california. later a senate hearing on alleged retaliation against federal whistle blowers. >> health and human services secretary sylvia burwell was on capitol hill this week to testify about the department's 2016 budget request and the healthcare laws implementation. secretary burwell also took questions about an upcoming supreme court decision that will determine whether federal subsidies should be offered to those who sign up for insurance through federally run marketplaces. this hearing was held by the

house ways and means committee, it's two hours. >> committee will come to order. we know that the secretary is on a tight timeline today with a hard deadline at noon. that's why the ranking member and i just discussed that we will limit members' questions to four minutes so as to accommodate as many members as possible in the questioning. but first 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 but 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, about you it shouldn't surprise you secretary burwell but 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 healthcare law is to easy task. i think any objective observer would say that this law is on the fritz. by the law's own standards the whole point of obamacare was to make healthcare more affordable but premiums aren't going down they're going up. way up. all over the country. insurers are proposing double digit premium increases, in maryland close to 30% tennessee 36%, south dakota 42%. tack 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 2/3 of the people who got them had to pay the irs

back on average over $700. that's not the kind of am unthat 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 debit or a fender-bender or flat tire, the whole law is a lemon, it's very linchpin, it's central principle is government control. that means higher prices, fewer choices and lower quality. so the answer isn't just to

tighten a pew screws and everything will be fine the answer is to tweak it here and tweak it there and we'll all be okay, the answer is to repeal and replace this law with patient senate reforms. 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 t 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 is subsidies. the law said people who buy plans on state exchanges can get subsidies. it doesn't say anything about federal cases and yet hflt hs 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 they ever

funded. that's one of the main reasons we are 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 healthcare system that puts the patient first, they deserve lower prices, they deserve more choices, it 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 preexisting conditions no longer are canceled or can't even get insurance, the doughnut 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 is you're livid because it's getting better. that's why you're livid. and i'm not surprised at yurour -- your fervor. we will be glad to take it on. we will be glad to take it on. and i think you just need to understand what this experiment is all about. it was combining increased access 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 is running around this country talking about the evils of healthcare when millions of people are benefiting 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 benefiting have healthcare 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 is administering this experiment in greater health coverage after 70, 80 years of nothing being done in this -- 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. we saw the power of common

ground in the recent bipartisan sgr fix and i appreciate all of your all's 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 abc the sequestration will return this full in 2016, bringing dis regs naer 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 healthcare science, innovation and human services. it maintains our responsible stewardship of the taxpayers' dollar, it strengthens our work, together with congress, to prepare our nation for key challenges both at home and abroad. for hhs the budget proposes

$83.8 billion in discretionary budget authorize. this is a $4.8 billion increase which will allow our department to deliver impact today and lay a strong foundation for tomorrow. it is fiscally responsible which in tandem with accompanying legislative proposals would save taxpayers a net $250 billion over ten years. in addition it is projected to continue slowing the growth of medicare by securing [ inaudible ] in savings as we build a better, smarter, healthier delivery system. in terms of providing all americans with access to quality, affordable healthcare 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 progress is the 10.2 million americans who are currently enrolled in health insurance through the marketplaces in

2015. the budget covers newly eligible adults in 28 dates plus d.c. where expanded medicaid and it improves access it to healthcare 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 so 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 child care available for working families. to keep americans healthy the budget strensness 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 description 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 t 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 combating ebola to assisting unaccompanied children at the border, the commitment that they show day to day day in and day out as they work to help their fellow americans have those building blocks of healthy and productive lives. 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 off 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 healthcare law we could not be more opposed to

what the administration is doing. we really think this is doing a great harm to the healthcare 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 and 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 withes us to give families greater freedom in choosing the healthcare that work 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 that were part of writing the law indicate that 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 is should not is not what we think the law inn -- >> i understand your opinion on what the court ought to do but it stands to reason that there's a pretty decent chance that they may not go your way. so the question then is then what? >> so 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 rhetorical

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 is the question i'm trying to get to is the president going to stand up and wave i have a one sentence fix, take it my way or the highway? is that going to be administration's position or is the administration going to be willing to work with congress to find a way to give people more healthcare freedom? ? that's the question i'm trying to get at. >> with the question of healthcare freedom it is it is important to reflect the marketplace is a market, it uses private insurers, people that sign up in the marketplace are not on 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 -- >> let me ask it this way because i want to be kind of

