terry gulo from here on in. and of course we have tom barnhold who is of immense value to this committee. the chief of staff from the jct for the members' benefit to ask any questions that they care to ask. any of you care to ask. mr. wern will you briefly describe the main features of the sfloem. >> thank you, mr. chairman. -- the proposal? >> thank you mr. chairman. at this markup the committee is proposing to extend the trade adjustment program and health care coverage tax credit. the proposal extends the trade adjustment assistance program

through june 30 2021 and re-establishes the programs in effect as of december 31 013. the proposal authorizes the statutory cap of $450 million annually, fiscal years ss 2015 through 2021 for training and expenses. it includes continuation of the re-employment trade adjustment assistance program, the proposal also makes changes to data collection or reporting requirement. with respect to the health care coverage tax credit or hctc, the proposal amends the definition of eligible coverage month for hctc purposes to include months beginning before january 1, 2020. the proposal also contains provisions related to election allowance of hctc by individuals and with respect to advanced payments of hctc. thank you, mr. chairman. >> do the senators have any questions regarding this mark?

let me recognize senator wyden for any comments. >> just quickly mr. chairman, this doubles job training, this expands taa to service workers which is extraordinarily important given the shifts in the global economy. most importantly this is a six-year extension of a program that otherwise expires later this year. this is something that has always been done as part of trade legislation, to stand up for the workers. that's why i hope all colleagues will support it. >> okay. i'll be happy to recognize any other senators who have any questions about the mark. >> mr. chairman? i do. >> yes senator? >> i don't have a question, but i -- i did want to have a brief opening statement. so if it's appropriate now, i'd be happy. if not, i'll -- >> that would be fine. go ahead. >> before you do, does anybody have any other statement about the mark itself? >> mr. chairman? >> you do, bill? >> i have a question. >> can you wait until after his

statement? >> mr. chairman, i had a question on this bill. >> you do? >> yes. what's been the interaction with the health, education, labor and pensions committee on this one? they do the job training information. and have covered quite a few of these areas. >> well, there are performance measurements that we believe senator ryan has puts into the bill. it was an agreement between our distinguished senator, ranking here, and chairman ryan in the house. >> i was referring to senator chairman alexander though -- >> sure, i know you were. >> thank you. >> okay. let's go to senator menendez then, let's give -- you give your statement and then we'll turn to -- >> thank you mr. chairman. mr. chairman, this is not my first trade debate. and i have not found many trade

bills that i could vote for in my years in congress. but there have been there have been a few. but right now in its current form i cannot support the trade promotion authority we have before us. as i said yesterday, all of us here in the committee have the same goal in mind, and that is jobs for our workers and markets for our businesses that build -- together build a stronger american economy. trade may offer a path to that stronger economy, but that is not something that is automatically guaranteed. it takes tough negotiations with high standards with the right countries and formed by a long history of trade deals that have not always contributed to rising living standards for the american middle class. so the trade promotion authority proposal before us today does not give me the confidhaens any trade deal that comes back here to the senate will meet those standards. especially when one of the major trade agreements, tpp, is already pretty much negotiated.

i don't see the strong protection for workers, for the environment, or for the intellectual property of some of our key industries. we're making a decision that goes right to the heart of our responsibility as members of congress, to protect the specials of our constituents. if we're going to vote to give the president additional executive authority over trade, we better make sure we empower and direct the executive branch to bring back deals that benefits all of our constituents. now, i have some amendments today to improve the underlying bill. i'll support some amendments by my colleagues, and we'll see how it ultimately ends up in form. right now, i believe there's a long way to go before we get to a product i can support. i do want to say i appreciate the hard work that you and senator wyden have put into this important legislation. i hope we are going to have a constructive, open amendment process with a fair airing of all the many complicated issues that are before us. thank you, mr. chairman. >> thank you senator menendez.

