forward. this is a very inexpensive way to adjust their attention span. people who are dealing with chronic pain and how that is a significant savings it. how dealing with chronic pain can be treated with this method as well. are you familiar with this? ne >> i am certainly a bit familiar with it but not nearly to the extent that you have just outlined. again, i think it is a prevention strategy that i know has the potential of paying huge dividends. otential of paying huge dividends. i have seen and used as a violence prevention technique

with kids in school, you know, teaching nefarious kind of control methodologies and you see violence levels rise with as you say folks becoming unemployed and the stress that is related to that. so i would just like to have the opportunity. we will have a new leader in the mental health area soon, and certainly it overlaps with half reform and work we are doing with early childhood and i just would like an opportunity to continue the discussion. i am not precisely sure what is going on right now it's a wonderful strategy. >> i have some information i would like to get it to you. i don't want to but your whole come under but i would like to talk about this in detail as well. i am done i guess. [laughter] but in an on stressful way.

[laughter] >> thank you, mr. chairman and welcome, madam secretary. that we again focus back on a couple of issues mentioned before. and i mention it because it needs to be mentioned and when things are not mentioned it doesn't exist and these are the two things que, the minority age initiative and issue of health disparities. on the minority age initiative, i met with the national minority counsel a few months ago and expressed that the initiatives funding hasn't been reached in the grassroots organizations. it's being redirected to other priorities within hhs or being directed or redirected to other priorities to larger hiv/aids organizations that don't focus on minority community tease but the white depopulation and not the intention of the m ar . this

year the funding was open for competition to the for-profit organizations for the first time and this puts a lot of pressure on the organization's and the local community organizations. understanding this and the possibility of the pressure on the organization's what faults do you have about that process? are you thinking of changing that or is it your opinion that it's a fair process that everybody is on even playing ground? and would you also can it to meet with the national minority aids council so they can also express themselves for themselves the way that we see the issue? and i think that those issues

will come and they will express that with you. i hope that you will be able to make some time for them. the other area is the health disparities. the try caucus i want to emphasize there's a recognition there is a stark disparity and it is evident in their tribal reservations where her very few people who take the time to visit but it is stark and i think it is time for this country to take a kodel through the tribal areas and look and understand what's going on and what's not happening in those areas. coming back to the other areas of disparities when we look at the needs that the communities

have we always talk about the great expenses that are in the area of health and lifetime said is because we are not paying attention to the gaps and disparities in the communities. i think that there needs to be a conscious discussion and attention paid to the issue of disparities that excess in the communities for cultural, social and linguistic reasons, and i think a blueprint on that needs to get together so it will always be on people's mind as we discuss the critical issues of health and health care. i was hoping you might have some thoughts about that. i know dimension the disparities

toward the end of your testimony. but it needs to be set up front very clearly so that people understand that this is an area that needs to be paid full attention as we move forward. >> well congressman, first of all on the minority aids issue, i would welcome the chance to meet with the council and in preparation for these budget hearings this from change in procedure was brought to my attention and i must confess i don't know enough about it to tell you if i'm going to change it or not change it but it certainly is on my radar screen and i intend to go back and take a look how it operated in the past and why the change was made and make inquiries. i do think that competition needs to be not only on a level playing field but make sure that we get resources into the hands of folks most likely to reach

out to the population meeting to be served so i think that is a very appropriate question to ask. even though it's not in the jurisdiction of this subcommittee, to your bladder point about disparities, this 2010 budget does have a sick mafic and request for increase for indian health services and one on would suggest is long overdue. we have agreed to a new leader who has been confirmed by the senate, yvette reubin gough, a doctor and native american who is coming in to lead the indian health services and has worked in this area for a long time, so i think there is a recognition that we haven't lived up to our commitment for appropriate health services of that come reality for generations, and that in the whole overview of health disparity that is a

