achieved from this war that is led by the children of my country in the face of this dark movement in history. peace that we are aspiring for because we are sure that you and all of the forces the peace will stand by our stand in this confrontation. i may seem more optimistic than necessary for some of you. but when i say that this situation in iraq does not call for disparity despite the blackness of the sea. the source of my optimism is because i know that the iraqi people do not look at the cost of this from the confrontation but with the values and principles at the forefront of which is peace. and reconciliation. but they need the help of their

friends to be able to be victorious of daesh and you are the closest friend to us. at the time we thank you were the partners in the international coalition led by the american country, which is standing by us in the middle of this battle. we could believe that they have to multiply their efforts, the military efforts in our country an have to increase the aid for equipping the emerging democracy through the countries that are members of the coalition to save or children from the policies of not keeping the previous agreements. dear friends as a speaker of the iraqi parliament and the law, i think that there is no other alternative to go into this battle side by side with

you. because it is complimentary and it is a world so that we will not have any other terrorist organization on the ruins of daesh that would threaten our security and peaceful peace. and implementation of the parties of the tri -- the three three-party solution in the public and the council. so the goal of the national guards will be the guarantee of the security of the governance. we must end all aspects of mistear outside of the military. because this is a militarization

militarization. and to have systems that are ar till tearian. we must have the political reform and restructuring of the security institution based on efficiency and away from the current system. ethnic as well as sectarian. it is important also to uphold the law of the yuan find federal law and to separate between the power of the state in order to maintain the independence in taking decisions. ladies and gentlemen.an.gentleman.the method cannot be successful without

getting from the policies of regional polarization which made iraq for a struggle on behalf of partners and the iraqis are paying the price for it in the blood and the wealth. we cannot get out of this policy expect through the help of our friends in the united states of america. and western states that have an influence in the region through pressures on the iraqi political forces and the decision-making centers in order to stop the intervention in the internal affairs of iraq and support iraq to reduce the period of confrontation. because it has become a method of interfering in the affairs of iraq through daesh the ways and

the repetition of a particular modern from the terrorist operations which muchtouched all of our children schools were churches and mosques and markets. and the success of the democratic success of reform and establishing confidence between the partners will be a source for a democracy in the whole area. as the american message was after getting rid of saddam hussein in 2003. dear friends finally i put before you some principles that expresses a comprehensive project for reform and overcoming the challenges. the fairest issue we must think

about stability after liberation of the areas captured by daesh. and to give a model that ewe can motivate or those who were still living under the thortauthority of daesh so they can do everything possible to face the challenge. the second thing, if the military support surrounded by restrictions of controls that cannot be violated by friendly countries, these states must not neglect human support. the fair issue there is a strug until iraq between the state and none state and institutions that were established based on elections must be maintained. that is also other institutions that work outside of the framework of the state that

wants to take the authorities to itself and to impose itself on the society and make the decisions itself building a stable state in iraq is the guarantee of the protection of our minorities and the marginalized. the important cannot be forgotten. arming the tribes and the training and equipment because the local populations alone are the ones that can end daesh and changing the role of the tribes, ignoring them will make the problem -- we must also rehabilitate the police in the areas controlled by daesh. and the reforces be under one

control, represented by the commander general of the armed forces. the problem of the multiplicity of the leadership will lead to the collapse of the armies just as happened in ramadi. national a real -- building a modern state through the help of its friends, extreme uchl and terrorism is a very strange phenomena in the iraqi society an it has resulted from political circumstances that were complicated and will end with the end of this problem. therefore, eliminating daesh will help our ability to establish peace and the national guns is a new idea and an important one. but it cannot be a cover for

emergency cases that threaten the security of the state. and some societies sometimes result to a miserable solutions. so we should not contribute to this. so with that hope nothing a person can take important decisions in his -- for his future. call on you to support the just west of our people to get rid of terrorism and your efforts to spread the ideas on living in peace and understanding and i call on you and all those who love peace on the earth to support the reform and democracy in iraq. and this is why i decided to come to you here so that we can invest our partnership in this endeavor or otherwise it would

be totally different. thank you for listening to me. and peace be upon you. and thank you. [ applause ] mr. speaker, thank you very much for that presentation. we were most impressed with your words at the outset expressing your optimism expressing your

commitment to peace, expressing your friendship with people here and other allies around the world. so this is a very positive message that you have brought to us here today. you have a difficult job. as the speaker of the council of representatives, a body that you would probably agree has sometimes had difficulties in coming to agreement and coming to compromise and coming to final conclusions that support the movement forward of the country of iraq. can the council of representatives, under your lineup leadership and the other leaders and the deputies that you have, can the council representatives be a place in iraq that does

bring together that does bring the reconciliation that does come with compromise to be able to move forward? is this something that you see under your leadership of the council council? >> thank you very much. when we started in this term for the council of representatives, we had a lot of compilations of problems. the nature for example between the executive and the legislative, between the council representatives and the government. and to the point that it had delayed the issuance of many laws, the laws and also postponed the side rule. this was the main challenge. we could have been able to build a balanced relationship, but at the same time we agreed about the common grounds and we can

differ on the details. but the situation iraq requires from us cooperation. so we decided to talk with the cooperation between old authorities and the respective authorities. today in this council of representatives, the president of the republic and the government that's present approved the budget for 2015 in record time. and we were able to issue some principle legislations that have reached the point of voting. and we are going to vote on the law of political parties which is a very important step. also the media law, it says in the council. and we were able now to reach voting for the federal law. and this has been in the council for eight years.

we also have other legislations principle legislations. the counter council came during very critical time, the appearance of daesh in civilian areas. the members of the council are doing their job within this framework. the national reconciliation and it's being launched from the council representatives. and without serious and real reconciliation between the political powers is very deceptive. we have a continuous dialogue with the parties in order to achieve this project. >> mr. speaker you mentioned several of the pieces of legislation that you have laid out as your agenda. you also mentioned in your

remarks a piece of legislation on -- you mentioned in your remarks legislation having to do with the national guard. many people here will know, you know all too well, that there are many military formations in iraq. the national guard law would bring some order to this. how would the national guard law work with the shia malitia or the forces under those controlled with the peshmerga with the sunni national guard? you mentioned that they should all be under the control, the command of the commander in chief. how would the new law and these three or more military

formations work together? >> translator: frank with you first, why did the idea of the national came out. why it was put into the political agreement and considered a condition for the formation of government. there was a feeling at the time that some governments are not represented in the security and military aspect. and this lack of representation led to the presence of daesh in areas because the population of these areas were not able to confront daesh because they are not partners in taking the security decisions. so the idea of the national guards emerged to deal with this problem. first the problem is that to have all of the iraqi communities communicate and the military apparatus and to improve the -- to defend the

areas so they will not need daesh. so particularly when we agreed to establish a national guard, at that time the agreement was to do it locally under the ores from the governor and larger issue he would take the role of the commander in chief of the armed forces after we established the law. now it is being put to vote. but part of the political forces, so that the project of the national forces have deviated from the main track that it was put forth. it will be another military establishment that will be added to the other ones such as army or intelligence or police. and that is not really the purpose of it. also, the national guard in the eyes of some is a cover for the

militias that work outside of the official service. in our institution, anybody who is not in the armed forces cannot carry arms. anyone who carry arm, he's a malitia. and according to article 9, these militias are prohibited. so consequently we must find an official way we can rely on to prevent this multiplicity of loyalty. because this is not going to lead us to any progress. the law of the national guards is now being discussed. what do we need from this law. some say that if this is going to be a new case, it's going to be like the rest, it's not going to do what it's supposed to do. others say no it's not going to be like that. >> mr. speaker, if this if this

unified national command and the military effort is successful in certain areas when the military in these various components does liberate areas and areas are liberated from daesh, you mentioned in your remarks that reconciliation, that stabilization would be important. we have some experience. you have some experience. so americans have some experience in this effort. how would this time be different from the previous times, stabilization, reconciliation to avoid the problems that could come if we make the mistakes again? >> translator: of course in is an important matter. it is a comprehensive project.

