people said you can't do it. it can't be done. you can't deliver good care and cost cut costs. well, i think we're on our way and in year three of doing exactly that. we see that same strategy into the future where you can actually figure out care strategies that work to benefit a growing number of seniors. we have 11,000 people a day turning 65 in this country. each and every day. we have the largest number of medicare beneficiaries ever involved in the program and yet we're on historic low in spending. .4% in 2012. never been seen before and as congressman kind said, the c.b.o. reconfigured their projections into the future years. so i think the president's budget captures the negotiation that there are very effective strategies that deliver appropriate care, make sure that

we take seniors' needs into account. we continue to update quality programs, at the same time constrain the costs into the future. >> all right, thank you. mr. ryan is recognized. thank you. >> i guess i should pick up where mrs. sanchez left off. the difference in our budget approaches were we make sure all of the medicare money stays in medicare. chief actuary of c.m.s. was here just a year ago saying you can't spend the same dollar twice. you can't on the one hand count savings from medicare to pay for obama care and count it as savings to medicare. he even went so far to put appendix in the report to that effect. the other point is in our budget we put a reserve fund, which is a budgetary mechanism to address any inadequacies in the community that may arise if the case occurs where we feel like providers are restricting access to beneficiary because of these cuts. so that's just to answer the

difference with the paradox, so- called. i have three questions and i just -- you just released your budget this week, madam. good to see you, by the way, madam secretary. first on the means testing for part b and d, you have in your s-9 tables, you have $50 billion savings associated with that. before we had mutually agreed on policy $30 billion in savings, where is the delta. where do you make up the difference, $20 billion? >> the difference, congressman ryan, is that there are -- there is a new formula rather then having i think what we're in the past four different categories. it's now nine. the lower limits -- >> the top still 80 or going up to -- up to 90? >> the top is 96. 196. >> no, no. the percentage, the beneficiary pays of the --

>> yes. it's still 90%. >> 90%. >> more categories -- >> still kicking 80,000 for individual and 100 -- >> i can -- >> 160 for -- >> i would love to get that you in writing just so i can make sure i don't -- >> i really want to know, so -- >> there are more categories and slightly different starting point and different ending point. >> different starting point on income or different starting point on thresholds? on percentage of the premiums that the person bears themselves? >> the percentage of the premiums the person bears themselves. >> ok. >> yes. >> all right, $20 billion is a pretty big difference. >> i would be happy to get you all of the details. >> so your medicare advantage demonstration program, which i think scored $8.5 billion where you're offsetting 71% of the hit

to the a.c.a. in 2012 and 32 in 2016 if i recall, i don't see that here in the budget. did you not put that in your budget? that's a pretty substantial change in mandatory spending, especially for a demonstration program. is that not in your budget? >> it's in the baseline, congressman. it's still going on. and i think the very good news is we're seeing beneficiaries choose higher quality programs and still very much on track to actually pay medicare advantage plans at the same rate fee-for- service plans will be paid on even faster pace, including the quality demonstration plan. so it's all working very well. >> you're sticking with the formula phasing it out in 2014? >> yes. >> ipab -- i'm sorry trying to watch time here, and i'm not going to ask you to pore through your budget here, but in the past you have not had attributed anything to ipab in your budget before because your threshold of growth rate, g.d.p. plus .5 was above what you estimated cross growth to be but now you have

savings starting in 2021, 2022, 2023, so that ipab is actually starting to score positive savings. how do i interpret that? does that mean you believe excess cost growth at the end of the budget window is starting to perforate, g.d.p. .5? or are there new proposals associated with ipab that accrue savings? >> congressman, there are not new proposals that accrue the savings except this budget captures the president's belief, which is different then the affordable care act, which is ipab should kick in at g.d.p. plus .5 rather then g.d.p. plus 1. >> that was in your budget last year as well. >> i understand. this is really based on just the actuary's estimate on what will happen in outlying years and when right now as they look at the snapshot into the future, as you just heard the c.b.o. estimates have revised long-term strategy.