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've got to tell you it's not real popular and 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'd say that the administration has been a little two-sided on this particular issue, mandates, 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 and all these 37 states 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. >> 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. >> we understand that. >> that is the decision and that is the openly decision before the court right now. >> okay. so -- >> so with regard to what happens if that decision occurs. >> yes. >> 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 this the situation? >> so the problem that occurs if the court decides against us is that 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. right. >> or states. >> 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 come out and 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 actually teal with the issue which is affordable healthcare 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 that 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. >> okay. >> 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 preexisting conditions. it is our experience at least it 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 mine. >> you're going off topic. i'm going to cut you off there. we both know 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 counter productive. 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 -- 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 -- 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 a plan for 60 years. so you can keep going after the secretary and she will keep trying to spell out -- i will

ask you when i finish how many people have been receiving subsidies, madam secretary? >> so 7.3 million people have received subsidies through the -- that are in the marketplace right now. >> so when you shed tears about 7.3 million, remember -- or about the law, it's 7.3 million. what's been the average subsidy? >> $272 per month is the average subsidy. and in terms of those that are 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 subsidyvíñ 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 healthcare 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 we're currently implementing that are reducing costs. we know 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 where it has been since '9 through '14 we saved $300 billion. with regard to per capita healthcare costs in the country in 2011, sae 12 and '13 the cost growth is the lowest that it has been in 40 years. so that's taxpayer savings, that's also -- >> but the insurance rates are going up, not down. everybody is paying more for it. >> so insurance rates before the affordable care act were going up on in the individual market well above double digit numbers. so 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 lloyd doggett and i have been after for a number of years and that's ending the use of social security numbers on medicare cards. as you know that finally became law earlier this year as part of

the medicare act chip reauthorization act. let me ask you is hhs already implementing that and how fast do you think you will 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 omv 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 excited. right now we are putting together the work plans to to that. we haven't established the exact time table but as soon as it was passed the next day i have asked the team where are the work plans, we want to do it as quickly as possible in ways that will serve the consumer. as you know, there are a lot of medicare consumers, we want to make sure we're not disrupting them or their services but we very quickly want to do it. like you we believe this is an important part of privacy and security. >> well, i thank lloyd doggett for helping me with that. how easy do you think you can

make it for seniors to get a new card? >> we want it to be easy for seniors and we want to make sure they understand. one of the things we don't want to do by making this improvement is create confusion. figuring out the way that we can enter in the new people coming in very quickly with their cards but those with the existing cards because we don't 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. rangel. >> thank you, mr. chairman. i don't want to thank my colleague mr. johnson for not drinking the kool-aid in the back against obamacare. obamacare. >> try that kool-aid. >> i can't try that kool-aid i was a former church boy and i thought that the right thing for

americans to do was to believe that healthcare was a part of the pursuit of happiness. it doesn't even seem like a political thing. if a kid is sick and someone says you cannen have healthcare it should pain you see as human beings if a person goes to a doctor and finds out that the child has an illness, but he can't get insurance. if we find the good samaritan on the side of the road and we know that most people middle class people have insurance but that pofr sometimes restricts people from getting this it just seems to me that instead of tearing down the system where you know if in your hearts people are getting healthcare, 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

healthcare to me is not just mean spirited -- >> will the gentleman yield? >> i don't think so, mr. chairman, because you are on a roll now and 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 and i don't care who the secretary is, if you are on the side of giving assistance to people that can now go see a doctor, that can now prevent going into intensive care because they have had preventive care that can now get insurance that they couldn't have insurance, from a political point of view i wouldn't want to be in your shoes explaining it. of course, those that already covered it's no problem there, i've got mine, jack, you get the best that 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 and if we don't like what's before us we should work hard to

repair and to fix it and to improve it. so, you know at 85 years old if i have to decide on what moral side i'm going to be raising issues on, wra find a better one than this. you know, it goes without saying if you cripple, if you're blind, 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 in is where you're sitting madam secretary to be able to see that you are on the right side of the issue you can see that 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 in the true sense of the word. if someone had had a conscious that when the doctor said i wish you would have 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 saying, this woman this man should never had to have been here if it was detected earlier and we have a mechanism for all of this. to we have to -- >> time for the gentleman has expired. >> well, thank you mr. chairman. >> i would just -- >> i'll take that. >> good. >> it was another minute there but you cut that off. >> we're doing four minutes so we can get to members of the other dias here. i would is ask members it if approximate you do 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. madam secretary.