some areas in which daesh they have committed heinous crimes and was liberated, the local population in several areas need some kind of harmony to be able to coexist. there are some who support daesh and some who are against it. so there is a control from groups that were allowed to carry weapons and others that were not allowed to carry weapons. consequently some parties became more stronger than others. for example, there are those who used to carry weapons even if he supports the military forces against daesh, but when daesh was moved out from the government, those who have weapons are in a much powerful situation than other.

how can we create an equal situation. we know that anybody who carries weapons has ability to impose his will on other. and we have several examples. so i call for the international community to focus on a project for stability after the liberation of the areas from daesh. this project for stability is not in kind, but just to achieve stability and to build a new democracy and work on the minds of people. and trying to spread this bridge of participation and reconciliation. and this is not a human project -- it is a human project, but it is also a security project.

so it's important that daesh does not come to us under a new name. how can we come if we achieve justice and stability. it will return if there is marginalization and exclusion. and if there was a feeling that people are not allowed to participate. so the important message we must send to the inhabitants who are not less than two and a half million people under the rule of daesh, some of them are afraid some of them doesn't have any financial power and some are women and children. the most important message to send to them is what we established after the liberation of daesh are in now much better condition. but if they are bad they would not think of their life against daesh. why would they defeat daesh.

we should have a project for establishing stability. takes into account the security and continuing democracy. >> mr. speaker, we're so pleased that on your first visit to the united states you're able to join us here. you will find a group of very interested people here very interested in your country, in the direction that your country and in the peace that you've just described. let me open the floor to questions. i'm going to do, i think, two at a time. we'll answer one at a time. but let me do two at a time so that a microphone can be in your hands and we'll save some time that way. so why don't we start up here, right here. yes. and then up here as well for the second question. now back up -- there you go. very good.

sir. name and affiliation for the speaker. >> i work for the council of extremism on somalia. thank you for hosting this very important forum and i would like to welcome saleem al-jubouri and his delegation. i worked for 2004 and 2011 on 2 11 so i have interest on what's going on in iraq and somalia. i have a question i cannot find an answer to it which is now specifically with the popular immobilization forces. many of the sunni area are complaining this is a shia led forces that are doing a lot of atrocities in the region. i would like to know your intake

into that. and very quickly many blame bush administration for what's going on in iraq today because of in 2003 what's called the number two plan or whaf, the dismantling of the iraqi army. i would like to know your insight into that as well. thank you. >> translator: immobilization popular i mobilization, i'm going to speak clearly about that. when dash controlled several areas in iraq, and the iraqi army collapsed we found ourselves in a big problem. how could we confront daesh. so directives were issued from religious leaderships to

mobilize the people to support. army and to stand by the army. there is a positive aspect to this and a negative one. the positive -- and when i look to the population of the government and they come, for them to have their bloodshed because of their presence with the army forces, this is not a kind of support. and we should not deny the great effort that were exerted and the important role played by these people. this is a very positive aspect. supporting the popular forces and to the iraqi army. what happened during the liberation and afterwards which give this negative picture they

were actions, theft, and there were some practices that showed that these forces are not regular forces and they're not disciplined and some of the misdemeanors were bad. and as a result, we cannot say who is responsible and should be punished and held accountable for this. and frankly speaking with even the idea of mobilization as an idea, which means a participation of all people sunni, sheena and the kurds, the kurds have peshmerga and they're stable. the shia has the popular mobilization. in response to the religious authorities. but the sunni how can we contain them pen a what is the framework they're working through to perform their duties in confronting terrorism.

they have a previous experience in the tribes. they confronted them and many of the children of the tribes had the desire to confront daesh but they don't have the weapons and don't have the capabilities to allow them to enter into confrontation. so they were using forces that come out of their governments to defend their a yas. now the number of those forces reaches 100,000 individuals. but from the population of the governance that's occupied by daesh alone, and swre 17000 only that belong to the mobilization. so we must also take into consideration that because we need training or equipping to these forces. >> so let me identify the next questioner here.

okay. but you will follow this gentleman right here. so if the mic can get to this person right here. yes. >> michael gordon "the new york times." mr. speaker since mr. abadi became prime minister of iraq, have there been any steps toward political reconciliation and are you satisfied with the pace of reconciliation in your country? there seems to have been no progress on an amnesty law. you mentioned the national guard. the national guard does not exist because your council of representatives can't pass legislation on it. a case can be made that the international community should do more. but the perception here is that iraqis haven't done enough on political reconciliation. do you share and that what do you think needs to be done. thank you.

>> translator: abadi, we look at him as partners. he needs support. and he also, he must take initiative to implementing agreements that were concluded in the past. because waiting or delaying will create a kind of feeling of no commitment to agreements that were neutral. and the project of reconciliation, we partner with him in it. we will continue to operate to achieve it. it is not an easy project. it is not slogans. it's a practical project. it was commitments on both sides. so my evaluation of this project is not up to the required level.

the reconciliation prongt is not really convincing for me. but there are many challenges facing us all. and definitely the matter requires efforts from everybody in order to be able to achieve it. we cannot blame one side alone. the truth, those who have committed with fall upon them the greatest bargain. we're all partners in the results achieved. >> that will be the next one here. but before you, madam, right here. >> hi director of research at the project democracy. you made a very compelling point that in order to inspire iraqi sunnis who are living under daesh controlled territory, to take up arms and to fight against dash that we have to offer those sunnis a vision of the future that they can hope to have in iraq and a vision of

iraq that treats them better than they were treated before, before the abadi government. and some of the key things that need to happen have been clearly stated by people such as yourself, a national guard, reform in a number of different areas that have been stonewalled by the iraqi parliament. what are the main obstacle to the reforms taking place? what are the objection to the reforms? how can we begin to overcome those objections? >> translator: with regard to the legislations and this framework and most prominent of course is the law of the national guards, it was decided that on the 30th of may we would

put it to vote after the committee provieweded its final report on the law. but as i said, in its final language, some of the political parties thought that this subject required discussion. is this the formula that we agreed upon or because if we work in voting to decide the matter, they will be large blocks that can -- according to its own interest. but we do not want this important issue to reach consensus. this is the method that we're follow now. the message of son census is very important in the aspect that we consider very crucial. the law of the national guards hire a simple instruction. and beginning in july we may in fact adopt it. but as i said, approval of this

law of national guards which deals with the problems that it was created for and not just the process of having a new system that is not different from what is present in the army or in intelligence and the security apparatuses in general. >> so this gentleman right now will need the next mic. but before you, madam, yes, please. >> actually i need to ask my colleague and my dear brother whom i work with him at the iraqi parliament one simple question. what is the definition of reconciliation.