i think it can be revised again as we say on sustained cost reduction. but that's just reflection of when they feel that the trigger point might meet. >> that's the question, so the actuary is now saying ipab mandate, keep spending within g.d.p. .5, which last year's budget didn't happen in the first ten years because cost below that, medicare below that. so now that i saying it's triggered and it will occur in 2021? if you could just answer briefly. >> can i get back to you on that? >> yes. >> my understanding is -- >> huge but effects in the out ear. >> i thought the old projection was 19 that ipab would trigger and it's now moved to 21. i need to check. that's certainly my understanding. >> thank you. miss schwartz is recognized. >> thank you. i'm pleased to have you and appreciate some of the good information that's been discussed this morning.

particularly in relationship to the unequivocal progress you made in the last three years in implementing affordable care act and continuing growth and cost in the private sector and public sector in between medicare and medicaid. some really important work is going on in this country and i think we moved that dial forward. you have, administration has in really quite extraordinary ways. so it bodes well for the future as we stay on this course. there are a lot of challenges you face. i know in states like mine, where there are real issues where the federal government will have to step in, you're going to have to step in to assure pennsylvanians benefit from the increased opportunity to buy insurance. and i hope we can continue to build on some of the really important work we're doing in some ways on health care delivery system reform. so i wanted to ask you specifically about an issue, i know i have been pushing on pretty actively. you won't be surprised i would raise this issue but it's one

that had some bipartisan support, as you know, repeal of the sustained growth rate, finally making a decision legislatively. i know you need us to do that, which is to recognize that we're not going to implement sustainable growth rate. we should not. we're not going to cut physician reimbursement in this country by 10% or 20% or 30%, which is all possibility, and the budget that the president has proposed actually says that. we're going to repeal and replace it. and you added, which is very important to me, it's not just saying this failed. i wasn't here when it happened but it failed and we're going to recognize that. it's really about moving forward in a way that does sort of universalize the -- what you have been talking about some this morning. we should be paying our health care providers differently, that would make sure that all providers in this under medicare meet quality standards that are accountable for that, that are transparent that help them do that. we're doing that.

but we improve the health status of our seniors in particular. think of it as a role for younger people as well but we actually pay them in a way that encourages that. encourages them to meet these standards and contain the rate of growth and cost. i have written legislation to do that. there's a lot of interest here in ways and means to pass legislation that would give you the tools to do that. i've written legislation to do that. there's been a lot of interest on the part of the health care subcommittee on ways and means to pass legislation that would allow you to do this so it wouldn't just be interesting demonstration projects in the states but exull -- actually changing the way we reimburse physicians in this country. i appreciate the language you put in and i would ask you how to speak to how to get there. i know mr. brady's been very heap -- helpful on this but to just see if we could get this

done this year, rather than saying we're not going to implement the sgr this year. and to rm not hold them back from embracing some of these new ways of delivering health care that meets the needs of seniors in this country. you want to help us out on that? your leadership could be very helpful. >> congresswoman, i know you've had a lot of interest in this for a long time a -- and i appreciate your leadership in this area. i'm sure appreciates that the lingering uncertainty of the s.g.r. cliff is probably the single biggest issue threatening the health care of our seniors. there is way too much time spent every year with doctors coming to capitol hill trying to get a fix that then takes them down

the road for the next 10 or 11 months and then they start all over again. so, starting, having a long-term strategy, we're eager to work on it. what we've proposed in our budget, and it assumes that the s.g.r. is fixed but we'd like to propose a couple of years of sort of status quo, if you will, done by congress a year at a time and then working carefully with this committee and others who have a great deal of interest in this and certainly the provider community on formulating a value-based pay ment system that would be our future look at how we pay medicare providers, very much recognizing that payments should be tied to outcomes. it should be died to care delivery, to protocol. i think there are ways to do that. we're beginning to see medical home models and a variety of

