how do we deal with these chronic diseases like diabetes? >> there is a new grant that we just made available which actually focuses specifically on areas with the highest rates of diabetes and chronic disease in terms of providing incentives and additional resources to not only coordinate care but also do much more effective monitoring of conditions. there is no question that preventive care at a much earlier stage helps but also what helps to prevent hostile stations and amputations is to make sure that those suffering from diabetes actually are on an appropriate regime. .

. have proven to be very effective and my guess is your area is likely to be, unfortunately, rising high on the list of an area that's likely to be one of the -- i think there are 133 communitieses that will have additional resources to focus on this effort. >> thank you, madam secretary and i yield back my time. >> thank you. mr. walden? >> thank you, mr. chairman. madam secretary thanks for being here today and the work that you're doing. i have some questions. like many of my colleagues i'm just starting to look through discussion draft that's out and i know that you've undoubtedly played a role in working with some members of the committee on the. so if you can help me with some of these things. is it true under the bill an employer could be subject to 8% tax even if they offer a worker an employer-sponsored health

care policy? >> yes, i think that's accurate that there are some ways, if it isn't determined to be credible coverage, that you could have the pay or play provision. >> if i'm reading it correctly, is it true that if the employee decided to go with eoh through their own plan, employer could still end up having to pay oh foe they went throughhe exchange, i guess it is. tell me how that process works. an employee could refuse the plan from the employer, correct? >> i must confess -- >> the people behind you are shaking their head, "yes." >> i am not familiar with that specific provision. i'd be glad to get back -- if you want to give me the questions, i will immediately respond. i'm just not -- >> my understanding is that an employer could offer an employee

employer-sponsored health coverage and the worker could turn it down and enroll in the exchange plan. the employer would still be liable for the 8% tax even though providing the employer-sponsored care would have been cheaper. that's what i understand. if you could take a look at that. >> i definitely will. >> is it true in order for an employer to avoid paying the 8% tax the employer has to offer a plan that the new commissioner deems to be qualified? >> that is correct. >> can an employer require an employee to accept the employer provided health care coverage in. >> can you require an employee to accept it? i don't know, again, thousand provisions are drafted. i'm not aware of any mandatory in a private insurance market, how you mandate that anyone accept a plan. but i haven't read the outline of the bill, sorry. >> do you know if these provisions, are states and federal governments considered

employees under this draft? >> state and federal government? >> mr. walden can i just -- >> i'm not trying to stop you, but, i mean, it's the draft -- discussion draft is put together by the members and i don't know that she can necessarily be the person to comment on what's in it. but i mean, if you want to continue -- >> well, yeah, we are on my time near. >> i'll give you extra time. but i want you to understand to that he didn't ask her here to comment on the provisions of the draft, per se. >> i thought earlier she was indicating that the administration support this is draft, did concepts in this draft, is that not true. >> i said we support principle that pronted the draft. i'm sorry. the draft came out on friday and i have -- i didn't write the draft and i'm not intimately familiar, but i'd be happy to answer questions if you have them for me. >> i don't want to stop you -- >> i'm reclaiming my time if i could.

so you haven't read this draft either, then? >> i have read it. i don't have it memorized. i appreciate that. >> you're ahead of me. i haven't read it fully. but i also know the way this committee has been operating of late it moves rather rapidly so i doubt we'll have the chance to ask you these questions before we have to vote on this. so that's why i'm -- i don't mean to be disrespectful. i know others on the committee have asked you a pretty specific set of yes and no questions. >> i'm just trying to be honest with you. if i don't know the answer i'm happy to get it for you i just -- >> let me go to another point. that was a comment you made about medicare and part d. in this, i don't think, is necessarily in the draft. do you know what the medicare part b premium was in 2000? i'm not going the play a got who game.