community very much off the radar screen and one that i think not only did the president recognized in the request in the budget for what amounts to almost 15% increase, but is one that i will personally commit to paying a lot of attention to and i worked closely with the tribes in kansas. the first day i was on the job i went to the tribal leaders meeting and told them that i want to stay involved and committed and will continue to do that. >> the gentleman's time is expired. what i would like to do is run a two-minute round so everybody gets the chance to ask one additional question. mr. tiahrt. >> thank you, mr. chairman, i will try to confine all of my questions in two minutes. we are on a path to single-payer healthcare the start with effectiveness a concept of having a subsidized public

insurance company compete with a private sector i think we will get further down that path. you have heard of this committee many would prefer a single-payer system. i would like to see your organization consider some competitive methods of approaching the problem. in many states including kansas we require everybody who drives to have car insurance. the result is we have a fundamental insurance package for automobile, for car insurance. we could do the same thing for a basic health care policy that includes a certain number of visits to physicians, clinics and putting hospitals, we could have an annual physical which i think would be very good including counseling for a healthy lifestyle which would avoid a lot of cost in the future. we could have an annual dental visit which many people need as well. and it would provide -- we could provide tax incentives for everybody to purchase a basic health care policy and it couldn't afford it a voucher for

those on the poverty level where they could go out and shop for it. it would have a provision that i think what address of the need mr. kennedy brought up, very compassionate man knows there are some people that get denied coverage and the examples although insurance we have a high risk pool where each provider takes a turn drawing in and from a pool which would cover people who had pre-existing conditions. it's an alternative that would provide competition and the lower-cost and if you look at right now healthcare is 20% of gross domestic product. if we did privatize or take the privatized portion it moved into the public sector cost at least $1.5 trillion a year this almost 50% increase with the federal budget is. i don't think we can afford that in today's economy set to provide an insurance plan that would be competitive would be a good alternative. would you consider developing a basic health care policy that could be considered as part of

the debate? >> congressman, those policies exist across the country and in most cases they are not attractive to other employers or employees. and i think that going to an individual market which is the description that is not what insurance is about. it's about sharing risk. so people right now are interested in getting in a will where they are pulling their own health situations with others driving the market which has been suggested strongly the last eight years it was the administration's primary suggestion for solving the health care crisis is is essentially having all americans move toward individual coverage and dismantling the employer coverage that we have right now isn't something i support and i

know it's not something the president -- >> it's not a poll of one it is a pool of 300 million. it would be policy applicable to everyone. so i think that is something i would like you to consider. >> if we are talking about health exchange we could join as an employer that is exactly what i think is contemplated with a benefit package that would be affordable. >> thank you. >> thank you, mr. chairman. madam secretary i want to make a comment and i will get the legislation to you. i think my colleague mr. kennedy would be interested it's called the informed choices, senator rockefeller has endorsed it in the senate commerce woman schwartz and i have introduced here. it provides a label which would streamline and it would make a consistent what was being offered so people could understand what's being offered. second it creates a federal office of health insurance

oversight to deal with the oversight regulation obviously the states have a major portion of that the federal level it would be helping monitor to that effort. i would love to get your thoughts and take conceptually at whether or not this is something that can fit in with the health care debate. let me move quickly to food safety. and i know you've had a little bit of time to settle into the department and you do cchair the food safety working group. i was wondering what you see as the most important goal and objective. how do you believe we ought to measure the success. a final comment is you know where i stand on the issue of food safety functions and taking them out of the fda in an agency that has its own commissioner and agency is this an idea you would be open to considering? >> i am enthusiastic about the work, the collaborative work

between the department of eckert culture and hhs and certainly appreciate your passion and leadership on this issue over the years. i would suggest that we have a new commissioner of the food and drug administration, peggy hagberg, who's now been affirmed and redoing the inspections and food safety system is essential. it's got to be public-private partnership whether or not it is a stand-alone agency or in the food and drug administration i think is almost secondary to what the system needs to look at. and i am eager to restore the fda to the gold standard which it is a long way from right now. >> thank you, mr. chairman. historically, health insurance

programs have been driven by the individual states. new york state law used to dominate this entire arena. commissioners across the state's played a significant role. you have indicated by way of your statement for the record that you intend to begin building on the system that we have. in doing that, d.c. the federal government's role core operating with the state's or do you foresee a more centralized federal government system? >> i met with my former colleagues the other day. the insurance commissioners were here, dealing with this very issue. i am most vote -- i am a strong supporter of the consumer protection rule that states play in the health insurance area.