strategies. the other thing that's going to be in place which is a key part of this is the broad implementation of electronic health records by for the first time will actually capture and measure what is actually happening in the marketplace. so we would love to work with you on this. >> and this is really very b b -- bipartisan. >> it is. and we have released a memorandum and outline and phase one and phase two with our friends on the energy and commerce committee and are working as well on a bi partisan way on this issue the dr. price is recognized. >> thank you. we are talking about the budget here. your comments in opening remarks talked about this budget strengthening the economy, providing middle class job growth and a, quote, thriving middle class, quote quote and i just

thought i'd share are you -- with you a couple be examples from the real world. car dealer in my town, 168 employees. because of the a.c.a., because of the a.c.a., 166 of those employees will be moved from full time to part time, 28 hours a week. a fellow visited my office this week here in washington, has a number of burger king outlets. over 900 employees. moving all but five of them to part-time. because of the a.c.a. madame secretary, that's not going to lead to a thriving middle class. not going to lead to job creation. this bill is harmful to the economy, harmful to job creation, and as a physician, you and i have had conversations and i can tell you that i believe it is fundamentally harmful to the quality of care and access to care that's provided by the doctors out there who are trying

as hard as they can to take care of their patients. to that point, this budget has $374 billion in new reductions in medicare spending, $307 billion of that in the provider high, the doctor payment. that's not a positive move. the guys and gals my age out there practiced in medicine are looking for the exit door. what's their strategy to be able to survive in spite of the law being put in place? v.h.r. is a classic example. rural docs out there in small community trying to care for patients and this imposition by the federal government makes it such that they're going to have to close their doors because they can't put in place the a.h.r. there is a piece of legislation

by ms. black that would take care of that and i urge you to take a look at it. and the other is closing the exception. as you know, often services provided in a physician's office are more efficient, more cost effective, have higher quality of care than in any other setting, yet this budget closes the in-office care option for radiation services, other services, something that medpac themselves said ought to be equalized so you don't incentivize one place or the other. is there any reason for why the in-office exception is being closed? maybe you can get back to me on that.

>> i just wanted to verify, doctor, what i thought was the case, and what we're looking atd is the utilizeation factor that often on the same day we're being -- seeing an increase billing, but i would like to get back to you in writing with some of the rationale behind what you have just identified. >> please do. same-day utilization of services is oftentimes the most convenient for patients. >> that's true. >> it may not be for government but for patients. >> we're not trying to diminish the number of -- well, just trying to diminish the number of billings that weigh patient is actually accessing a physician. >> heaven forbid that the patient should be cared for in the physician's office. i understand that. let me move to medicare part b. quality of care for cancer patients in this country is

being harmed because of a decrease in access to care because of a decrease for cancer drugs in the office setting. your budget proposes a further cut in cancer drugs through medicare part b drug services. is there any rationale for that in -- >> actually i think, congressman, what you're rougher referring to is what happened with the sequester cuts -- >> the cuts were a.s.p. -- your budget is 3%, a lower amount. >> but actually the cuts in the budget that we have put forward would not interfere with the administrative service of the cancer drugs. those are held harmless the we're taking an additional cut actually from the drugs themselves. what we learned during the drug shortage is that it is not the pricing of the medicare pricing that's impacted the shortage at all.

what happened in the sequester with that blunt cut of 2% across the board is that the entire cut actually came out of the physician' side of that puzzle and it did not affect the cost of the drug, it affected the administration of the drug. that's why some of the cancer centers told us they were choosing not to admit medicare patients any longer. >> correct. and that's increased in this budget the thank you. >> mr. reed is recognized. >> thank you, madame secretary for being here today. i'd like to take some of my time to focus on a very important issue to me, and that's the solvency of medicare itself. in particular the part a trust fund. you are a public trustee obviously for medicare, and the report in 2012 indicates that part a will be bankrupt in 2024. do you agree with that report? is that still when the trust fund will go underwater?