we'll go to senator nelson. >> mr. chairman, as you know, i intend to support this tpa bill. but i was just surprised to find out that your staff last night rejected trying to keep an industry in my state alive on the extension of the bahrain trade preference which has been in effect since 2005 where they bring in yarn and make it into garments going into the u.s. now this is going to shut down in a little rural town of 1,500 people, it's going shut down 300 employees. my question to you since i will offer it and then everybody can decide, i thought it was going to be accepted. would you prefer me my question

is would you prefer me to offer it ahn of the other three bills other than the tpa? i don't care what it's put on. >> i think i would prefer it on one of the other bills. >> custom -- >> customs -- that all right with you? we'd like to keep this bill clean because we've got to get it through the house. they've told us that -- both sides over there that if we can do that, it should go through the house. and this is a very very important thing. the president want this done. i'm doing everything i can. i'm actually getting exhilaration in supporting our president on this. [ laughter ] >> i think it's -- it's nice to support him is all i can say. he certainly is right on this.

he's been working it, and i appreciate what he's done. and we'll move in that basis in we can. i appreciate your accommodation because if we can keep this bill clean, it's really going make a difference. >> i wish you'd have a prayer session with your staff before we get to the customs bill about this amendment. >> we have a prayer session every day. and -- >> if i could just tell the senator from florida, i know that this is an extremely important concern to him. >> yes. >> i'm going to visit with the chairman perhaps the preferences bill is a better vehicle. we'll work very closely with the senator from florida. >> we'll see what we can do, okay? all right. if there are no further questions to our leaders at the table, the proposal is open to amendment. are there any amendments to the taa bill? senator enzi did you have an amendment?

anybody have any amendment? >> senator -- >> i don't see any hands. >> senator cantwell was going first, but i'm ready. >> she's not here, but if you have an amendment, now is the time to bring it up. otherwise i'll move the bill. >> mr. chairman? >> senator? >> thank you, mr. chairman. i have amendments one, two, and three. i ask unanimous consent to roll -- sorry amendment 12 13 and 14. i ask to roll the three into one. >> without objection. >> sorry -- excuse me it's amendment one, two, and three. it says brown one, brown two and brown three. >> without objection. >> thank you, mr. chairman. i -- i call up these amendments of the taa bill and as i said, i ask unanimous consent be considered in block. i ask unanimous consent that senators bennett stabenow,

casey, agwell, and menendez be as co-sponsors? >> without objection. >> it would restore the funding levels of taa for workers to $575 million a year. it's the same level that was included in the bipartisan taa bill in 2011. i earlier thanked senator portman, and in his opening statement he talked about the importance of vigorous assistance, what it means to workers in our state. and i look around this room, states that have had pretty much all of us have had layoffs ascribed to trade or sometimes not ascribed to trade with countries with whom we have ftas. the moment is fully offset with the application of six-year statute of limitations in case of overstatement base chisle raises $1.3 billion over ten years. some will say that $450 million the amount included in the underlying bill, is enough to operate the program. there's no reason to increase the funding. the truth is we don't know that

450 will be enough. 2009 and 2010, taa worker could -- cost for workers cost $685 million each year. those were years of course, during the great recession. but if you take the average of funding levels for the alerts to when the eligible -- the three years to when the eligibility is the same as we're considering today, expenditures averaged $571 million a year. this $125 million a year reduction is cuts for the sake of cuts. the truth is taa works. 76% of taa participants who completed training in fiscal year 2013 received a degree or industry recognized credential. that means it does work. during the same year, 3/4 of workers who exited the program found unemployment within six months. workers who became employed over 90% were still employed at the end of the year. again, indications that it worked. the package of amendments ensures that all workers including public sector workers are eligible for taa.