healthcare is about patients not politics. i was pleased to hear you answer, mr. ryan, if it the court rules against irs in this case that the administration will do it 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 and where we've been is when there is repeal of fundamental elements it -- >> 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 approximate sh. >> so the president has and i think will continue to sign legislation that we believe improves affordability, quality access and takes care of the deaf is sit issues. >> so the answer is -- and thank you for saying what i hear you say the president will sign

legislation other than simply extending the subsidies to the federal exchange? you're saying that's correct? >> the sgr bill that we recently signed includes very important provisions that actually extend the affordable care act's effort to do delivery system reform. >> did you know that's not in the supreme court case is specific to that asking your guidance the president will sign legislation -- >> specific to the supreme court case. >> -- other than merely extending subsidies? >> specific to the supreme court case, if the question is the supreme court case, i want to return to what the supreme court case is about. >> no i'm really just looking -- we're looking four your guidance in a bipartisan way. so your answer is yes the president will sign legislation other than extending the subsidies the federal exchanges? >> with regard to the question of the supreme court case, that is an issue about subsidy. that is all that is about. >> and your guidance to us would be -- >> if your question is are we willing to consider things that

would improve our enhance affordability, quality and access, we are open to those things. >> so yes. >> 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. >> that is about one item. >> i'm very well aware. i want to make sure again as we look to work together to put patients ahead of politics you're saying, where he the president would definitely sign legislation other than exchanging -- extending the subsidies of the federal exchange the answer is clearly yes. >> i want to distinguish between the question of how one resolves the problem that gets created. that is -- that has -- doesn't have anything to do with any other parts of the affordable care act. >> no. this this is such an easy question. >> no, i actually -- >> 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 legislation. >> no, it's actually not hypothetical as we know the court is going to be ruling not

hypothetical. if they 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. madam secretary i don't mean to interrupt. i'm really speaking seeking your guidance. so the answer, no though, to finalize it is yes? >> my answer, congressman is we will review any legislation we get that has to do with the affordable care act based on -- >> i'm asking about signing so the answer is no? >> with regard to legislation that we sign we'll look at any piece of legislation and we'll judge it by four things access -- >> let me ask this, again, guidance. 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 that those is subsidies are available, that is something that -- >> so the answer is yes. yes, he would sign legislation other -- >> check time. >> -- than extending it, correct? >> congressman, i apologize but when you say other -- >> time. time for 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 this and we're all talking about if the president does this and whatever but let's talk a specific because i think that we haven't heard a specific come out of the republicans in -- 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 and his -- it's his solution if the bill fails, and as i read read it quickly it repeals the individual mandate, it reveals the employer mandate and it says that 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 will be lower because it already is, they won't cover people in medicaid. so they clearly don't care about the level of healthcare, but explain to me how you would -- >> will the gentleman yield -- >> to 1016. >> will the gentleman yield. take back the disparagement of the citizens of georgia. >> he has a it -- 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 is repealed because it gets rid of preexisting 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 repealed 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 is in its current form is repeal and the president has said that

he will not the sign something that repeals the act. >> is there anyplace 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 releases 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 law scenario, at some point i think it actually is important to focus on the win as well in terms of how we all go forward if there is a win >> tell us about the costs of healthcare. we hear the chairman says the president promised that the -- there would be a reduction in

premiums. now, would you explain why that's a little bit misleading in that certainly everything is going up in the society, but they are not going as much as was predicted, i think, is what you would -- i'd like you to talk about that. >> that's correct. and as we have seen, the premium increases that occurred in the individual market and even in the employer-based market we are seeing smaller increases in those premiums than we saw before. so while there are increases, the increases that we were historically seeing that were driving costs for individuals for employers and in terms of medicare and the cost to the government that is what we have seen shrink and slow he. >> thank you, mr. tea berry. >> thank you, mr. chairman thank you secretary burwell. >> the recent sgr medicare reform bill that passed a couple months ago included a bipartisan bill that i sponsored to require binding bids from suppliers participating in the durable

medical equipment and please competitive bidding program the provision supported by my democratic colleagues removes bad actors from the program, something i don't have to i know go over with you and ensures that seniors get quality medical equipment. in a compromise with the administration the law requires that cms implement the provision not earlier than january 1st of 2017 but not later than january [ inaudible ] -- very generous timeline to implement the bill and would hope with your leadership that we could move it closer to the january 1, 2017 timeline because at the end of the day as you know, again there's bipartisan support for this concept, my good friend bill pascrell is all over this issue as well. we think this will ultimately help separate the good from the bad and ultimately help our seniors. so your leadership would be