>> well, i think with this budget we've added four or five years again to the life of the trust fund. as you know, the a.c.a. i think added eight years to the life of the trust fund, so repealing the a.c.a. would actually accelerate that timetable significantly. >> with this budget under your opinion is that you move it five years. that essentially means everybody who is -- >> four years. i'm sorry. yeah. >> four years. so that means everyone who is 51 years of age today and younger are being promised by the president's budget and your office that medicare part a will be bankrupt in is that correct? >> well, sir, as you know, first of all, it isn't bankrupt. it's that it would bring in less than is anticipated going out. we have two opportunities -- >> no, no, no. that didn't -- >> 25% short -- >> it brings in less. >> so we're using the same term,

what would you describe it as? >> well, bankrupt to me means out of money. >> what term would you use? i've had this discussion with people on the other side of the aisle. they say bankrupt is not the right term. insolvent? underfunded? >> well, it's underfunded i would say. i think we have great opportunities between now and then to change those projections dramatically. >> between now and then. but as of today the best we can do -- >> the vote taken by the majority of this committee would move that insolvency date much closer to where we are right now. it would actually accelerate the date because eight years of the trust fund were added with the passage ever the affordable care act 79 we would love to continue to work on strategies

with this committee, keeping medicare benefits in place and making sure that we can accommodate them into the future. >> so the plan i'm hearing from the administration is we're going to take each year small steps to fix -- push it out two or three years and not fix the problem in perpetuity? see, i'm interested in solve, fixing the problem. i want people to look at that 2024 date and have people who are 50 saying it's underfunded? i'll use the term bankrupt, or underfunded. that's a real problem. i want top find out what the plan is and all i'm hearing is we're going to take it each year by year and move that three or four years.

what is the long-term plan? >> we would love it work with congress on a long-term plan with the contingency that the long- term plan is not to destroy medicare as we know it. that's what's been put on the table, that in the future seniors would not count on a guaranteed set of benefits. they would have a voucher and negotiate with their care -- >> i'm familiar with how -- >> rm and beneficiaries -- >> i'm familiar how you categorize and classify the house republican budget and the proposals on that. but the bottom line is that the system is going bankrupt. it's underfunded and we need to solve it and all i hear from you today, is we can't change the program. medicare as we know it cannot be changed. >> in the last four years -- >> if you would wait for the question i have for you, madame secretary. do you think we can balance or make medicare solvent in

perpetuity by leaving the system in the exact same way that it is today? >> i don't think the president or our administration supports leaving the system exactly as it is. and i would suggest in the last four, years, sir, that with the legislation passed and with the budget that's before you, more significant changes are being put forward than have been put forward in decades. we would love it continue to work on how to preserve medicare well into the future, keeping the promises that we made in 1965. >> all right. thank you. thank you. >> now we'll go back to the beginning. i just want to know for the record that our budget does have a guaranteed benefit in it. last week wall street journal columnist peggy noonan dedicated her column to the vixary leader who created modern singapore. in describing the book, her

words, she said he is bullish about america's immediate prospect but concerned about the long-term prospect and greatly concerned about the prevailing culture. and to quote him, a major problem is the day to day violence that people are exposed to on television. i'm concerned, madame secretary, what you think is the linkage in our culture between violence and our kids, and young adults, particularly troubled young adults. are you concerned about the pervasive violence in our culture and entertainment industry? >> well, mr. chairman, i am concerned certainly about the pervasive culture of violence both throughout media, in the entertainment industry, movies,

on tv, video games, but also on our street corners. the number of children who live in extraordinary violence day in and day out -- they don't have to turn on the tv. they have to walk outside. i think we have a culture of violence in this country that is alarming. it clearly has different impact on different people, but there's no question that i think it does have at minimum a desensitization for a lot of developing minds about what the impact of violence is and certainly for someone who is disturbed, may have even a more frightening impact. >> does it concern you, then, that the federal government provides subsidies to some of these industries, often through the tax code? and should the federal government be in the business of subsidizing something such as

this that may contribute to the breakdown of mental health in this country or contribute to this culture that people find outside, as -- if you will, and the desensitization that occurs on the street as well as in the minds of those who are troubled? >> again, i think, mr. chairman, that's an appropriate conversation for those of you who are looking at the tax code to have. i do feel that there are lots of influences throughout our culture that impact folks and what the appropriate balance is between industries that we want to encourage and censorship and what they do i think is always open for debate. but i do share your concern that there is a pervasive culture of violence both through the media and the answer -- entertainment industry, but also also i think, america is a violent country and that's acted out in neighborhoods and on