congress shouldn't pick winners and losers. all workers who are impacted by trade should be able to apply. it increases funding for taa for firms from $16 million to $50 million. ta for firms provides financial assistance and expertise to import impacted manufacturer force help them become more globally competitive. taa helps workers retrain for new jobs so they can compete in the global economy, underfunding each programs, either when they were trying to expedite a trade agreement representing 40% -- 40% on this trade agreement coming up, tpp another 20% for ttp, underfunding them when we're having this kind of impact on the world's economy would be the biggest mistake. again, $575 million is the same level that president obama included in his budget. that's the same level that 70 senators, 307 members of the house of representatives supported in 2011. and it's a level that co-sponsors of the amendment, some of them were voting for tpa final passage, some voting

against it. it should be bipartisan, it should be across the board. this number is defensible and important for workers, and i ask my colleagues for support. >> well, senator let me just say this -- i strongly oppose the offering and let me give the following reasons why i oppose it. committee amendment number 12 would increase funding to $575 million. >> correct. >> i don't personally believe that training funding level for workers should be increased from the proposed $450 million to $5 5 million. as you well know, i have always had reservations with regard for this program. and the extent to which the workers' program has expanded over the years is unfortunate in my opinion given the lack of measurable benefits the program has to offer. and the lack of accountability. in administrating the program. i'm not convinced that this

program works. i certainly will not support increasing funding for it and would ask our colleagues to agree with that. i might add that i also oppose expanding coverage to public sector workers whose w.h.o. staff such non-tradeable services such as transportation hospital care and state and local benefit offices. taa was never intended to cover public sector workers whose job loss shared little to no nexus to trade. so i'm going to have to oppose the amendment. i appreciate the energy behind it. and your kindness in trying to put it forward. >> mr. chairman? >> the ranking member. >> just very briefly, the obama administration is urging the support of the proposal before us in its current form. and the senator from ohio, nobody has put the kind of sweat

quit equityco wit -- sweat equity into workers as the gentleman from ohio. the bottom line, it is a six-year extension. doubles the funding, it expands the program to include service workers and the department of labor. and i think this reflects why the administration is supportive of it is the amount here has opinion deemed by the department of labor to be enough to cover all workers. i'd like to do more. i'm going to be working with my colleague in the years ahead. there are a host of questions that remain about the taa program, particularly what's going to happen to public sector workers and senator brown has done work in this area. i would urge my colleagues to support the measure in its -- its present form. i yield back. >> okay. senator stabenow?

>> thank you, mr. chairman. briefly i want to support the amendment. i do appreciate the additions and the positive pieces of this particular bill. but i do believe that putting in the level at which was in the president president's budget is significant. you know, we're in a global economy. if people are losing their jobs we all have a stake in their having the ability to be re retrained. people want to work. we have a need for folks to be independent and working and contributing and taking care of their families. and from my perspective, making sure that there's adequate funding for people to have a fair shot to do that is very, very important. i support the amendment. and mr. chairman i have one question, though. and that is i've always assumed -- we're assuming that this bill moves with tpa and the other bills. and is that the correct assumption? because it would be very, very unfortunate when we've always

moved them together even though there are differences in terms of support and so on. i'm assuming they move together? i wonder if that's a correct assumption? >> i said in my opening remarks that we will move them in tandem together. but not -- not as one bill. >> correct. but they will move during the same -- thank you. >> i'm going to vote -- >> mr. chairman? mr. chairman? >> get enough votes to move it -- >> thank you. >> mr. chairman? briefly? blm? mr. chairman? >> yes. >> i'm concerned as senator stabenow in knowing that the opposition generally to taa that the members have and house members have that as this works together moving them together could result at some point in taa being jettisoned as the tpa goes to the president's desk. i think that would be a tragedy for workers. a couple of responses to your comment. i understand taa dollars have gone up. but look at what's happened with trade deficits. president bush, the first, said a billion-dollar trade deficit