[ speaking foreign language ] i am the first female judge in the history of iraq and the middle east. i am proud to be that because this is something in the favor of my country iraq. >> judge, we are very honored to have you here. welcome. [ speaking foreign language ] >> translator: the person works for this country, those misguided people who are now -- with whom should we make reconciliation the murderers -- >> now joining the isis and killing, raping, selling iraqi women. so with whom?

[ speaking foreign language ] >> translator: we are all iraqis. >> she keeps switching from english into arabic. it's very confusing. least to speak in one language. [ speaking foreign language ] >> translator: all of the -- [ speaking foreign language ]

>> thank you so much. >> judge, thank you very much. thank you for being here. [ applause ] >> translator: thank you for the words that given by the lady the deputy. she was a judge and became a deputy and we work with on on human rights and various areas. frankly speaking there are two classes in the iraqi society. the society and the politicians for ten years they raised the motto of reconciliation of society. i would like to say clearly that the iraqi society, as a society not as a political class does

not have what distinguishes it with regard to sectarianism. i believe that i am from the largest tribe in iraq which is in the north and the south sunni and shia, and they all have relationship. our problem with regard to the project of reconciliation when people start to use it for their -- the politicians for their own -- when they want to get the sympathy of the people by speaking in sectarian terms. he tries to use what he thinks is suitable to face his opposition. this is something that should be -- that we should deal with and we can overcome as a matter of fact. >> so we have bob here and then the next one will be in the back

here. there was a question further up. yes, right here. that's good. you'll be next. >> so i will speak in only one language. >> thank you. >> my name is bob kelly. i'm the counselor with jefferson waterman, a washington consulting firm. as an iraqi, how do you feel about iranian influence in ieraqiraq? >> and secondly, were there anything in the vote to discharge -- here the congress cannot take away -- discharge jerry brown from the governor of california. so i wonder if you thought there were irregularities in that vote. first about irana iran. >> translator: we -- in our law

there are two methods to remove a government. that is through the council of the government through voting and the second throw the council of representatives based on a request by the prime minister in accordance to the law. yet, if there is something wrong with the procedures the law gave the right to appeal the procedures. and the decision by the council can be vetoed. any decision by the council can be vetoed when looked by the federal court. it's then decided whether the procedures are correct or incorrect. one of the problems in iraq or the neighbors countries have influence in iraq and they have presence in iraq. not only coordination of

positions, they sometimes go beyond that to achieve priority on one interest or the other. and i mentioned in my statement that the iraqi field has become a field for struggle of influence because states but we are paying the price for it in our blood, iraqi blood and iraqi wealth. consequently, yes. sometimes some countries think it's a part of its national security is to intervene in the iraqi affairs and this is rejected by us. we reject any intervention in the same we reject to intervene in the affairs of others. no state should intervene except for the amount needed to achieve common interest which is allowed by law. >> we'll choose here in the back. yes. thank you sir.

>> i am with a news network from iraqi kurdistan. i have two questions. you seem to agree that in order to liberate the areas under daesh we would need to have the par participation of the sunni forces. but i would like to know your assessment of prime minister abadi's reachout to the sunnis. hasn't it been slow, too slow so far? and whether the united states can do more to make sure there's a sunni force, you know being formed. and do you believe the united states should arm directly the sunni forces or go through baghdad? and the second question is there have been a lot of talk about

creating zones like the kurdistan region which has been a model of stability for iraq. do you believe that sunnis want that? the sunnis initially when iraq was invaded, they were opposed to that. are they more in favor of that idea now because they believe that they're marginalized in the shia-led government in iraq. thank you. >> translator: the first question gives me a chance to speak about the accusation daesh wanted the shia, to blame shia and to say that the sunni has connection. i am a sunni myself and i'm proud of that. but i am -- i have nothing to do with daesh. and daesh is not presenter of the sunni or the kurds or any component.

because it has a project that have a track limited to killing and blood. and this is not an iraqi -- but how can we deal with the sunni so we can insight them to -- we can encourage them to confront daesh. when the people in 2005 were able to defeat it, after all of those who were carrying weapons confronted, was charge of carrying weapon against the law. many of them were chased and tried and detained. now when daesh came, many of them need guarantees if they confront daesh who is going to protect them from the state yards? who is going to protect them from the law if there is no mechanism in this respect. therefore they're looking for

someone who can stand by them. and the most -- the party they need most is the prime minister to act with them. and he is responding to their desire. there is economic problems and problems related to weapons. but the fact of the matter is that in my own conviction that the arming of the tribes is not good, not complete. and the question is can we equip them directly? there are three points that i mentioned, and i mentioned we must arm the tribes. we cannot eliminate daesh except with the local population throw coordination with the federal government to have guarantees so that these weapons could reach the local population to confront daesh. three matters that are very

important for the elimination of daesh. with regard to the regions between kurdistan and the other areas, the fact of the matter is some of it is under the control of darve now. some of it is also in the control of daesh and they engaged in commerce. daesh is investing these areas economically, is benefitting from the weapons that were left by the iraqi army during the battles. and so we have to go on the road of interest and exchange of relationships, not struggle. what is the value of the land if its inhabitants are not protected and are not taking their rights. so the more we save their lives, the more we're able to build partnership between the region and the other governments. >> so yes, good. hold your question just one

second. and there's a gentleman here who will get the next one. thank you. sir? >> thank you. senior fellow at the foreign policy institute johns hopkins and the director of the institute. thank you, mr. speaker, for coming. in your statement you mentioned that there was a need for -- or there is a need to dismantle and disarm the fighting groups that currently exist. but also in the same sentence you ask for arming the tribes. i'm interested in knowing how you view a reconciliation between these two demands. and wouldn't it be better since there are no other alternative to fighting and defeating isis on the ground in the kurdistan area than the current group you want to dismantle shouldn't there be more control of

government over there anduntil a better alternative is available. thanks again and thanks for the question. >> translator: we have two options. militarily to confront daesh. the first is to rely on the official military forces only and to strengthen them and build it and restructure it and go in the direction and don't give anybody else to have the authority to carry weapons. this is a fair option. it's ideaistic and consistent with the idea of the state and its stability. but the problem is we're in exceptional circumstances. the armies, the official forces, other official forces don't have this efficiency. so we resorted to something other than the army. so if we arm groups, the shia arm groups and the tribes, sunni

tribes, the fear is that we eliminate daesh will there be a strug until the future. yes. the answer is yes there will be. therefore, we must contain the situation within the frame, official framework and within a unified command. but the multiplicity of command and the victory of those who are armed will create a society that is in dispute with itself. we're using p 1 to take the second approach. there are dangers but we must be cautious about establishing a system that we can distribute. >> so -- you will be next. but fist hererst here sir.

