up in the early 1950's during the eisenhower administration, the idea was to address all of the panoply of needs of the individual, and they did not use the term "holistic" in those days, but that is really what they meant. we have not achieved that. congress is as much as odd as anyone, and as the chairman suggested, they did not identify particular needs, find them, and as a result, we have this vast array of different programs, different people and programs -- fund them, different people and programs. others do with human services, and others deal with nutrition, at central, etc., -- accenture, etc., but the problem is is that it is the same individual -- etc., etc. and if we went to achieve the most savings but, more

importantly, perhaps most effectively address the needs of that single person, we would start combining and finding overlapping jurisdictions and finding ways that we could better integrate the services that we are trying to offer, and your budget alone, even after you take education, has got to be hundreds of programs, and some individuals are eligible for half of them. are eligible for half of them. one of the things that has been done around the country for example is to set up school based health clinics. i know we had some opposition when i did that as mayor of alexandria virginia, but once it was set up, we have reduced the level of teenage pregnancies and thus abortions. we founded a number of cases of cancer that adolescence never would have had a checkup and identified at an early stage.

mental health problems, etc., and we achieve the kind of coordination, collaboration that they think best serve the individual. now, i am wondering how you feel about those kinds of efforts of achieving more overlapping, more integration of all of those hundreds of the areas of services that you are responsible for? >> well, congressman, i think you make a great point that all too often the same family may have people coming up-- coming at them from 14 or 15 different angles and only four or five hit the mark, as we just talk about enrollments strategies often fail, so i am a huge fan and believer in a sort of systemic approach and a collaborative approach. i can tell you in my brief tenure in this position, i know the president shares those

concerns and has implored cabinet members to really come together on strategies, leveraging assets and opportunities in departments. we have had a robust conversations already on childhood obesity, on certainly to look to the food and drug administration combines strategies. my first few days in washington were cabinet what approaches on h1n1 and it was a great illustration of how various members of the cabinet and various departments needed to collaborate and cooperate, not just in terms of that kind of emergency but i think on a regular basis, so i really look forward to not only figuring out within our own agency how to break down some of those silos and put people at the table on crosscutting issues, but then with colleagues in cabinet

agencies, because often all of us are approaching the same problem but from different lenses and taxpayer dollars will go a lot further and the programs will be a lot more beneficial if we can actually approach them as you say in a holistic approach. >> thanks very much madam secretary. madam secretary the president requested over $600 billion as sort of they set aside seed money for the health reform proposal. although half of that was dependent upon generating revenue by reducing the tax deductibility of charitable contributions. it looks like the senate has rejected that so we are probably at about 300 billion in terms of revenue that would pay for health insurance overhaul, and yet the cost over ten years is 1.2 gillian-- i should say the 600 billion was over a ten year period. most people assume-- so we

really are short about $90 billion a year, 900 billion over the decade. are there other ideas that the administration may propose to ways and means and finance particularly as to means of financing this gap, or are you anticipating any modification of the original goals? >> well, congressman, i think that discussion is very much underway. i would suggest that the president hasn't retreated from his initial proposals, even on the revenue side and i find that, as members engaged in the work of trying to identify where money is available, they are likely to be back on the table for starters. we have been asked in our agency, as have other agencies to identify additional opportunities and we are in the process of doing that right now within the department of health

and human services. i also think that there are opportunities for various savings that frankly haven't been scored and whether or not they will end up being scored remains to be seen, but in the prevention and wellness area, at least in the out-years, that may have significant payoffs. we know that we are now spending 75% of our health cost on chronic disease, and some efforts to better manage, better control, better outcomes with chronic disease management have significant payoffs down the road, so we are currently underway, working on that. i think there is a great belief that the investment in health technology again will pay huge dividends, not just in helping

to drive appropriate protocol but lowering of medical errors, again not quite in the system yet so there is some work to be done in terms of identifying i think some of those out-year savings that most people agree are very much there but just haven't been part of the discussion yet. >> thank you secretary sebelius. thank you mr. chairman. >> thank you mr. chairman. i join my colleagues in welcoming you. madam secretary many of us were shocked and saddened by the horrific murder of dr. george tiller over the weekend in four years the bush administration went out of its way to protect doctors from being forced to provide services they found objectionable, yet did nothing to shield physicians providing legal and life protecting medical care to women from ongoing harassment, threats and violence. this is unconscionable and must change in my judgment. the federal government must send the gibbet-- that acts of

violence will not be tolerated. i was pleased to learn that attorney general holder has indicated that the u.s. marshal service will begin protecting certain abortion clinics and doctors, and this is a good first step. today "the new york times" also pulled on attorney general holder to revitalize the national task force on violence against healthcare providers. that was originally established in the 1990's. i realize this task force would be under the jurisdiction of the department justice, not hhs. i want to know number one, would you support its revitalization and how does hhs intend to work with the department justice to ensure that these acts of violence are eliminated and do you agree that this type of violence could discourage medical schools from teaching doctors how to perform abortions, and how will hhs work with medical schools and provider organizations to ensure that this procedure is being

taught? >> congresswoman, i share your interests in making sure that health services are delivered within the law, and that providers certainly are protected for their activities, and the attorney general was quick to reach out and make a very clear that acts of violence would not be tolerated, that he would use the assets of the justice department to provide protection, and they think to also send a very strong message about axe in the future that would be prosecuted. ..