medicare part d for divine was $29, which was 30% lower than the original projected when we passed medicare part d in 2003. i understand you issued a report yesterday showing that employer-sponsored premiums for health care doubled between, i think it's 2000 and 2008, for health insurance? medicare part b premiums have more than doubled. 110% increase in the same time span. i think what a lot of people are asking me about when i was home in arlington and fossil and out in my district they're saying, if medicare is going broke by 2017, and we're going to just expand and add all these people into a government-run system and we can't get access to providers now, when the government runs the system, which you know is a big deal in rural areas, they're saying, how does the new government-run plan going to hold down costs? and how is it going to expand? how are we going to pay for this

is the underlying issue here. the estimates they are just saying, you talked about health insurance could cost us, you know or health coverage, $4 trillion. this plan alone, i think, some estimates are that. so people at home are really struggling with the dollar amounts here. >> congressman, the plan, again, that at least the payments side that the administration has put forward not only saves dollars through medicare but helps to expand the life expectancy of the medicare trust fund and lower overall costs in the part b premium for the beneficiaries who are currently paying, as you say, higher costs. i'm a believer that medicare has to get at the front of the lower cost-higher quality care for the beneficiaries of the system and that we can be not only

innovative but help to drive best practices which exist now in various parts of the country, to scale. so that's really one of the intents of the new program moving forward. >> i appreciate that and i'll close with this. i spent five years on a small community hospital board. and it seemed like medicare gave us the most headaches, not the least reimbursement been second to least, reimbursement and there was an enormous cost shift going on when the federal government was involved and now you have the access issue trying to get physicians that will take medicare patients. i don't want to see us create a government-run system that mirrors one that's not sustainable right now. and you know as well as i do, some of the goofy rules in medicare that drive seniors to the hospital to get, you know, an injection when they should be able to get it at home, telemedicine is a great thing but if you're a provider and you're on the other end of telemedicine you don't get

reimbursed under medicare so there's a disincentive, irrespective of this debate, that we could do to improve medicare. >> thanks for your generosity on time. >> let me remind mens. we mentioned this earlier but i wanted you to know that the secretary has to leave at 12:00. now, of course, we'll have written questions for many members including those that have already spoken and those who have not to follow-up and she'll get back to us. >> mr. chairman? >> yes. >> could we ask the secretary if show could have those answers back by july 6th? i think that would give about a week? >> normally we submit the questions within ten days. so that would -- i'm triing to figure in out here. if you all agree to sends her questions within ten days, then i think she has to have at least, i don't know, july 6th is

kind of early, isn't it? >> mr. chairman, if they have specific questions if we can just address our question to her and not get a response but get the response that -- >> she has about ten minutes left or five minutes left. i have mr. engel is next. i'm not putting a timetable on when you get back to us with the written responses at this point. >> i'd like to be on the list for questions. >> let me explain again. anyone can submit written questions. norm think committee asks members to -- >> i think on something this important we can -- we don't have the opportunity to ask questions to her. i don't want to waste the time

that we have remaining. >> other directors and secretaries came in when we were the majority you raised holy hell if they didn't stay her for every question. >> there's not much i can do about that now. >> i'm going the ask mr. engel to -- you're next. >> thank you very much, mr. chairman. madam secretary, welcome. i heard your opening statement and i was delighted when president obama selected you and i think you are degree and will continue to do a great job, so welcome. i want to call two things to your attention which are two health priorities of mine. personally, i was pleased to see that my legislation, the early treatment for hiv act that i introduced with speaker pelosi was included in the house trihealth reform draft. we call the bill etha. and in conjunction with the house pros poles to cover all low-income people under medicaid program to up to 133% of the

federal poverty level, is a significant step toward reducing the number of indiana insured people with hiv in our country. as you know, etha, this bill, addresses a cruel irony in the current medicaid system. under the current rules people must be disabled by aids before they can receive access to medicaid. this is care that could have prevented them from becoming so ill in the first place. in other words, medicaid won't help you unless you have full-blown aids and as you know, if someone tests positive to hiv, it could be a number of years before they have full-blown aids so it makes much more sense to help those people once they test positive to stave off the full-blown aids and it's an irony that you couldn't do it. what etha does is gives states option do provide people living with hiv access to medicaid before they become disabled. president obama repeatedly in

his quest for president said he supports it. when he was in the senate he co-sponsored the bill. i want to ask you if i continue to count on the administration to continue to support etha and will you work with the states to take up this option if it's included in the final reform package? >> yes. >> thank you. that's the answer i was looking for. >> and secondly, the second priority is home infusion. we know that some delivery system changes need to be part of our health reform package and this legislation, the second piece, addresses an anomaly in the medicare program that forces patient into hospitals and nursing homes to receive their multiweek infusion therapy when the same care could be delivered safely in the patient's home where the patient prefers to be without standing results and lower cost and virtually no risk of health care acquired infections.