[ speaking foreign language ] [ speaking foreign language ] >> we're not getting interpretation. >> repeat? >> please. [ speaking foreign language ]

>> translator: between the federal government and the government and the issues raised for the success of this idea, the proposal i have now is to have the command of the national guard of the republic and not the prime minister. an order to be achieve the idea of checks and balances. the president is kurdish. if it is under the command of the president of the republic to

solve many problems. again, it could be a constitution because the constitution gives the authorities. but because the shia component has violated the constitution, we as a sunni component should review the law and we should make the national guard under the president of the state. thank you. >> do you want to speak? okay. so we have time for one last question. it's here. then we will conclude. >> thank you mr. speaker. with the woodrow wilson center. i'd like to go back to the issue of the iraqi army to which you have already referred.

there has been a lot of controversy for the reason of why the army did not fight as well as was desirable in mosul and again in ramadi. and why, in your opinion, is this the case? it's a problem of training, which seems to be what the u.s. believes at this point. is it a problem of weapons? is it a problem of morale? what is the reason for this failure? >> translator: since we're talking about the military to bear comment on the remark made by the gentleman, the demand of having the chief of the armed forces, we have a commander in chief with authorities, which is the prime minister and higher command for the armed forces for the protocol, which is the

president of the republic. someone with protocol authorities cannot be. so the second thing in the army, and in mosul and repeated in ramadi, in addition to the morale itself which was not up to the acquired level there are indicators to move military sectors not in a unified vision which raised a lot of question marks. the council of representatives began to look at the military orders to certain second sorstorssectors. this is a problem resulting from the lack of unified command. we will not be able to hold

anybody accountable because we don't know who took this decision and why he did. >> sorry. >> [ inaudible ]. >> it is. however, we're out of time. i understand he has another meeting. mr. speaker, on behalf of all the people here today let me thank you for your frankness, for your willingness to answer questions, and thank you for your optimism that you began this discussion. i hope this is not your last visit to the united states and i hope you will agree to come back to the institute of peace when we have more peace to celebrate. so please join me in thanking the speaker. [ applause ]

>> ladies and gentlemen, please remain in your seats until the official party departs. >> the senate special committee on ageing investigating the recent increase of telephone

scams aimed at u.s. seniors today. members are looking into why laws allowing consumers to opt out of unsolicited telephone marketing calls have not stopped these calls. the hearing is live at 2:30 p.m. eastern here on c-span3. >> this summer, book tv will cover book festivals from around the country and top nonfiction authors and books. near the end of june, watch for the annual roosevelt reading festival. in the middle of july we're live at the harlem book fair with author interviews and panel discussions. and at the beginning of september, we're live from the nation's capital for the national book festival, celebrating its 15th year. that's a few of the events this summer on c-span2's book tv. director of clinical cardiology at brigham and

women's hospital in boston on the advances in heart surgery and the progress being made in the understanding of heart health. >> this actually is a valve that has been crimped on to this catheter that's being now positioned into the diseased valve, and it will be deployed here in just a second with the balloon being inflated. a new valve will be inserted inside the old calcified valve. as you can see here, the delivery system is being withdrawn. then the wire will be withdrawn. what we've just seen in this little pictorial display is replacement of a diseased aortic valve in a manner that does not require open-heart surgery. so we're trying to become smarter about predicting who will get disease. we're trying to become smarter as to identifying the most

effective means to prevent or attenuate the disease and smarter about following up over a longer period of time. we're currently in an era where we're trying to harness the promise of the human genome research project that's now been in existence for more than a decade, with all of the informatics that can be driven by the giants of the industries, like google, for example, and information about sociology, geography, demographics, where you live, where the railroad tracks are in your city what's your likelihood to get diabetes on the basis of your educational background, and what's your likelihood of developing something like diabetes or hypertension if you live in a certain part of a city where you have less access to the right kind of food or even the right kinds of instructions about sodium consumption. little things like that that could have enormous impacts on population health. >> dr. patrick o'gara sunday

night 8:00 eastern and pacific on c-span's q&a. we're live on capitol hill this morning for remarks from health and human services secretary silvia burwell. she's expected to talk about the king v.burwell case, which challenges federal subsidies implementation of the law and the hhs budget request. live coverage here on c-span3. it should get under way in just a moment.

committee will come to order. we know that secretary's on a tight timeline today with a hard deadline at noon. that's why the ranking member and i just discussed we'll limit members' questions to four minutes to accommodate as many members as possible. let me start off by thanking our witness, secretary burwell. i understand that you've got to get going, so we're going to move this as quickly as we can, but we were supposed to have this hearing earlier in the year. events overtook us. so here we are today. i understand that the majority

of your remarks are going to be about the budget. that's all well and good, but it shouldn't surprise you, secretary burwell, that we're a little more interested in talking about obamacare, especially given the president's remarks this week. i hope he gives you a medal for this job because defending this health care law is no easy task. i think any objective observer would say this law is on the fritz. by the law's own standards, the whole point of obamacare was to make health care more affordable, but premiums aren't going down. they're going up. way up. all over the country, and insurers are proposing double-digit premium increases. in maryland, it's close to 30%. tennessee, 36%. south dakota 42%. tax season was like a bad dream before. now it's a total nightmare.

people could never afford these plans on their own, so the law gave them subsidies, to some people. well, now two-thirds of the people who got them had to pay the irs back. on average, over $700. that's not the kind of money that people just have laying around. and for all of this hassle, for all of this what are we getting for it? the argument was that if people had insurance, they'd go to the doctor instead of the emergency room, but now even more people are going to the emergency room. so whatever the supreme court decides later this month i think the lesson is absolutely clear. obamacare is just flat busted. it just doesn't work. and no fix can change that fact. we're not talking about a ding or a dent or a fender bender or a flat tire. the whole law is a lemon. it's very lynch pin.

its central principle is government control. that means higher prices fewer choices, and lower quality. so the answer isn't just to fight tighten a few screws and everything will be fine. the answer isn't just to tweak it here and tweak it there. the answer is to replace and repeal this law. the truth is i don't have to convince this administration that the law is broken. i know that you know that it's broken because you keep trying to fix it. for several years now, hhs has delayed parts of the law and sometimes, in some cases, they've rewritten it on the fly. we know the most egregious example, the subsidies. the law says that people who buy plans on state exchanges can get subsidies. it doesn't say anything about federal exchanges. yet, hhs has sent millions of subsidies out the door, putting millions of people at risk. more and more it seems the administration isn't so much as

implementing the law as they are improvising it. we have already seen the evidence of the administration using one account to pay for multiple programs. programs that congress never funded. that's one of the main reasons that we're holding this hearing today. it is congress that wields the power of the purse, and more and more the administration is acting like a purse snatcher. so again my kudos to you, secretary burwell on a very difficult assignment. but the american people, they deserve better. they deserve a health care system that puts the patient first. they deserve lower prices. they deserve more choices. they deserve higher quality. and the committee is going to do all it can to make those things happen. and with that, i'd like to yield to the ranking member. >> welcome. you know, i'm glad we're having this hearing, and obviously the republicans want to focus on