as it translates into 13,000 lost jobs. when the trade deficit with china, when this body passed pntr was $15 billion or so. today it's $25 billion a month. it means there's going to be more need for taa especially now that we've included non-fta countries. and second, as senator portman and i know, when a plant is closed in sandusky or toledo, ohio public sector worker are -- are directly impacted by trade because property tax revenues are down police and fire and teachers get laid off. and those layoffs are due directly to trade issues. that's why public sector workers should be included. i ask for support for the amendment. >> let me just say that the agreed-to taa bill offers a generous extension for taa firms authorizing appropriations of $16 million for each year from 2015 through 2021. but i really can't support

expanding this program at this time. and one reason is we've got to get the -- this through the house, as well. so keep in mind i understand what the distinguished senator is saying does the senator want to vote on this -- >> i do. i ask for roll call. >> you want a roll call vote? >> please. >> any comments on the amendment? the clerk will call the roll. >> mr. grassley? >> no. >> no. mr. crapo? >> no. >> mr. roberts? mr. robert no. mr. enzi? >> no. >> mr. cornyn? >> no by proxy. >> mr. cornyn no by proxy. mr. burr? >> no by proxy. >> mr. burr no by proxy. mr. isaac son? >> no. >> mr. portman? >> aye. >> mr. toomey? >> no. >> mr. coates? >> no. >> mr. heller? >> no. >> mr. scott?

>> no by proxy. >> no by proxy. mr. widen? >> no. >> mr. schumer? >> aye by proxy. >> ms. stab my? >> aye. >> ms. cantwell? >> aye. >> mr. nelson? >> aye. >> mr. menendez? >> aye. >> mr. carper? >> aye. >> mr. cardin? >> aye. >> mr. brown? >> aye. >> mr. bennett? >> aye. >> mr. casey? >> aye by proxy. >> aye by proxy. mr. warner? >> aye. >> mr. warner aye. mr. chairman? >> no. >> the chairman votes no. mr. chairman, 12 ayes, 14 nays. >> the amendment is not agreed to. any other amendments for the taa bill? senator cantwell? >> mr. chairman? yes, i wanted to thank you and

ranking member wyden for including my amendment to approve collection of labor statistics in the chairman's modified mark on the customs and enforcement bill. i filed two amendments that i believe are critical to our competitiveness. one amendment is the expansion of the apprentice program and work force development which i think is a very important one as we talk about how we're going to open up economic opportunities in other countries. we also have to talk about how we train and skill a work force. we had two witnesses yesterday at the hearing. both labor and business supported the apprentice program. so i would hope that we can look at this moving forward so appreciate looking at that. the other one is obviously the clean energy tax credits which, you know, i'm -- we have many jobs here that the u.s. would continue to be competitive in if we get this done. we look forward to working with you and senator wyden on both of those amendments in the future. >> thank you very much. you filed three amendment to the taa bill.

and i included the first amendment in the modification to the chairman's mark of the customs bill. i think the other two amendments would be more appropriate to look at in the tax extenders context which requires timely attention, by the way. and i look forward to working with the -- with you on these two issues. we will try do -- i appreciate your willingness to facilitate this taa markup by not seeking a vote today your amendments if that's -- if i'm correct -- >> if you mean timely attention to extenders, you mean before december, i would agree. >> that's what i hope it will be. >> thank you. >> i can't guarantee. >> thank you. >> mr. chairman? >> a humble senator, you know. >> if i could just respond to senator cantwell. i think this is an exceptionally important area. nobody has done more to drive innovative in the united states senate particularly in renewable energy than senator cantwell. senator cantwell understands that the policies that have been successful make for

improvements, costs come down, and manufacturers can build out their supply chains to support vital renewable energy industries. i want her to understand, i consider this priority business. i'm going to work closely with her both on the energy committee and on the committee. i appreciate my colleagues handling of this today. we will be working closely together. >> thank you. >> thank you, mr. chairman. >> am i understanding correctly that you're withdrawing? ? yes, mr. chairman. >> okay. thank you. any other amendments? senators from virginia. >> mr. chairman, i want to echo what my colleagues said. thank you, and the ranking for your work. you've done, i think the ta bill before us is terribly important. proud to support senator brown's amendment though it was unsuccessful. one thing i think most of us agree on both sides of the aisle that sequestration is stupidity on steroids. and i was a little disappointed that we included an extension of sequestration as part of the pay