i was engaged in that, myself. sthand theindividuals covered individuals covered by the erisa plans to have nobody to turn to if the benefits were denied or the claim wasn't paid or if the company suddenly ceased offering insurance. so i am a strong believer that there is an important consumer protection of role and oversight role the states will continue to play in the future. markets are often regional or local and i think having somebody in that role who understands that and not a cookie cutter approach that is nationwide makes good sense and i would say nothing five seen being discussed runs counter to that at this point.

>> thank you, mr. chairman. madam secretary i have been a supporter of community health centers because in my district health centers provide access to affordable high quality care to medically underserved individuals who might otherwise go without. i know president obama is acquainted with the role they play as health care in it illinois and nationwide. indeed the president stated and i quote health center's primary care prevention are at the heart of my plan for affordable accessible health care system. my first question to agree we must continue growth in this important program as we and take comprehensive reform? >> yes i do. >> secondly the epidemic continues to rage in the african-american community according to the cdc and the blacks account for about 34% of population the account for half, 49% of people who get hiv and aids. i'm pleased to note while we continue negative but testing and treatment activities among

african-americans i am concerned the program and by quote the heightened national response to hiv/aids crisis and the african-american community has been scaled to mobilize to conduct the hiv/aids testing activities, for and the initiative. madam secretary can you review the situation and see what needs to be done on this testing activity? >> is i will. >> thank you, mr. chairman. >> thank you, mr. chairman. we all agree it is enormously expensive to undertake health care if we have government program it's expensive for families and which leaves a wife got two questions. one is the administration considering taxing health care benefits to pay for the expansion of health care and second, is the administration considering allowing those who are not an employer based plans. for health care with after-tax dollars to do it with pretax dollars to have the same deductibility people are covered

governmentally or by private companies? >> congressman as you know during the course of the campaign the issue of taxing employer based health coverage was discussed in a fairly robust fashion and the president then and continues to oppose taxing employer based health benefits feeling it would dismantle the current system that 100 loss negative kuhl 180 plus million rely on. he also proposed and continues to support tax credits particularly for small employers but for a variety of individuals and employers currently struggling in the marketplace he's open to further discussions about the whole taxing issue. i think there is no question looking toward the future there are a variety of ideas on the table in both the house and senate but at least he feels at this point that providing tax to

all employer benefits would dismantle the market so many rely on. >> thank you. >> thank you. madam secretary, a couple of things with regard to the recovery act funding. bourn is as you know it's very difficult oftentimes for communities of color to access federal funds for grants and so i appreciate the diligence and urgency hhs has placed in putting these forward that we provide in the economic recovery package but i wanted to see if you had specific outreach efforts for the african-american latino and native american communities to be able to compete with these bonds and if so how york coordinating facts and also ensuring minority serving institutions such as hispanics serving institutions and historically black colleges have the benefit of being able to understand and compete with funds so they can certainly

access. and secondly, just want to ask about mental health services as part of the economic recovery funding. i know we provided funding for a variety of health care strategies and initiatives but how does mental health in to that and finally thanks to congressman kennedy and others, his father, senator kennedy we do have mental health parity now astelin all of the land and so have we considered that in the allocation of the funding under the economic recovery act? >> i do know that in the recovery act, conquers woman, there is a new stream of funding that is targeted for capacity building for community not-for-profit organizations that i think is not explicitly targeted to minority groups but certainly would be applicable source of funding to build capacity in the kind of neighborhood resource groups