aca. and i think that's a good idea. because what's busted is not aca but your attacks on it. endless attacks. never coming up with a single comprehensive alternative all these years. so you sit as armchair critics while millions of people have insurance who never had it before. millions of kids have insurance who would not otherwise have had it. people who have pre-existing conditions no longer are canceled or can't even get insurance. the donut hole is gone. millions of people in lower income categories are now insured through medicare. millions and millions and

millions. cost containment is beginning to work. it's beginning to work. the increase in costs, that rate is going down. and so you're livid because it's getting better. that's why you're livid. and i'm not surprised at your fervor. we'll be glad to take it on. we'll be glad to take it on. and i think you just need to understand what this experiment is all about. it was combining increased excess to medicare, to medicaid with an increased reliance on

the private insurance sector. that's really what this is all about. an experiment. and you talk about government control. more and more people are getting insurance through the private sector. and the states that are denying their citizens further coverage under medicaid are essentially telling people, well get lost when it comes to health coverage. get lost. and you have a governor mr. chairman, who's running around this country talking about the evils of health care when millions of people are benefitting from what happened. so you decided to turn this from budget to aca. welcome, welcome. your frustration is millions and

millions and millions of people are benefitting, have health care when they did not before. so madam secretary, i think they've thrown down the gauntlet. i don't think you -- i don't feel sorry for you. i think you love this job and you like being the person who's administering this experiment in greater health coverage after 70, 80 years of nothing being done in this town or throughout this country. so i happily welcome you because i think you're a very happy warrior. i yield back. >> i'd like to recognize the happy warrior now for your opening statements. the floor is yours, secretary burwell. >> thank you. chairman ryan ranking member levin, and members of the committee, thank you for the opportunity to discuss the president's budget for the department of health and human

services. i believe firmly that we all share common interests, and therefore, we have a number of opportunities to find common ground. and we saw the power of common ground in the recent bipartisan sgr fix, and i appreciate all of your efforts to get that work done. the president's budget proposes to end sequestration, fully reversing it for domestic priorities in 2016, matched by equal dollar increases for defense funding. without further congressional action the sequestration will return in full in 2016 bringing discretionary funding to its lowest level in a decade, adjusted for inflation. we need a whole of government solution, and i hope both parties can work together to achieve a balanced and common sense agreement. the budget before you makes critical investments in health care, science, innovation, and human services. it maintains our responsible

stewardship of the taxpayers' dollar. itnm]í0ij better smarter, healthier delivery system. in terms of providing all americans with access to quality, affordable health care it builds upon our historic progress in reducing the number of uninsured and improving

coverage for families who already had insurance. a recent example of this plog is the 10.2 million americans who are currently enrolled in health insurance through 2015. the budget covers newly eligible adults in 28 states plus d.c., where expanded medicaid and improves access to health care for native americans. to support communities throughout the country, the budget makes critical investments in health centers and our nation's health work force, particularly in high-need areas. to advance our common interest in building a smarter better, healthier delivery system, it supports improvements to the way care is delivered providers are paid, and information is used. to advance our shared vision for leading the world in science and innovation, the budget increases funding for nih by $1 billion to advance biomedical and behavioral research among other priorities. it invests $215 million for the

precision medicine initiative, which will focus on developing treatments, diagnostics, and prevention strategies tailored to the individual genetic characteristics of individual patients. to further our common interests in providing americans with the building blocks of healthy and productive lives, this budget outlines an ambitious plan to make affordable quality childcare available for working families. to keep americans healthy the budget strengthens our public health infrastructure with $975 million for domestic and international preparedness including critical funds to implement the global health security agenda. it also invests in behavioral health services including more than $99 million in new funding to combat prescription opioid and heroin abuse dependence and overdose. finally, as we look to leave our department stronger, the budget invests in our shared priorities of addressing waste, fraud and

abuse. initiatives that are projected to yield $22 billion in gross savings for medicare over the next decade. we're also addressing our medicare appeals backlog with a coordinated approach. we are pleased that the senate finance committee last week passed bipartisan legislation, and we look forward to working with this committee on it. i also want to assure you i'm personally committed to responding promptly and thoroughly to the concerns of members of the committee. i want to close by taking a moment to say how proud i am of the hhs employees from their work combatting ebola to assisting unaccompanied children at the border. the commitment they show day to day, day in and day out, as they work to help those fellow americans. i look forward to working closely with you to advance our common interests on behalf of the american people. thank you. >> thank you. let me first start by saying where we agree with the

administration, we work with the administration. this week's action on trade is a perfect example. but on this health care law, we could not be more opposed to what the administration is doing. we really think this is doing a great harm to the health care system and to the people we all represent. so let me start by just addressing the big elephant in the room. any day now the supreme court as you well know because your name is burwell, in king versus burwell is about to rule. if the court rules against the administration, then millions of people will be stuck with a government-designed health insurance that they cannot afford. so i mean, the big question is then what? what about the people who are going to lose their subsidies and possibly their coverage? is the president going to dictate to us how to fix this flawed law or is the president, is the administration going to be willing to work with us to

give families greater freedom in choosing the health care that works best for them? >> so with regard to the question of the courts. i think you know we believe that we are implementing the law as it was written as the statute is written as it was intended as cbo has scored it for all these years, as recent articles have reflected that those who were part of writing the law indicate it should be. the idea that citizens in the state of new york should receive federal subsidies that taxpayers contribute to and citizens in the state of texas should not is not what we think the law intended and therefore -- >> i understand your opinion on what the court ought to do. but there's a pretty decent chance it may not go your way. so the question is, then what? >> if the court does decide and if the court would decide for the plaintiffs in the idea that the court would say that subsidies in the federal marketplace are not eligible, those states that are part of the federal marketplace, that those citizens can't have those

subsidies, if the court makes that decision, we're going to do everything we can, and we're working to make sure we are ready to communicate, to work with states and do everything we can, but the critical decisions, if the court says that we do not have the authority to give subsidies, the critical decisions will sit with the congress and states and governors to determine if those subsidies are available. >> so here's the question. is the president going to stand up and wave, i have a one-page bill, i have a one-sentence fix take my way or the highway is that going to be the administration's position? or is the administration going to be willing to work with congress to find a way to give people more health care freedom? that's the question i'm trying to get at. >> with regard to the question of health care freedom, i think it's important to reflect the marketplace is a market. it uses private insurers. people that sign up in the marketplace are not -- so they have many choices.