>> thank you. and following up on another issue, with the insurance industry. from 2001 until 2004, health plans in new york state may more than $5 million in profit while its hospitals lost $600 million, and i think it is interesting that the westchester county association, which is run by many of the businesses in westchester county, point this out, in many of their discussions and sessions with us, so, first of all, do you

agree that the relationship between private payers and the financial viability of the health-care system needs to be examined? and if you could share with us your experiences, not all in the insurance industry in kansas, and how that has impacted consumers, i would like to know if there are lessons with this experience that can be applied across the country including in health-care reform legislation. >> congresswoman, i share your concern about oversight, and my colleagues who are serving as insurance commissioners across the country? have jurisdiction to review everything from loss ratios to appropriate setting, and some are aggressive, and others, frankly, have very little choice, because often, there is a dominant carrier and a single

provider, because the opportunity to have oversight is limited. limited. we did have a situation in kansas when i was commissioner of proposed takeover of the blue cross blue shield plan of kansas by an out-of-state company, and i ended up ruling against that takeover ultimately because after reviewing the testimony after having a series of hearings, after having providers and hospitals come before us it became clear that the only way really to produce a profit statements to the shareholders, which accompanied had promised was to either reduce benefit or reduce payments to providers all of which would not have been good for kansas consumers so i do think there is an appropriate oversight role and it's

certainly one that in the proposal of the public plan i think is the president's goal and members of congress that either regulatory oversight or competition within a marketplace work very well and that's part of the goal of the public plan option. option. >> thank you. pleasure to have you before the committee today. and the department of health and human services has a full plate, and i am very grateful for your commitment and your team at hhs to work to reform health care and meet the services which millions of americans depend upon. you have a big job and i know he will do it well. and as you know, as congresswoman blight pointed out on saturday, an assassination took place in your home state of kansas. a decision was murdered. it was an act of terrorism in a church.

this act of the anti-abortion vigilante is some -- the murdered dr. had previously been shot in the clinic which he worked had been previously bombed. abortion in this nation as a legal health care procedure and i support a woman's right to make her own health care choices. the work of the courageous health care providers meet women's needs daily, and they should do so without fearing a loss of life. what america witnessed on sunday was a taliban-like tactic to prevent abortions by murdering a doctor. this is terrorism, and i hope this administration as you pointed out will continue to accept protection of women's clinics all across this country. and i know that planned parenthood in minnesota there was an article in the paper has been targeted in the past and they have received protection.

thank you so much, and the women in the a@@@@@@"@ @ @ @ @ @ @ @ >> prince of family planning and for all women to insure they have the best informations about when they decide to have their children. that is how we reduce abortions and that is how we of power -- that is how we empower their need. we provide all women of all ages reproductive health services and you can count on my support to get that passed. i do have a question. as we take on the challenges of health reform, i firmly believe that every american has a right to health care and should be especially true for every single one of our children.

we need to remember that no population stands to gain more from national health care reform than our children. re from health reform than our children pete children ensured by medicaid and schip are covered under 50 different state programs and the d.c.'s coverage. 51 different programs. a child's access to health care coverage and health care should not vary by location in this country. so, the question is how does the federal government ensure that its most important investment, the investment in the health of its children, standardized in terms of uniform eligibility, national pediatric benefits and access to pediatrics specialists for medical necessary care. how can i work with you to make this a reality madame secretary? >> congressman, i would love to have a chance to work with you on that critical.

as you know, there are some mandated benefits for young children in the medicare packages which all states must follow, but beyond that you correctly identified that eligibility rates vary from state to state for particularly the chip program and very -- in terms of the very earliest prenatal care. so the likelihood of having reducing low birthweight babies and bringing people into the system very, so it is a huge challenge and i support and i know that the president supports the notion that the system starts with a focus on children. i think that is why he was so enthusiastic during the course of the campaign about a mandate applying to children and we felt we needed to start universal coverage with children.

so working with you making sure all children have access to the benefits you've described is something i look forward to. >> [inaudible] [laughter] >> and i am not calling. [laughter] [inaudible] [inaudible] >> thank you, mr. chairman. welcome. >> thank you. >> can i ask you in terms of health insurance reform the most basic tenet of health insurance reform is community rating. that means that insurance companies can no longer cherry

pick who they cover based upon who is healthy and who is sick thereby make their money not by how well they provide the care and manage the care, but rather how good they are at choosing this person verses that person to be in their plan, therefore excluding the sick people and only covering the healthy people. is the administration going to commit itself to community rating as a central part of any health care reform plan? >> i definitely think that the commitment that the president has made consistently is to eliminate the pre-existing condition, opportunities, and to move to a system of affordable