critically important to moving that closer to the beginning than the end. >> so it is related to mr. johnson's question too. as soon as the bill passed which was such a very important bill, i don't think i need to articulate to this committee all the important things have worked to put together the work plans so that we are specific and we do try to meet and where we can beat deadlines we've been able to do that on some bipartisan legislation on behavioral health that was supported both in the house and the senate in terms of beating deadlines we were given. where we can we're going to try to. thank you for your support and help in doing that. if we need further support and help i will come and ask. >> thank you. >> but it is something that is a priority. >> thank you. the other issue, is intellectual property rights. incentivize the creation of innovative new medicines that improve people's lives and supporting 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 is unfortunately dee

rated pretty significantly. in the u.s., i p intensive industries has suffered including pharmaceuticals, they've expressed significant issues with respect to the indian market, most notably courts in india have issued license as well as denied and revoked several patents for popular medicines held by u.s. companies citing an indian law many believe die verjs from india's international trade commitment. have the compulsory license and revocation patents on medicines been a part of any hhs discussions with its indian counterparts? i know this is kind of a question that might have come out of left field based upon what you prepared today, but would you agree it would be ill-advised for any u.s. government employee to undermine the policy of the u.s. to promote strong international property rights in foreign markets and if you aren't prepared to answer 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. ustr would probably lead in in any of those conversations that were in that space, so i think what i will 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 programatic input to them and they lead. we will make sure one of the two get back. >> i 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 and there are all sorts of stories now that indicate a nationwide trend and i'm curious about the response of your department, the agencies that you oversee and also to ask specifically about description drug misuse. >> where he. >> the evidence that you're

coming across on that basis. >> so with regard to the issue that you have raised thank you for raising in our budget there is $99 million additional dollars to implement an evidence-based strategy on the problem, let's just quickly touch on the problem. when we think about the problem as you articulated in your district across the country opioid and overdose deaths have exceeded the number of deaths from car accidents or any other accidental death. in the year 2012 there were 259 million prescriptions for opioids. that's more than one for for every -- >> would you say that again? how many prescriptions? >> over 250 million prescriptions in 2012 for opioids. so that's how many prescriptions there were. so that's more than the number of adults in our country. so that was one prescription for every adult in the country in terms of where we are and the magnitude of the problem. let's go to the solution space. we have worked and worked with states and worked with the

congress. 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 rob as you can see from that number is prescribing. what we need to to there is we need to provide new prescribing guidelines for pain and pain medication that will help the problem, but also in the prescribing space 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 that a controlled substance was already given to you and control it that way, same thing with pharmacists. so prescribing is number one. number two is the use of meloxone which is a very important drug that actually stops death when there is overdose and making sure that first responders have access. that is a very important part of that picture. nick christoph had a piece about it this week. number three is the issue of medicated assisted treatment

combined with behavioral issues and making sure we could t. do treatment for those who are addicted. those are the three things, the 99 million additional funding in our budget cuts across cdc and sampsa. i've been in massachusetts with your governor and done a joint event with your governor. this is a bipartisan and statewide issue and whether it's governors or both sides of the legislative body in both you know, sides of the aisle. certainly your all's colleague from kentucky is leading in this effort on the house. so that's your plan, that's what we're trying to do. >> it's noted that in some places in new england heroin is selling for $3.50 a bag on the streets ever some of our old industrial cities. i have house bill 1821 that i would invite members to take a hard look at. senator markey has a companion bill in the senate and what and what specific actions should congress be taking along these

lines to assist you in noting as you have that there are now more deaths from overdose than from automobiles? >> with regard to the places where we need help from congress to implement the strategy is one in the area of another drug that helps in this. the question of prescribing. so we believe that's an important place. the second place is in making sure people are trained with the guidelines. >> thank you. >> thank you mr. chairman. welcome, secretary. last fall last fall they proposed the child enforcement rule. and dave camp along with senator hatch sent a letter expressing concern about this. and the issues that were raised were that the administration in this area was usurping the authority of congress to write law and was in effect writing

law. this has been a repetitive theme. i think chairman ryan raised this issue regard to certain issues relating to obamacare. but we've seen this with immigration, obamacare, other issues of telephone law, tariff measures. this committee in a bipartisan way has been willing to work with the administration on these child support policies. why does the administration choose to trample on the constitution and article i powers in an area where we want to work together? i just don't get it. i understand there is always tension where we disagree. i get it. and that's a fight we're seeing play out in the courts. but why in an instance where we do have willingness to work and cooperate on this important issue area. >> we would look forward to the