as a matter of fact, in the marketplace this year there were 25% more plans. that's more choice. that's more competition. that is why -- >> i want to be kind to everybody's time. let me ask it this way. if the plaintiffs prevail if the king side wins and then the exchanges are deemed unconstitutional, not legal in the federal exchange states, then the individual mandate is effectively struck down for those taxpayers in those states. is the president going to say, reinstate the individual mandate? i got to tell you, it's not real popular. we here, at least on this side of the aisle, aren't eager to reinstate the individual mandate. we would like to free people from some of these mandates. i would say the administration has kind of been a little two sided on this particular issue, where you've delayed the employer mandate twice. that goes away as well. so is the administration going to take the position congress must reinstate this thing in all these 37 state, reinstate the

individual mandate reinstate the employer mandate, my way or the highway, or is the president going to be willing and flexible to work with congress to fix this mess and negotiate with congress? that's what i'm trying to get at. >> so i think it's actually very important, though, with regard to the decision before the court, the decision before the court is who receives subsidies and whether or not those subsidies can be given in states that have a federal marketplace versus a state marketplace. >> yes, we understand that. >> that is the decision. that is the only decision before the court right now. >> okay. so -- >> so with regard to what happens if that decision occurs, three things occur. the first thing that occurs is for the people -- >> secretary burwell, we know what will occur. we all know this. the question is, what will the administration do? will they stand up with one piece of paper and say, my way or the highway, or will they work with congress to address the situation? >> so the problem that occurs if the court decides against us is

they have made a decision that the subsidy -- >> you're not going to answer the question are you? >> no, the answer is the problem that gets created is subsidies aren't available. they aren't available for millions of americans. they lose their insurance. it drives up costs in the individual market. to solve that problem the critical decisions are going to sit with the congress. >> okay. >> or states. >> so for a bill to become a law, house, senate, then the person at the other end of pennsylvania avenue, the president, signs that law. is the president going to say, only my way or the highway, one sentence, one-page fix, or is that president of the united states going to be thinking less about digging in and defending his law as exactly written, or is he going to be willing to exact deal with the issue, which is affordable health care for millions of people who are losing their health insurance? is he going to work with congress to address this situation, or is he going to put concrete around his ankles and say, it's my law or nothing? that's the question i'm trying to get at. >> so the president and we have

said, the administration has said all along with regard to improvements -- and we believe there are improvements that can be made, we look at three things. and a fourth underlying. affordability, access, quality, and the issue of how it affects the deficit and our economy. we will look at anything and have that conversation with regard to the specific that you raised. i do think it is important. the issue of the individual mandate, that is related to a very fundamental part of the system, which is pre-existing conditions. and it is our experience, at least in my conversations across the country, that most americans believe that you shouldn't be kept out of insurance or banned. if i have a child that has a condition that's born with a particular condition, that i shouldn't spend my time worrying that that child will never get insurance once they go off mine. >> you're kind of going off topic. i'm going to cut you off there. we both know that there are ways of dealing with those problems

without having to impose an individual mandate. let me leave it there. in the interest of everybody's time, mr. levin. >> well i'm not surprised at the tone but i really think it is so counterproductive. chairman, you talk about two sidedness. the two sides, when you say you worry about the millions who will lose their insurance when it's your allies who brought the suit that would deprive them of insurance. you talk about concrete, having feet in concrete. that's exactly where you've been in terms of aca. your feet have been in concrete while you have brought up bill after bill to try to destroy

aca. and when you say will the president be my way or the highway, that's precisely what has been your approach to aca. precisely. you've never sat down with us to say how could we make some changes. instead, you have been out to destroy aca. and you say where's the president's plan when the president believes the court will and should uphold the law. all you've done is issue op-eds. >> and bills. >> and bills. contrary, contradictory bills. so you don't have any plan like you haven't had plan for 60

years. so you can keep going after the secretary, and she will keep trying to spell out -- i'll ask you when i finish. how many people have been receiving subsidies, madam secretary? >> so 7.3 million people have received subsidies that are in the marketplace right now. >> so when you shed tears about 7.3 million, remember about the law, it's 7.3 million. what's been the average subsidy? >> $272 per month is the average subsidy. in terms of those in the marketplace that are subsidized, that's the 7.3. so 10.2 million people are currently in the marketplace overall. about 85% of those receive subsidies. the average subsidy is $272 per month, which is what results in the affordability.

>> and just quickly, tell us how many people have received additional care through expansion of medicaid. >> the question of the total number, because there are people in terms of the expansion itself, about 10 million people are the estimates in terms of those states that have expanded. >> so add those two together, and we're talking about individuals with families, and the republicans come here and castigate you and this president. the shoe should really be on the other foot. i yield back. >> mr. johnson. >> thank you, mr. chairman. i hardly know how to follow that. i guess i'm supposed to thank

you for being here but i have to tell you i'm not in agreement with much of what you're saying. let me just ask you, you know we're trying to get the health care back in shape, and it sounds like to me that you want to go your way and not try to work with us. let me just ask you if there are any proposals that hhs supports that will reduce costs for consumers without setting price controls or imposing other restrictions that will reduce access to care. >> yes, in terms of there are a number of things that are part of our budget and that we're

currently implement taging that are reducing costs. since the passage of the act -- >> but it looks like to me everything is going up. >> well medicare spending if we look at what it was projected to be in terms of the previous ten years up to 2008 to where it has been since '09 through '14, we saved $300 billion. with regard to per capita health care cost in the country in 2011 '12 and '13 the cost growth is the lowest that it has been in 40 years. so that's taxpayer savings. that's also savings for providers. >> well, the insurance rates are going up, not down. everybody is paying more for it. >> insurance rates before the affordable care act were going up often in the individual market well above double-digit numbers. what we've seen since the implementation is while those rates are still continuing to go up, they're going up at a much lower rate. >> okay. let me just change subjects for a second and ask you about an

effort that my colleague and i have been after for a number of years. thuáwnending the use of social security numbers on medicare cards. as you~4 law earlier this year as part of the medicare access reauthorization act. so let me ask you, is hhs already implementing that, and how fast do you think you'll be able to issue cards without social security numbers on them? >> first, let me say thank you. having put this in the budget when i first arrived at omb, i thought, as i told you on our call, that it would take years. so thank you for your leadership and effort on this. we were pleased. and i personally was very excited. right now we're putting together the work plans to do that. we haven't established the exact timetable, but as soon as it was passed, the next p!trñday, have asked j+ we want to do

we believe this is an important part of privacy and security. >> well, i thank lloyd for helping me with that. how easy do you think you can make it for seniors to get a new card? >> i think that's the part inv1'z terms of understanding the timing because we wantíów7 h it to be easyúab)vy seniors. and we want to make sure they understand. one of the things wenokykfdñ don't want to do by making thisfh(,h improvement is create confusion. can enter in the new people their cards but those withr@'v$ed-b. existing cards by#]ktq ez want to have a confusing situation. so that's what we're working to do. and look forward to staying in touch with you and your office about how we do that. >> thank you, ma'am. thank you, mr. chairman. >> mr. engel. >> thank you mr. chairman. i want to thank my colleague mr. johnson for not drinking all of thats kool-aid you have in the back against obl- k'ñ and bringing something constructive.i

i can't try thathl i was a former altar boy. i went to school, learned all the for americans to do was to f)qc%á t that health c)xdp/ was a m $ it doesn't even seem like a p[lâ"ájjt if a kid is sick and someone saysv you]39 y can't have health care. it should pain us as human beings if a personm goes to a doctor and finds out that the child has get insurance. class people have insurance. but that probably sometimes restricts people from getting this. it just seems to me that instead of tearing down a system where you know in your hearts people are getting health care that you would say, i don't like the way you've done it mr. president. i don't like the way you democrats have done it. let us help you to do it better.