so i believe that it makes no sense that medicare pays for all costs associated with infusion therapy when it's far more costly in a nursing home setting that won't pay for home infusion. for decades private health insurance has covered home infusion therapy used extensively by medicare advantage plan. medicaid programs cover it. but medicare fee service stand as loan in the failure to cover the services, equipment and supplies needed for home infusion therapy. so my bill which is the medicare home infusion therapy coverage act, i've introduced with 92 members of congress. i've introduced it with my republican colleague, tim murphy and 20 members of the energy and committee are sponsored. can i have your commitment that your staff will work with me >> we will certainly look forward to working with you and seeing what can be done in this

area. >> thank you. i'm turning back my time. i want it duly noted, mr. chairman. >> it is duly noted. >> thank you so much. madam secretary, thank you very much for taking your time to be here. i understand you have to go to the white house for a taping and i would hope -- >> with the attorney general. >> i am sorry. then i was misinformed but i would certainly hope that you will be able to return and answer the questions that those on the committee have about the health care plan. could you give us a commitment to answer these before the mark-up? >> i'm not going to take away from your time. i'll give you an extra minute or so. i know that members are interested in getting timely responses but we don't have the opportunity at this point to say that the secretary is going to come back. the opportunity at this point to say that the

secretary is going to come back so what i'll ask is that members submit their questions as quickly as possible and i'd ask the secretary to respond to those questions as quickly as possible. >> will the gentleman yield? >> i want to get through this. ms. blackburn' -- are you telling the witness not to answer the question? >> parliamentary inquiry. are you telling the witness not to answer >> i thought i said the opposite, which is that -- >> no, you didn't, you told her not to answer. let her answer the question. >> i would like to reclaim my time, mr. chairman, as soon as you finish. >> what i'm saying is we're not asking the secretary to come back at this time. >> mr. chairman -- point of order, the secretary is hear to speak on the single most important piece of legislation, most far reaching piece of legislation in my 15 years in the united states congress. there are at least four members

here, at least four, maybe five or more, who have not had an opportunity to question her. we fully understand her schedule. she has important things to do. that's perfectly all right. it would be unreasonable for this committee given the scope of legislation that is moving to ask the secretary to come back sometime before this bill moves to full committee. >> what i'm saying to you, and i will repeat again is the following. the secretary is here to give the administration's response to the discussion draft. i am not asking her to commit at this time to come back. first of all i don't know her schedule. i don't know whether that's possible. miss blackburn can ask, but i don't want her to feel she has to mitt. >> point of order, mr. chairman. >> i think we're on my point of order. >> when she's done we're going to have to ask the secretary to

leave because she has to leave. so i'll go back to miss blackburn. we'll start the clock again. it's the gentlewoman's time. >> thank you, mr. chairman and madame secretary. i hope we'll be able to resolve this. when my constituents talk about the issue they are fearful of what may be included in this plan. and coming from tennessee and you having been a governor, i think you can understand that. and when they hear remarks about it being deficit neutral or -- yes, deficit neutral, not increasing the debt, you've made statements that it would be paid for, you've talked about reducing the itemized deduction. my constituents are very, very concerned about how this would be paid for. the other members of this committee have constituents who are equally concerned about this. of course, our concern in tennessee is in the problem that

existed with care. i know governors have many times gone to school on what happened with ten care, and you set us an example of what they did not want to do i would like to have a response here. i do have some questions. on what you would see as the lessons learned and what you would not want to do that was from the template. what were the lessons you learned? do you realize that you can't provide gold-plated all health care for free for everybody? do you realize that a public option which is government-run, government financed, does not work in competition with a private option. that's one question i have. the second is medicare advantage. i know you have a heart for dealing with health care for

seniors. i appreciate that. my constituents, i have 56,000 seniors in tennessee on medicare advantage. they very much want to keep those options. i would like to hear from you what you envision a medicare advantage program looking like once the obama plan goes into place. how you see that being delivered, what you think the options are going to be. it is of concern the options are going to be restricted. when members of this committee sit here, when we hear from constituents the panic that they feel, especially from seniors who say, look, i've paid. >> what's going on with the mike? do we know? >> my mike is not being touched.