opportunity to work in this space. in terms of that particular rule, there were some very important things that i know you were familiar with and the fact that some of these things were done in the 1990s. so people have to do paper applications with regard to child support. so a lot of the rule was about things like improving ability to use technology and other things. and improvements and simplifications to the rule. if there are specific policy areas that are of concern, we are listening to those comments that have come in. i think you know we have not finalized the rule. and we'd welcome the opportunity to work on the issues and the substantive areas. some of the things that have been mentioned in the release that happened yesterday are in areas where the states advised us, in the state of texas in terms of we are following what the states have asked us to do in terms of things like using money for people to do job training, which is an issue that is important in a number of the states. >> chairman ryan and i introduced legislation yesterday

dealing with this. in order to protect our constitutional right to write law, i know this companion legislation and senate by senator hatch and senator cornyn. but we want to put the administration on notice that this body, the legislative branch, writes law, and that the executive branch executes. and we're getting tired of it, especially in an area where we have some agreement. just be put on notice that we're going to assert our constitutional prerogative. on a different issue, the employer mandate has not been implemented. a lot of complications with it. we know how complicated it is. we have heard testimony in the past on this. and i know it does not apply to small businesses 50 or fewer full-time equivalents. but those individuals would still be subject to the individual mandate. why is it, has the administration been reluctant to assist these kinds of small businesses? i questioned secretary liu when he was before this committee earlier this year with regard to health reimbursement accounts. and there was a move i think for a six-month reprieve on really

onerous penalties for small businesses. but six months. i just don't get it. have i legislation that would actually make it more effective for small businesses to use these health reimbursement accounts which are completely legal under aca, but yet for some reason your agency and the administration has decided to close the door on these. >> i don't get it. shouldn't we be helping small businesses and their employees at a troubled time? >> so we agree with you and want to try and do more. in the budget right now the budgets proposal that is before the congress right now for fy-16 we've proposed expanding the tax credits available for those up to 25 employees. we want to move it up to 50, to expand the access to tax credits they can get. >> health reimbursement accounts are very effective. >> time. >> thank you. >> the time of the gentleman has expired. >> mr. doggett, are you ready? >> 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 for these marketplaces are not yet enrolled. and i think there are things that your office can do for more effective implementation. i would encourage you strongly to do the same kind of cost benefit analysis like you did at omb. look at the contractors and see if they are delivering on their services. i have a number of queries to you about those. i hope to focus on how we can make it better and make the implementation better. when i hear you accused of being a purse snatcher, it does get my attention. the easiest thing for the court to do and i think 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 law to work the way congress intended for it to work. there are many other ways to address this problem and some states are looking at the possibility that the best way to fix the law, should the court render the wrong decision, 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 as much of the hated obama care as possible, preserving the right of young people up to age 26 to participate in their family's health insurance program, attempting to maintain exchanges. if today we're asking you about how to make improvements to reach more people in our laws,

that would be a reasonable thing instead of the polemics that are going on here. i think, i think it is probably historic. i could not find another circumstance in which members of the house and senate ask a court to deny thousands indeed across the country millions of people an opportunity to get a federal tax credit to say please deny in texas our two senators, please deny our constituents $600 million every month in federal tax relief. but let them keep paying taxes to finance the same kind of tax credits for people in california. or someone from wisconsin, since chairman ryan joined the same brief in the court, who says, please have my constituents continue to pay taxes to fund tax credits in connecticut but deny thousands in wisconsin.m; k

to say it's a lemon to provide families the relief with insurance for pre-existj conditions that they never had v+ç$

there's two issues that i'd like to use our couple of minutes on. first, they're related. it's the discussion around cost sharing reduction payments and then also the basic health program. so just to set the table, the cost sharing reduction payments, the issue is whether the administration has the authority to spend out of an account that hasn't been appropriated. as you know, chairman ryan and chairman upton wrote to you and secretary liu on february 3rd. your response back at a staff level -- look, i mean, it was sort of predictable. it restates the obvious in terms of the number of truisms about the affordable care act. and then it says, go talk to the lawyers at the department of justice because there's pending litigation.

little bit of a cute response in my view, but it's your play. now, where there is no litigation pending and the issue is exactly the same is on the issue of basic health programs. so it wouldn't be satisfactory to say, you got to check with justice, because they're not involved in any litigation because there is no litigation between us at this point in time. so here's my question. the law's really clear that you can't spend money that hasn't been appropriated. there's no ambiguity about that. the constitution's clear, the gao states this, many, many different entities say that money cannot be spent absent an appropriation. and yet there are a number of states that are announcing that, you know, minnesota was a state that says they're going to be implementing the program, new york has announced that they'll operate the basic health program starting in january of 2016. new york has estimated that they'll receive $2.5 billion, "b," billion. how is thi