but to take some sense of pride that the supreme court will just strike down the opportunity for people to get just basic health care, to mem9 is not just mean spirited -- >> will the gentleman yield? >> i don't think so mr. chairman. you're on a roll now. i don't want to have you to become a nice guy at this point in time because i'm glad that you have rehearsed the attack that you intend to do. i don't care who the secretary is. if you're on the side of giving assistance to people that can now go see a doctor, that can now prevent going to intensive care because they've had preventive care they can now get insurance that they couldn't have insurance, from a political point of vu to be in your shoes explaining it. of course, those that are already covered, it's no problem there. i've got mine. you get the best you can. but i don't care what religion

you believe in, and even if you don't believe in any, it seems like compassion should override partisanship. if we don't like what's before us, we should work hard to repair and to fix it and to improve it. so at 85 years old if i have to decide what moral side i'm going to be raising issues on i can't find a better one than this. and, you know, it goes without saying. if you're crippled, if you're blind, if you're disabled, if you want help and if money and insurance is what is keeping you from getting it, you could not give a better political home run ball to the american people to decide a basic question, which side are you on. so i'm glad that politically my party would never put me in this position and the only position

i would rather be -- and it's where you're sitting madam secretary, to be able to see your on the right side of the issue. you can see people don't really want to discuss the millions of people that are being helped. and we're not talking about -- we're talking about life and death and a true sense of the word. if someone had a conscience that when a doctor said, i wish you'd seen me earlier and they said i wish i could, but i didn't have insurance to do it doctor, or how many cases we have in intensive care says this man, this woman shouldn't have been here if we had detected it earlier. do we have to -- >> time of the gentleman is expired. >> well, thank you, mr. chairman. i'll take back the balance of my time. >> good. >> there's another minute there. >> we're doing four minutes so we can get to members here. i would ask members if you have

a question, ask it earlier on so that the secretary has a chance to respond. gentleman from texas is recognized. >> thank you, mr. chairman. health care is about patients, not politics. i was really pleased to hear you answer mr. ryan that if the court rules against the irs in this case that the administration will do everything we can. can you give us some guidance here? will the president sign legislation other than merely extending the subsidies to federal exchanges? >> with regard to the question of legislation and the affordable care act, we've had -- that has been a question and a comment. where we've been is when there is repeal of fundamental elements -- >> but on going forward. i appreciate looking backwards, but going forward, if the court rules for the plaintiffs will the president sign legislation other than extending subsidies to the federal exchange? >> so the president has, and i think will continue to, sign

legislation that improved afford affordability affordability, quality, access, and takes care -- >> so the answer is -- and thank you for saying -- i hear you say the president will sign legislation other than simply extending the subsidies to the federal exchange. >> we have always -- >> is that correct? >> the sgr bill we just recently signed includes very important provisions that actually extend the affordable care act's effort to do deliver ri system reform. >> but as you know, that's not in the supreme court case. specific to that asking your guidance the president will sign legislation -- >> specific to the supreme cour¥> case --t5b1 >> other than merñl! xtending subsidies? >> specific to the supreme courtr3 case f the question people court case, i want to return to what the supreme court case is about. >> we're looking for your guidance in a bipartisan way. so your answer is yes, the president will sign legislation other than extending the subsidies to the federal exchanges. >> with regard to the question

of the supreme court case that is an issue about subsidy. that's all that is about. >> and your guidance to us would be -- >> if your question is, are we willing to consider things that would improve or enhance affordability, quality, and access, we are open to those things. with regard to the supreme court case, though, i think it's very important for me to be clear. that is about one item. >> the subsidies. very well aware. i just want to make sure again as we look to work together to put patients ahead of politics you're saying, yes, the president would definitely sign legislation other than extending the subsidies to the federal exchange. the answer is clearly yes. >> i want to distinguish between the question of how one resolves the problem that gets+( that is -- that doesn't have anything to do with any other pa 9u= act. >> no, no. this is such an easy question. it can be yes, the president will sign other legislation or

no, he will sign only that legislation. >> congressman, i think it's very hard for me to answer a question about hypothetical ,75f legislation. >> no, it's actually not hypothetical. as we know, the court is going to be ruling, not hypothetical. if the rule for the plaintiffs, guiding us, you're saying the president would sign other legislation. he will not, as mr. ryan said he will not say my way or the highway. >> with regard to fixing, improving the affordable care act, these are two different issues. >> no, no. madam secretary, i don't mean to interrupt. i'm really seeking your guidance. the answer, to finalize it, is yes. >> my answer is we will review any legislation we get that has to do with the affordable care act based on -- >> but i'm asking about signing. so the answer is no? >> with regard to legislation we sign, we'll look at any piece of legislation, and we'll judge it by four things. >> so would the president sign -- will the president sign

legislation to extend those subsidies temporarily while republicans and democrats and the president work toward a long-term solution? >> with regard to the subsidies as i have said the critical decision is with congress. if the congress writes legislation that makes sure those subsidies are available, that is something that would fix the issue. >> so the answer is yes. yes, he would sign legislation other than extending it correct? >> congressman, i apologize, but with you say other i want to make sure -- >> time of the gentleman has expired. mr. mcdermott. >> mr. chairman, thank you. ms. burwell, it's really nice out in seattle. i'm not sure you made the right choice coming back here to work. >> i'm in the wrong washington. is that what you're telling me? >> i listen to think and we're all talking about if the president does this and whatever, but let's talk about a specific. i think that we haven't heard a

specific come out of the republicans since the bill was passed. they've never put anything on the table. now we have a bill 1016, put in by senator johnson from wisconsin. it's his solution if the bill fails. and as i read it quickly t repeals the individual mandate, it repeals the employer mandate, and it says the states can continue the funding down and the standard of benefits that people get are not the national standards but whatever the state of mississippi or alabama or georgia or texas or one of these states that has not had an exchange, whatever they set as a benefit. we know it'll be lower because it already is. they won't cover people in medicaid. so they clearly don't care about the level of health care. but explain to me how you would -- >> will the gentleman yield? >> -- to 1016? >> will the gentleman yield?

>> no -- >> will you take back the disparagement of the citizens of georgia? >> she has the right to explain what the president would think of a particular piece of legislation that's been put forward as a serious thing by a senator in the united states senate. >> so with regard to the johnson piece of legislation that piece of legislation is from our perspective, repealed because it gets rid of pre-existing conditions. it stops the funding for preventive services. it undoes that people up to 26 would be covered. and it actually takes away subsidies from all over time. so with regard to that particular piece of legislation that is a bill that from our perspective is repeal, and we've spoken to the issue of something that repeals the affordable care act is something that the president will not sign. >> so in answer to mr. brady's question, will the president

sign a bill that we pass if we pass this bill will the president sign that? >> as i have said, this bill in its current form is repeal. the president has said he will not sign something that repeals the act. >> is there any place that you see that there is a proposal on the table by any member of the house or senate that makes -- that looks at this point as though it deals with protecting the aca in general and fix the one specific problem? >> we have not seen anything. >> and you've looked at all the legislation and read all the press releaseskíw and everything else? >> at this point we have not seen something that addresses the specific issue of the question. although, i think there's also the issue i think we're all very focused on the loss scenario. i think at some point it is important to focus on the win as well, in terms of how we all8 go forward if there is a win.