coverage for everyone. i haven't seen the specifics are around community rating and how wide the bands would be, but certainly that is an essentials element of the pre-existing condition discussion. you accurately lee described i think the market as it often exists. we are either a health condition eliminates you entirely or at least puts you in an on affordable category. so either 1i think wouldn't be part of the health exchange moving forward. >> that's good to hear. in terms of the whole issue insurance oversight, we know that from insurance company it's roughly 30 cents on the dollar for administration versus medicare and medicaid which is 3 cents on the dollar fred mabus st oversight -- administrative oversight. what is this plan going to do to

go into it and do a forensic audit of these insurance companies to ensure that they are now going to be able to pass along these enormous administrative costs dave embedded in the current administration of their plans that they pass on to the consumers? i mean this is part of something i think as you already know being an insurance commissioner is unattainable for us. this is where our savings are going to be is going after these 30 cents on the dollar that never make their way to health care at the bedside. >> well, i think that is one of the essentials elements of having some competition in the new marketplace. so, a health insurance exchange combining options and they would compete for benefits and for

costs, and i think that part of the competition is a way to get to regulatory oversight over the overhead cost. 30 cents on the dollar may be high but i don't think there is any dispute that somewhere in the 15, 20, 25 depending if you are talking about a large employer plan or smaller plan, and those are not only not only medical dollars being spent, but the estimate is most americans who have private health insurance currently are paying another ten to 15 cents on the dollar for the cost of those coming through the emergency room doors without insurance. so you get close to 50 cents on the dollar that's not a body and a drop of medicine or doctor's visit or treatment and i think that is why we need competition and why we need choice.

>> would you not say when we have this new plan that we need to have teeth to enforcing regulatory oversight of the insurance companies, but never happens? i think of what happened recently with aig and i think if we are going to put out to bid billions and billions of dollars, essentially to manage our dollars in health care for provision of health benefits, what scares me is i see the battle on the hill between northrop grumman for a particular weapons system. i can't imagine the lobbying that is going to go on up here between health care providers when it comes to health care contracts. so don't you think it's important that we have really strong oversight at the department of justice to make sure that when it comes to these

bidding wars for various alphacontact that there is government oversight through the department of justice to make sure there are no shenanigans'? >> well i think the appropriate jurisdiction for the department of justice is publicly any antitrust issues that could come up. i do think that a regulatory framework makes sense but i am a believer competition also goes a long way to help regulate costs and if you have a competitive market place you don't need as heavy-handed regulatory oversight which is why i am often an enthusiastic supporter of standing side by side with private plans and that competition be the determinant of the price and benefit. >> mr. rollin and? >> thank you mr. chairman. thank you, ms. secretary who is a buckeye i must remember everyone, originally from

ohioans and her governor was the -- father was the governor of ohio in the early 70's. an issue that has come up a couple times is unplanned pregnancies and abortions. excuse me. and the president and i watched with great interest the speech at notre dame and i think that he articulated not only a framework for public discourse over the next few decades, but also a way of approaching these controversy issues we truly want to find common ground, and i know chairman obey and members of this committee have made a large commitment to reducing unplanned pregnancies and therefore reducing the need for abortion and support and pregnant women. and as you may know, chairman obey has in the past directed significant funds towards this purpose and congressman rosa delauro and i have been working in number of years to introduce legislation on the past several

congresses that would help address this issue. what is the department doing, going to do to try to implement president obama's initiative and partner with congresswoman rosa delauro and i to reduce the need for abortion? >> well, congressman, i think an enormous challenge that we face and one that something i've been working on in my home state of kansas for a number of years and one that i think brings together people who have varying views on abortion services are now some common ground and the notion that if we can work providing a host of services to reduce unintended pregnancies we therefore reduce by anybody's

count the number of abortions that are performed in this country which is i think a ball will allf us could support. so we have a range of services in the hhs i think can help toward that end and it's everything from comprehensive sex education which has already been discussed, affordable available health care is an important piece of that puzzle. there are adoption incentives, which worked along the way. early childhood education support for women, a range of programs for women and girls that provide an environment where they have options and choices that are so essential to, you know, reducing the situations that produce unintended pregnancy. so i think that -- i was alarmed by the recent cdc study that

says we have an increase now in teen pregnancies again having had a decrease the last years that is not good news. we know that 40% of births right now are testing parents -- to single parents. so there's a lot of common ground and work to be done and i think a lot of the assets to do that are in the department of health and human services and i look forward to working with you and congressman delauro and others because i think this is an area where some focus, collaborative attention can play huge dividends and the long run. >> i appreciate that and i think congressman delauro and i and others would love to sit down and hash this out. one other topic i would like to touch upon i think when we have these discussions about health care there's always an issue we never talk about and that's the issue of stress and a lot of it

see it now and the congressional districts because the economic situation we are dealing with. and the issue of stress leads to i think, we know increased illness and, you know, these people losing their jobs, losing their health care and has an affect -- i just want to ask we had this conversation a little bit with nih, the brain research on being able to regulate yourself and regulate your emotions and reduce your level of stress is a significant so when nih was here i asked them specifically about doing more and more research on mind foynes and congressman jackson brought up meditation and stress reduction. they've been studying this for 30 years at the university of massachusetts and different places across the country and i just want to know if you are familiar with this if it is a part of your approach moving