how the work we were doing in kansas could work with some early-education money, and i have circled back around as the new secretary about ways -- have a very collaborated and coordinated strategy. i think it is very important to have all of the childhood providers at the table, to have a neutral goal of where this money is best directed based on the science and evidence-based research and also to recognize that all children do not thrive in identical programs, that we need a variety of programs for parents and children to succeed, but i can assure you that those conversations are very much underway, and that is a passion that we both share. >> the early-learning grants, do you have any idea how those are going to be implemented? >> hef i think, again, those conversations are just under way, but i think what is

important is to set up some kind of a platform for a program basis that is based on what we know works in the long run, what gets children ready to go to school. we did an alarming study in kansas a couple of years ago, conducted by the board of vegetation, that found that about 50% of the 5-year-olds that hit kindergarten were not ready for it, so early-childhood education, i think, needs to aim towards readiness and hopefully close at learning gap so kids are ready when they hit kindergarten years. they hit the kindergarten years. >> thank you, thank you mr. chairman. >> thank you very much mr. chairman. again, welcome. is a pleasure to be with you. the last time we had a major review of the nation's healthcare system and raise questions and discuss with the

federal government might be doing about it was when the secretary of state hillary clinton was then associated with the president of the united states william clinton and he formed a commission that she headed, and they spent considerable time and energy reviewing where we should go with their healthcare system. once the product was developed itself, i think many a message was sent to the congress that we would be well served by reflecting upon-- that package, out there for long enough that essentially the people got a chance to understand what was in it and they didn't want it very much. they send messages back to us that were very clear and rather direct. they said first, that the chairman suggested that i believe your statement suggested people want first to be able to keep what they have and above and beyond that, that they want to ensure that they maintain choices as the go forward with such a package. i do not know what a government

single-payer system might lead us to come up but a lot could be learned by also not just looking at the hillary clinton commission, but some of that which john maynard keynes might have taught us about what socialites process these deliver in the final analysis. all of it will be a part of the discussion that is ahead of us. it will be a healthy one and an important one. the chairman and i have spent some energy attempting to figure out what we do with a thing called pandemic flu. i want to commend the department for taking on h1n1 virus seriously and going forward with a program that will attempt to make sure that we are ready and that we benefit from that which we have learned so far as a result of work by people like dr. gerberding and the like. i know that, within your budget, there's a request that includes

three begin $54 million for public health and social-service emergency funds. at the same time i am concerned that there are plans to move bioshield money from flu vaccine, for flu vaccine production. within that makes it is awfully important that we make sure we are not stealing from peter to pay paul, that we have enough money to ensure that we are protecting the public and our country from difficulties with bioshield chemical, biological, radiological problems etc.. could you tell me what your thinking is presently regarding that funding, and if you agree that there are conflicts that could lead to finding difficulty? >> congressmen, i don't think there's any question that the investment made over the past five years by this congress and

the previous administration in preparation and planning and beginning to work on the new vaccines that potentially are needed for a variety of deadly diseases have been critically important, and i know this committee and chairman obey and others have been any real leadership role on pushing that ahead. i think that, as a governor, i was able to see some of the results of that because we were able to do planning and put a pandemic plan together, to cross-state preparation, bring private industry in, do a whole series of initiatives to really get ready for an outbreak, which would not have been possible with state only funds, so i have seen it both that the federal level but also experienced what

does investments have done. i know that currently, we are in the process of the value waiting steps forward with h1n1, at the same time recognizing that we need to keep the planning stages in place with bioshield for whatever eventuality might hit next, so i think that the budget reflects and the current actions of the administration to ask for supplemental funding to deal specifically with h1n1 reflect the notion that safety and security is first. we know what is facing us right now with the whole series of uncertainties with h1n1. we know we have a new virus. we know we have a need to take a look at the potential vaccine program but we also know that there are a series of other outbreak potentials and terrorist acts that still are living and we need to do both simultaneously and i think that

is what is reflected in the budget before you and in the supplemental request. >> mr. chairman could i proceed with one more question? thank you mr. chairman. i can't help but be concerned by the fact that we have within the samels package increase nih funding significantly, like the 10 billion-dollar adjustment and that baseline. as we go forward, know that your department is making a request that is a pretty moderate request of 1.3% i believe in the projected year ahead of us. there is kind of a cliff out there that involves the $10 billion it is bound to create pressures and a shift in priorities at etc. i would appreciate your letting the committee know what you are thinking is, how you are going to deal with that very real ten delvin-- 10 billion-dollar problem? >> i would love to tell you i know what the request will be in 2011.