that are often so vital to deliver services. i think that back to congressman jackson's notion there are also expansion as you know of community health centers and work force, and that the health of minority student loans being paid so we can increase the number of health providers. so i think there's a series of strategies that are in that on perella named to the trouble down services to appropriate populations. this 2010 budget request does include an increase request for mental health services particularly for children. it has a grant proposal to serve 11,000 more children and provide services to 35,000 additional parents and siblings something i know congressman kennedy and others have worked on diligently

so i think expanding those health services is an important feature of this budget request. >> thank you. madam secretary, thank you for mentioning that. i think if we could elaborate on the expansion of services for young people mental health needs could you explain your work with your counterpart arne duncan about early education and how we could better use the money that are being appropriated for headstart early education programs from his point of view and department so that the dollars aren't used where they are needed the most as opposed to across-the-board because frankly, we need to target the dollars. target them towards children who come from families where there is domestic violence, where

there is depression, where the parent is in jail, where there is addiction. we know those are the dollars that are going to go make the biggest difference as opposed to trying to blanket the country with dollars for every child. we would love to do that for every child but in the metrics of things those are ongoing to be as successful if we target the dollars where they make the most sense. if you can respond to that as one point and it in the second point is in terms of the prominence of mental health in the administration and where it will figure into health care reform obviously there has been no appointment to the director but could you comment on the notion of a medical home as a central part of any health care reform manningoordination of integration services and mental health being a key part of any

medical home that is being adopted under the president's plan for purposes of reimbursement and particularly program which reimburses doctors and the white coat community through the icg codes for their work during brief screening intervention and treatment for mental health services. >> well, i would say congressman, i know first of all you have done extraordinary work in this area, and i would look forward to learning more about the identification you've been able to make on what are the most cost-effective strategies and best practices because they exist but i can tell you that there is no question as we look at overall health costs, focusing on mental health as a strategy is going to be

extraordinarily effective and depression is often an underlying in related link to a number of chronic disease that we just talked about as being one of the cost drivers and vice versa if you suffer from depression you often are more likely to have some of the conditions which create chronic disease so there is a partnership that has to be addressed as we look at ways to reduce not only the 75% of health dollars we are spending on chronic disease but also produce healthier lifestyles in the long run. the earlier focus, early identification of precursors to mental health issues is done in young children and so having a strong link in the early childhood headstart community with those warning signals of violence potential and high

stress households and as you say substance-abuse households focus on those children as a early prevention strategy also pays huge dividends down the road, so we have had those discussions and i can tell you if potential directors looking for somebody who understands this can't be an isolated strategy, stand-alone or second or third chapter it's got to be at the forefront of dealing with health reform. >> thank you very much. >> ms. mccollum. >> thank you and thank you for your comments about indian health care services. i was just with a band and leach like minnesota, and they are very excited there was an increase. they are happy for the other tribes who have seen their health care facilities listed in the upgrades.

they are anxiously awaiting their opportunity as well, so i know that we will be working with you and i was with some pueblos and mexico, too. in fact i will get some information to you. i was in a hospital i thought should have been shot down very concerned about the patients who were there and the patients there were concerned about health care they were going to get. one had a great health care, this other moderate and another what was awful. i went also like you know i'm going to be submitting a question for the record on health care technology. i'm concerned with some of the contract and i know the chairman was trying to get copies of the contracts that had been submitted by the administration for providing many health care services plan and very concerned about eight alphacontact submitted under previous administration and i supportive of health care but i don't want the fox watching the hen house and that might be happening but i would like to very quickly without that i am very concerned

about low-cost high-quality states like minnesota. we are doing everything from medicare program could ask to have done. we are delivering services and a cost-effective manner until we are being hammered. we are losing physicians because of the reimbursement formula so i applaud you for making high-quality health care long-term sustainability of health care reform a priority but i urge you as we move forward to bring comprehensive health care reform. i can't urge to be enough to carefully craft provisions to avoid having disproportionate impact on medicare beneficiaries like states in minnesota doing everything asked for them but at times being paid half the amount for states with doctors and facilities delivering abysmal outcomes compared to what we are doing. >> it probably won't come as a great surprise i had just this conversation with senator