for for taa. i think that medicare sequestration which hurt our rural hospitals and health centers is unfortunate. i proposed a -- to replace the medicare sequestration with a bipartisan pay for that was previously voted out by the committee. and the specific pay for would allow -- alter mortgage reporting requirements that the irs would have additional information to evaluate mortgage special deductions, including whether refinancing occurred in that calendar year and unpaid balance of the mortgage. it would not increase any reporting requirement for the taxpayer. it's my understanding that under some strange sense of logic our friends on the house would view this as revenue and con squentsly would then be unwilling to support the taa amendment in the sense of trying to work with the other ranking members we go to the floor. i hope we can revisit the issue. i think it's critically important that we pass taa. i would appreciate the number of bipartisan members who support this amendment. i will withdraw it at this point

and look forward to working with you and the ranking. >> i thank the distinguished senator from virginia. >> i'll be very briefly and i just want to thank the senator from virginia for handling this in this manner. he's got great expertise in health care. i think we all understand that we are going to have to move aggressively toward health care reform. and particularly chronic disease which is dominating the medicare landscape means that we are not going to have a lot of time to get started. the fact that the senator from virginia has can wdrawn today i think gives us -- virginia has withdrawn today i think gives us impetus to withdraw the health care reforms. i want to thank him personally for what he's doing. >> likewise. any further amendments on either side? without any further amendment, if there's no further debate, i would entertain a motion that the committee order the bill reported as modified, an amendment as an original bill.

>> i so move, mr. chairman. >> do we require a recorded vote? >> i believe we do another voice vote s. that acceptable to colleagues? >> voice vote? >> taa? >> let's do a recorded -- >> you want a roll call vote? >> okay. recorded vote has been requested. the clerk will call the roll. >> mr. grassley? >> no. >> mr. crapo? >> no. >> mr. roberts? i'm sorry? mr. enzi? >> no. >> mr. cornyn? >> no by proxy. >> mr. cornyn no by proxy. mr. thune? >> no. >> mr. burr? >> no by proxy. >> mr. burr no by proxy. mr. isaac son? >> no. >> no. mr. portman? >> aye. >> mr. portman aye. mr. tomb? >> aye. >> mr. coates? >> aye. >> mr. healther?

>> aye. >> mr. scott? >> scott is no by proxy. by the way, burr is aye by proxy. i apologize. >> mr. burr aye by proxy. mr. scott, no by proxy. >> no by proxy. >> mr. wide glen is. >> aye. >> mr. schumer? >> aye. >> ms. stabenow? >> aye. >> ms. can't well. >> aye. >> mr. nelson? >> aye. >> mr. menendez? >> aye. >> mr. carper? >> my. >> mr. cardin? >> aye. >> mr. brown? >> aye by proxy. >> mr. brown aye by proxy. mr. bennett? >> aye. >> mr. casey? >> aye by proxy. >> aye by proxy. mr. warner? >> aye. >> mr. chairman? >> no. >> the chairman votes no. mr. roberts? >> i would like to record it as

aye. >> aye. >> the clerk will announce the vote. >> mr. chairman, 18 ayes and eight nays. >> the ayes have it, and the amendment is adopted. okay. are there any other senate amendments. >> yeah. mr. chairman? i would like it change my vote to no. >> you want to change -- would it change the outcome? >> it would not. >> no. >> without objection, your vote will be changed to no. are there any further debate on this bill? >> mr. chairman? my understanding is i thought that was on final passage of taa -- >> it was. >> it is. when you asked are there further