i am aware that there is a significant investment in the recovery act, which i think is very appropriate and will pay enormous dividends, and i can assure you that we are going to begin to work and look forward to working with this committee and the committees on the senate side about the future, about a multiyear planning strategy because i think that everyone is aware that there has been a significant investment and it is basically out there, but the worst of all worlds is to, i think he up a number of new initiatives and then actually taking huge step back, so i to look forward to your ideas and suggestions of working with you as we look at the out-years. >> mr. jackson. >> thank you mr. chairman. let me first begin by welcoming the secretary to r. subcommittee. i also want to associate myself with chairman hoby and other

members who have spoken on the question of specific earmarks for health related diseases in this bill. every member of this subcommittee has a personal story to tell. every member of the subcommittee has a case to be made for their constituents that drove us to seek an appointment to the subcommittee in the first place, from cancer to mental health, to meditation and other forms of health related practices that can improve the nation's health, and there's a constant battle on this committee for the years that i have been on it to try to find an appropriate and necessary resource to address each of our individual and collective concerns. one of my sinful project since i have been on the subcommittee has been addressing the issues of health disparities. when i first got appointed to the subcommittee, then chairman porter of the subcommittee while i was trying to advance what i

thought for closing for found gaps that existed in our society existed on good science. he said as much as i want to be supported the needs to be driven by good signs. sipe what line which in an appropriation bill many years ago to address ethnic and racial health disparities, and the language charge the top scientists, doctors, around the country at the institutes of medicine to come up with an approach, a scientific approach that would justify spending on this committee for addressing some of the profound gaps that exist in treatment. the scientists named the report on equal treatment and for as long as i have been on the committee since the report was released, this committee has basically tented to follow the road map laid out by these scientists in terms of the appropriations requested that we made to close the gaps. madam secretary's you know, many of us on the subcommittee had

made a point to prioritize reducing health disparities through a friday programs at hss. we further focus their reducing health disparities by supporting many of these programs to contribute to diversity in the healthcare workforce. if you could, and i to understand the budget lays out specifically in the other three ended 54 million for combating these issues, could you lay out for us your thoughts and overtime we will get to more specificity, your thoughts on how the department will approach the issues of health disparities? thank you mr. chairman, thank you betton secretary. >> thank you of 11 and again thank you for your leadership on that critical issue of health disparities, and i have been working on it for a long time, and the work has hit off to some degree but there is a lot more work to be done. and my first week as secretary, we really to this year's report

on health disparities, which is continues to be pretty grim in terms of the proper treatment, really by ethnicity is very disparate of around the country. i think that is one effort that can be actually enhanced, is just the transparency about what is going on. i don't think there's any question that the debate that is currently underway about health reform will have an impact on health disparities because unfortunately, what we know is that by income and buy a minority group, the likelihood of an insurance, lacking insurance and under insurance is a predominant case and i think having an opportunity for a health, homand ongoing treatment protocol for every american is a

step in the right direction for custard like, some of the steps to address also workforce issues. again not one that we necessarily automatically think is part of health disparities but there is some investment in the workforce of money that looks particularly for minority students and combine that with underserved area because i think cultural competency is an issue with healthcare delivery and whether or not folks feel comfortable about seeking out health information and follow it is often due to whether or not they feel a relationship with the health provider, so i think in addition to the funding that you have just cited for specific programs, i think there are other range of investments, workforce issues come on health reform that will also help close

the gap of disparities that we continue to see. >> madam secretary, welcome. >> thank you. >> i spent a great deal of my time last week traveling around the state of louisiana. we had several healthcare summits if you will. we have panelists made up of physicians, nurses, healthcare providers, nursing homeowners and so forth. they are afraid, they are scared about what lies ahead. i represent the ninth congressional-- night worst congressional district, one of the unhealthy is in the nation. my question is, in louisiana we have i voted against the expansion of the schip, as we have not met