>> tellg í cost of0p,u.k93÷de>6 we hear the chairman=yfd>váháhe2:(u president would be80 premiums. now, would you explain why that's a little biéå ! ñ misleading in that,deçcertaiç>h bp everything's going up in the societyúj>j but they're notíjájjt as much as was predicted,"[ ?e i think is whata:ukk i'd8r4xu you t57 >> that's correct. as we have

months agooíw included a bipartisan bill that.;! i2(n: binding bids participating in the medical equipment and supplies competitive]!0:ñ4zihn bidding program. ipje provision supported by my democrat colleagues removesqxñó(q actors from the program something i don't have to go over with you and ensures seniors get qualitym8 ç medical immaterial equipment.i çutñ

>> i don't think i need to articulate to this committee all the important things. we've worked to put together the work plans so we do&d and meet deadlines. where we can, we're going to try to. thank you for your support in helping doing that. if we need further support and help,ly come and ask.[hnjñ >> thank you. priority. >> thank you. the other issue is intellectual property rights. incentivize the creation of innovative new medicines that

improve people's lives in supporting good u.s. jobs. we're talking about trade this week. i want to ask you specifically about india. over the past couple years, india's intellectual property climate has unfortunately deteriorated significantly. the u.s. i.p. intensive industries have suffered. they have expressed concern with respect to the indian market. most notably, courts have india have issued compulsorykzd

that, would you mind looking into it and getting back to us as we have this trade debate this week? >> yes, i'm happy to get back. i think what i'll do is coordinate with ustr so we get back to you together. because i think you probably know those conversations with the governments are being led by ustr. we give our policy and problematic input to them. we'll make sure one of the two get back. >> thanks so much. appreciate your leadership. i yield back. . >> thank you. mr. neil. >> thank you, mr. chairman. madam secretary, the opioid addiction issue is pronounced now across my congressional district. there are all sorts of stories

now that indicate a nationwide trend. curious about the response of your department, the agencies that you oversee and also to ask specifically about the prescription drug misuse, the evidence you are coming across on that bases? >> thank you for raising that. in our budget there is $99 million additional dollars. when we think about the problem as you articulated in your district overdose deaths have exceeded deaths from car accidents or any accidental death. in 2012 there were 259 million prescriptions for opioids. >> would you say that again? >> over 250 million prescriptions in 2012 or opioids. that's how many prescriptions there were.

that's more than the number of adults in our country. that was a prescription for every adult in the country, and let's go to the solution space. we worked with states and the congress, and there are a number of bills here up on the hill right now, three basic areas we need to focus. one is prescribing. a big part of the problem is prescribeing prescribing. what we need to do there is prescribing new guidelines and states need to do what are called prescription drug monitoring plans. they are almost in all 50 states, and they are the means by which a physician has the opportunity to look up and see a controlled substance to see it was already given to you and controlled that way. prescribe something number 6kúj÷one. number two is the use of a very important drug that actually stops death when there is overdose, and making sure that

first responders have access and that's a very important part of that picture. and christoff had a piece about it this week. and then assisted treatment for those that are addicted. it cuts across cdc, and we are doing this in conjunction with states, and i have been in massachusetts, and whether it's governors or both sides of the legislative body and both sides of the aisle, certainly your colleague from kentucky is leading in the effort on the house. so that's our plan and what we are planning to do.

>> i have a house bill 1821 that i would invite members to take a hard look at. there's companion bill in the senate. what should congress do to assist you now that there are more deaths from overdoses than automobile accidents. >> with regard where we need help from congress to implement that strategy, one is in the area of another drug that helps in this, and the help in the question of prescribing. the second place is in making sure people are trained with the guidelines. >> thank you. mr. beau stepby. >> welcome, secretary burwell. last fall the administration proposed a child support enforcement rule and former chairman dave camp and senator

hatch sent a letter, and the issues raised it was the authority of congress to write law and was in effect writing law. this has been a repetitive theme and i think chairman ryan raised this issue with relating to obamacare, and we have seen it with immigration and obamacare and other areas of the law, and so why -- especially in this area where this committee, in a bipartisan way has been willing to work with the administration on the child support policies, and why does the administration choose to trample on the constitution in an area where we want to work together? i don't get it. i understand there is always tension where we disagree, and that's a fight we are seeing playing out in the courts and we do have willingness to

cooperation. >> in terms of that particular rule i know there are things that i know you are familiar with, and some of these things are done in the 1990s, and they have to do paper applications in regard to child support, and a lot of the rules was the ability to use technology and other things and improvements and simplifications to the rule. if there are specific areas we have not finalized the rule and we welcome the work on the substantive areas. the states advised us the state of texas in terms of we are following what the states asked us to do in terms of things like using money for people to do job training, which is an issue that is important. >> well general ryan and i introduced legislation yesterday dealing with this in order to

protect our constitutional right to write law. we want to put the administration on notice that this body the legislative branch writes law and that the executive branch executes and we are getting tired of it and especially in an area where we have some agreement, and just be put on notice that we are going to continue to assert our constitutional constitutional constitutional constitutional progresstive. now, if individuals would be subject to the individual mandate, why has the administration been reluctant to

assist these kinds of small businesses? i questioned secretary lou earlier this year with regard to reimbursement accounts and there were onus penalties for small businesses, and i don't get it. i have legislation that would actually make it more effective for small businesses to use these health reimbursement accounts that are legal, but for some reason your agency and the administration decided to close the door on these. i don't get it. shouldn't we be helping small businesses and employees during a troubled time? >> well, we want to help it. we actually have proposed expanding the tax credits for those up to 25 employees and we want to move it up to 50 to

expand the access to tax access. >> health reimbursement accounts are very effective. it's a simple solution. >> the time of the gentleman has expired. >> thank you for being here. it seems to me that the focus of this hearing and all of our work should be on how we could make this health care system work better and deliver services and insure more families instead of speculating about some court decision. as you know madam secretary, i have a number of concerns about the way this law has been implemented, particularly in texas, and the fact that two out of three of our texans who are market eligible are not yet enrolled, and there are things your office can do for more implementation. do the same kind of cost benefit

analysis like you did at omb and look at the contractors and see if they are delivering on their services. i have a number of quarries about those. when i hear you accused of being a purse snatcher, it does get my attention. the easiest t(aí to do and i think for the right thing is to not ignore the other 900 pages of the law and focus solely on four words, and if it's necessary to have a legislative fix deleting four words solves the entire problem and allows this to work the way congress intended it to work, and there are many ways to address this problem and some states are looking at the possibility that the best way to fix the law is to simply create their own exchange. it's also extremely impressive to me that of all the proposals

that have come in at the last minute of republicans to deal with the possibility of an adverse court decision, how many of those proposals attempt to include much of the hated obamacare as possible preserving the right of youngá56g people up to age 26 to participate in their family's insurance program, andby attempting to maintain exchanges, and if today we are im htkujbo_qp(r more people in the paw limbics going onsvxc here.1úgzo i thi,dpuú it's96aap&tr+@v thousands ñ theó2oñ2&za w ky!w+ 'ie1ñ@6jz t kyk