>> now it's okay. >> okay. but seniors are very fearful that they have paid into a system -- this was a part of their retirement security, a part of their savings, if you will. because it was money that the government took first right of refusal on their paychecks. took that money out. and now you've got somebody in their 70s, they've got doctors's set, medicare advantage set. they have their system in place. and they are seeing this savings devalued. finding out now it's going to be a one size fits all program. this is a great concern to all of them. your responses to what medicare advantage would look like would be appreciated. >> congresswoman i would be happy to answer both of those questions. i can't do it now in person as you said earlier. you wanted to address the question and have me respond.

i will do that promptly. >> thank you. i appreciate that. at this time i will yield the balance of my time mr. chairman -- >> i couldn't hear her? mr. pitt. >> thank you. section 222 of the bill states an amount for purposes of starting up the government government plan. that is to be applied in the text of the bill. do you have any idea how much it will cost you to start up this government-run plan? >> no, sir, doi not. >> you mentioned the president's repeated promise that the health reform bill will be neutral. are there any other deal breakers? does the legislation have to include a government plan? does it have to include an individual mandate? does it have to include an

employer mandate? can it increase taxes on families making under $250,000 per year, for example? >> i think the president's principles are that the plan needs to lower costs for everyone. needs to improve quality of care, needs to provide coverage for all americans. and around those principles that he -- and be paid for within the period of time. those are the fundamental principles he's ar the ticklated. during the course of the discussion various proposals on some of the areas. i misspoke to the congressman earlier. st proposal he had for the itemized deduction return is for families making 250 o$250 or mo $250,000 or more. i was corrected, and i'm happy to provide the additional information. >> the gentlewoman's time has expired.

now, i'm just going to repeat -- i know you have to leave. members will get back to as quickly as possible with written questions. we would ask the madame secretary to respond as quickly as possible. >> very quickly. >> thank you so much for being here today. we appreciate your time. thank you. now let me explain. we are going to adjourn the full committee, and then the subcommittee reconvenes, the health sub committee reconvenes at 1:00. and we have three panels for the rest of the day. mr. chairman -- >> mr. diehl. >> mr. chairman, with all do respect to the secretary. this was billed as a legislative hearing on a draft. >> yes. >> we have heard the secretary say she did not participate in

the draft preparation, nor has she apparently as she said had the opportunity to read it. one of the situations we all labor on in this time frame. i would simply urge you to urge our full chairman of the full committee that it would be mandated that she return to answer questions when we move to a legislative proposal. we're talking about a draft. hear we be allowed the opportunity to answer -- to ask and to have answered questions. you made the statement she was speaking on behalf oaf the obama administration as it relates to the draft. i think there are specifics that we should have the opportunity to ask specifics about. i would urge you to urge our chairman toe ask her to return to this committee. i think it is due diligence for all of us to have the opportunity to explore these

questions in person with her. >> well, let me just say, i can't make that commitment, mr. diehl. for various reasons. a part of it is the fact that we're -- you know we have a draft. obviously changes based on your input. we really asked her here today to comment on what the administration thought about the draft. the bill is never going to be exactly what the president wants. i just can't make the commitment. i appreciate your asking. >> you were saying you can't commit to ask? >> i can't commit -- >> his request was that you ask -- >> she's been here. she's testified. you can ask her questions. i'm going to leave it at that. we're going to adjourn. >> object! >> subcommittee hearing at 1:00. >> there are 12 republicans that have not had a chance to speak and ask our questions. >> members were told that she was going to leave at 12:00.

>> we understand that. we're simply asking she comes back. >> i can't make that -- >> you're refusing to ask a question. >> i can't make that commitment. we're going to adjourn the committee at this time. >> can you at least commit to ask the chairman? >> that's it? >> gentlemen, look. i'm going to certainly express your views. but i can't commit the secretary to anything at this time. >> request a recorded vote on a motion to adjourn. >> you can make the request, sure. all those in favor? on the motion to adjourn. let me just ask parliamentary point of view. >> we already have a motion

before us, a motion to adjourn. the chairman has entered that motion. >> i think what we'll do at this time -- we had a vote and it was defeated to adjourn. so at this time we're just going to recess. >> we asked for a recorded vote. we asked for a recorded vote. [captions copyright national cable satellite corp. 2009] [captioning performed by national captioning institute]

>> coming up next on c-span, critics of president obama's health care proposal discuss the issue at a forum called americans for tax reform. at a white house briefing, officials announce changes in college financial aid and news about iraq, iran and north korea from wednesday's pentagon briefing. >> tomorrow on "washington journal" woul talk to congressman rick boucher and eric cantor. also former homeland security secretary tom ridge and journalist david frost. and on c-span three we'll continue our live coverage of the senate health committee as they continue work on