amendments, are you talking about the next -- >> no, we're enjoying this so much. i want to know -- >> okay, all right. didn't want to foreknow it the possibility we were on to the next. >> okay. let's move along. the committee will consider the chairman's mark, modification of s 1009, a bill to extend the african growth and opportunity act. the generalized system of preferences, the preferential duty treatment program for haiti, and for other purposes. i'm pleased that the committee is considering legislation extending and renewing several of our trade preference programs today. first let me see after months of hard work and tough negotiation, ranking wyden and i were able to reach agreement on the bill with the ways and means committee chairman, ryan and ranking levin. as a result, the identical legislation is being considered in the house. i hope we can pass it into law in short order. it's a good, strong package and i hope members will support it. so are we caught up on that

particular bill. let me say, senator wyden do you have comments? senator wyden, do you have any comment? >> no, mr. chairman. >> did he questions that may arise. could you briefly describe the main features of the proposal. >> thank you. at this market up the committee is considering a proposal to extend the african growth and opportunity act and the preferential duty treatment programs for haiti.

the proposal also authorizes the president to conduct out of sight reviews of any benificiary country. it also adds notice and consultation requirements for the president and makes certain technical changes to 506a. it's an extension of duty treatment programs for haiti

through september 2035. thank you. >> i recognize senator white on this. >> i think it's important. i want to commend you. i want to note a number of our colleagues have been involved in this and also the gsp legislation. any other comments?

>> i'd like to call up amendment number two. >> without objection. >> i'd like to ask that senator carpenter be added as co-sponsor. africa is the continent of the 21st century. it's also a maturing marketplace.

in this approach to reviews. he's traveling extensively to south africa and dealt with a number of trade issues with that country. it's important we send the signal to those that have not been in the spirit we believe important in this agreement to have the review take place and have people held accountable. this has been cleared with the administration. it's a good amendment and makes

a lot of sense. i ask for its adoption. >> mr. chairman. >> pleased to join senator isaacson in supporting this amendment. i don't know if anybody thinks about the value of the poultry export what we sell in the country. it's about $5 billion. it's a lot of money. we make sure those that are trying to keep it out are not

successful. i hope we get a big vote on this amendment. >> let me thank the senator for his comments. we're standing up for america and open markets. this is a good way to approach it. south africa is the largest beneficiary. >> i want to thank the senator from georgia not only for taking the lead on this amendment but also like delaware and maryland, poultry is very important in virginia as well. i want to appreciate the way i think he's navigated this to make sure the office uses that authority to hold south africa's feet to the fire. >> i had filed ten amendments

that deal with capacity building which is critically important. this is an issue that we are working the senate foreign relations committee in addition to senate finance committee. both are interested in strengthening the next round. ooem i'm not going to offer the amendments because it's not been cleared. i did want to compliment the chairman on the bill he's brought forward and urge us to adopt the amendment. >> thank you. i support the legislation in

front of us. i would offer an amendment that's joint. last august i had the privilege of leading -- yes. i'd be happy to do that. >> voice vote is fine. >> sorry to interrupt you. >> not a problem. i was pleased to lead a delegation of women senators to africa. one of things that we were all struck by is the significant role. the majority of those are women.

they work very, very hard all day, all night. they aren't able to own the property that they farm. they aren't allowed to get loans. they aren't allowed to have an inheritance laws that allow them to pass their work on. they were not afforded the same opportunities to develop their businesses and their farms. archdiocese feeting with women from at least 15 different countries and the leaders of different countries it became clear to us that we should make sure that it's very clear about the importance of moving forward and sending a strong message to our african trading partners for them to recognize the critical role that women play in the development of their economies.

the leaders indicated they were aware and moving in that direction. we expect our african trading partners to make sure they are making problem toward establishing policies that support women and men in their economies is an important part of this legislation. i would ask support from our colleagues. this is an important part of growing the economies in africa. >> seems to me that promoting the role of women and social political and economic development and subsaharan african is something we can get behind. it highlights how critical the role of women will be