everything in louisiana yet, although it has been an effective program compared to other states. i do not know if it is apathy or lack of knowledge about where people can sign up, but the question is, how, now, as we look at the potential of compulsory insurance, what happens? how do we make it work in louisiana? we still have 100,000 children who are eligible for schip that are not signed up, so how do we encourage, how do we engage people to care and go sign up? and what happens -- to return them away at hospital emergency rooms because they do not have insurance of their own? what happens? how does it work? >> well, congressman, that is a great question. i think that one of my

interests in the chip program is certainly taking some of the best practices of and roman -- of the enrollment and spreading those throughout the country, because there are some states that have done pretty creative work and have had great success in enrollment, and there are others that have not, and i think that that is one of the ways that our department, and that is a key building block for health reform, is actually getting folks to enroll and engage in programs that are currently eligible for and provide that coverage that congress and the administration has seen as a high priority, so outreach strategies, assisting with everything from presumptive and ii simplifying enrollment forms, not having the situation -- presumptive enrollment, not having to rely

on fairly easy technology or relying on face-to-face visits, which often complicated for families who are working and juggling opportunities, so there are, i think, a bunch of strategies that we can engage in the departments of medicare and medicaid to make it easier and more seamless for families to actually enroll their families and programs that they qualify for, but i think that as we move forward, having discussion and debate about everything from autoenrollment, which is one of the things that i know some members of congress are taking in the gatt, to presumptive enrollment -- are taking a look at, that is one of the, i think, discussions that is under way with the committees that are looking at this because it is no -- the last thing we want is to make affordable health care have

another huge barrier and that the sum and roman -- and that be some enrollment that sets up its own restrictions along the way, but we know what has worked in many areas. know what has worked in many areas. we know what has worked for employer care, and for their care and i think we can take those lessons learned and help spread that information as we move forward. >> thank you. >> thank you very much mr. chairman. hello madam secretary, good to see. congratulations. i look forward to working with you, and i will just say how delighted i yum that you are in this very critical position. i want to follow up on congressman and jesse jackson's point, first of all with regard to healthcare disparities requestor of the congressional black caucus, along with of

course my conduct as chair of the asian pacific american congress and congresswoman glossal whitson chairs the hispanic caucus, we are working on healthcare disparities bill, closing the disparities, and you know the problems. you would knowledge them, but i am wondering in this overall healthcare debate that is taking place, we don't hear much in the debate about this being a critical element of the healthcare reform package, whatever package we come up with so i went to raise that with you because i have raised this with the white house several times in just know that in this debate, this is got to be front and center for many of us because our communities of course are the ones to are you know, the unfortunate beneficiaries of the terrible beneficiaries of these disparities. secondly, with regard to single-payer, i note the realities of single-payer as it

relates to what ultimately will be the type of healthcare package that we come up with, but i hope that single-payer is on the table for discussion. i don't think we need a healthcare reform debate without looking at all of the options that exist, and so single-payer is an option that needs to be considered on the table as part of our efforts. thirdly, i just want to commend you for and the president, for your proposing to end the ineffective and discredited abstinence-only education programs. for many years now senator lautenberg and myself have worked on legislation, h.r. 1551, the response of bill act that allows for states to use federal money if they want to teach comprehensive sex education. it is abstinence and abstinence plus, so i hope that you will look at that but i want to commend you and the president for that.

finally, let me just say i want on behalf of congresswoman why don't allard, who comes from california, she was detained in her district until this morning. unfortunately she could not be back in time but she wanted you to know that she would be submitting questions for the record and to extend a welcome to you, madam secretary. >> thank you so much. i definitely think, as the health reform debate and discussion is firmly here at the capitol, underway in both the house and the senate, three committees and the house and to committees in the senate and lots of you have been intimately involved, so whether it is single-payer or health disparities, that information that you have the expertise about, and the data that you know so well, needs to be part of the discussion as the bills move forward, and i think that

is not only very appropriate but very important, that you know, the options be looked at. as you know the president laid out some principles that he believed in with healthcare moving forward, and he did feel very strongly that we needed to start with the premise that we build on the current system and not dismantle the employer-based health coverage, but i know there are a number of strong advocates for the single-payer system, particularly here in the house and i assume that will be part of the options that you look at as you move along. >> thank you. i have killed more time. let me just ask you, i will make a point with regard to that though. yes we are going to make sure that here in the house it is laid on the table and that is included as part of the debate, single-payer and healthcare disparities but i would hope we hear from the administration the importance of not letting that slide because sometimes, you

know, we follow in many ways with the administration is laying out in terms of the general parameters. finally, dha the travel span. i know hhs cent over a proposed rule but it is taken a long time. do you have an idea of when we are going to appeal to finally lift the ban as a relates to hiv-positive people coming into the united states? >> my understanding that is very much on the radar screen and it should be soon. >> thank you very much madam secretary. >> thank you mr. chairman and then secretary. it is great to have you here and i want to associate myself with the common bipartisan sentiment by directing money toward specific diseases. if i was drawing on personal examples i would talk about alzheimer's and ms in my family. if i was looking at my district i would talk about diabetes and the native american population. once we go down the slope we would have a lot of arguments here that would be well intentioned but probably not

productive for us and i don't think i have opened the door for two and not open it up for all. let me ask you specifically. i think, but i want to make sure, is the president's position on healthcare now that it would be mandatory everybody participate, somewhat of a shift from the campaign, so has the made that decision yet? >> he has not congressman. key, as you know in the campaign he supported a mandate with regard to parents with children. he did not support any individual mandate. i think what he has it pretty consistently though is that he is open to engaging in that conversation with congress. he knows that a number of members of congress are very committed to an individual mandate, as have been some of the stake holders at the table, so i think at this point he has not made that part of his proposal. >> as i am sure you know, it is a concern simply because we use

a lot of numbers about the uninsured population. there is always a subset, 25% to one-third, whatever that could afford insurance but choose not to sell that is going to be discussion we have. the second question, because the single-payer or government plan option is a big impediment for a lot of this and i actually think it makes a bipartisan compromise much more difficult. have you thought about anything model after something like medicare part d, which actually has worked pretty well with it came in a lot less than estimated in terms of the cost in has a high satisfaction rate. the premiums are comparatively low with family estimated at the time. it is and all private system that obviously has the government framework to operate and, and while it was a matter of a great deal of contention, when we dealt with it, it is interesting to me that no one has one to go back in and do it. it is actually worked pretty well without a government plan as an option.

>> congressman, i certainly think that is one of the recent examples of benefit package that was put on the table. i would suggest that it is not accurate to describe the public auction as part of the health exchange as a single-payer plan. i don't think that is a, an accurate description of what i think is envisioned as a health exchange where private plans side-by-side compete with public plans. as they do now in many states in the country, in state employee health plans, as they do in many states in the country with the childrens insurance program because absent a public auction, in many parts of the country would not have a choice and you would not have competition because when private insurer has a monopoly essentially over the marketplace, so again, in my

insurance commissioner days, you can easily design and actuarially level playing field, where it really is competitive go and frankly, i think that having a plan potentially that has you know, miserable benefits and low provider rates is not likely to attract many americans to choose the plan if they have a choice of another plan. so, i think the notion of a public plan is to have a health exchange, where you actually provide choice and competition. to me, to grade driving features that give a number of americans who right now don't have the choice then there is nobody to compete with some cost competition. >> i would suggest a lot of senator tiahrt's concern. i have got a very limited time and let me ask you one last question here. u.n. the chairman and a dialogue and i think express concerns

about long-term care. it is obviously a huge problem for the country in terms of how you find it. there are a lot of folks who clearly star moving assets early. habte thought about or are you considering an expansion of healthcare, savings accounts, again with the idea that over a lifetime you could build up a certain amount of capital and use that to do for a long term healthcare costs? i'm not saying is a solution for everybody but the more people you pull out of the system that way or allow them to operate that way the less public cost of might have. >> i have not been engaged in that particular discussion. iowa's engaged over a number of years and i know it's been a proposal before congress for years, that looked at everything from tax credits to incentives for individuals to do more purchasing of private long-term care policies. i think the balance always was that a number of the private long-term care policies did not

include very robust consumer protections and in fact many of them had cost escalators that had people paying in for a decade and then the policy became so expensive that they dropped it and ended up with nothing. so, but i think we need to look at a friday strategies because as you well know if you are, and up meetings the income guidelines, then you become eligible for long-term care benefits at basically the state level, and if you don't need the income guidelines, med >> thank you, mr. chairman. >> madam secretary, i know you are going to make us all very proud. the department of which you are secretary used to be called the department of health, educati