street corners on a regular basis and that has an impact on our health, on our mental health, our communities, on our kids. >> all right. thank you. mr. levin is recognized. >> mr. chairman, in a way i'm kind of glad you shifted the approach from mr. reid's approach to violence. i share your hope on that hand and hope the senate will act on gun violence in the next weeks and bring it up to the house and we can look at the tax code, too. i'm sorry that -- mr. reed is still here and i just want to say something if i might because i think we have a friendship -- look, health care reform isn't going to be repealed. i think everybody should accept

that as a given. and for those who wanted it repealed, i think the case has become more difficult because of the diminution in health care cost increases. they've been going down now for three years, madame secretary? >> yes, sir. >> and there's some evidence that in part it's because of health care reform. >> will the gentleman yield? >> let me just finish. >> ok. >> also there have been some clear benefits, and you mentioned, madame secretary, some of them. the millions of younger people now insured. as an example. the millions of seniors who now are paying less for prescription medicines.

so i think with that situation it's hard to -- for those who opposed health care reform to be sure what to do. and i just urge that there be resistance to overstating, to doom and gloom, and i think often to kind of scaring people. that's why i think the secretary resisted your characterization of medicare going bankrupt. on this committee we have faced underfunding of medicare many, many times. you were in control for a number of years. and there wasn't this perpetual

long-term resolution of the problem. but again, many times we've faced underfunding and sometimes as a result we have reduced provider reimbursement. what health care reform really does in good measure is to begin the path of changing from fee- for-service to a very different reimbursement system. and while there is some agreement across party lines on this, in terms of scare tactics sometimes they've described ipab as a death panel when it's really not that at all. let me just quickly ask the secretary, and then if there's time i'd be glad to yield.

i think another kind of doom and gloom approach of those who never wanted the health care reform that's not going to be repealed is to talk about premium increases. so just address quickly, if you would, your feeling about what's going on. >> well, congressman, the insurance plans are in the process of beginning to submit preliminary estimates on rates in the new marketplaces. those will be negotiated by either the state-based markets or the federal market and by later this summer we will have a clearer picture the again, what we know from the congressional budget office is that the estimate is that rates will be significantly more competitive than people find them right now.

there will be an elimination of a lot of the overhead and administrative costs. there will be competition as a market strategy. i've seen this as an insurance commissioner, it does work, that when plans have to compete side by side and it's very transparent, that in and of itself drives prices down. so we are anticipating having people, if you compare policies to policies, what they have now and what they're going to have, a very beneficial set of rates and benefits that people will have an opportunity to choose from. some of them for the first time ever in their lives because they've been priced out of the market. >> thank you, madame. i appreciate that. all time has expired. i appreciate mr. reed's concern about the need to save medicare. the clock is ticking. we need to act now, republicans and democrats. i don't see that as frightening. i see that as a genuine concern for a program that's in very severe financial straits.

to try to bury our heads in the sand is really the wrong thing for our seniors. i think the only scare we heard is the witness' claim that the republicans want to end medicare as we know it and didn't that win award for the national political untruth two years ago? maybe we'd be better off if we actually came to the table together and figured out how to save medicare rather than throwing out what everyone knows has been discredited? and to that point i'd be cautious claiming that the slower growth in health care costs from from obama care. independent experts don't say that's the case. in fact, 20 million people can't find a job. many more have just given up looking for work the it's jimmy carter days for them. since the recession you are more likely to go look for food

stamps to feed your kids than to find a job the it's clear that if you can't find work and can't feed your kids, you're likely not going to the doctor. so i'd be cautious at a time when the stimulus claims why exaggerated and the sequester, claims were exaggerated. let's stick to the truth the this is the marketplace timeline for the exchanges. that's for the public as well as lawmakers to track how the exchanges are on track. but as i look at it what i see is deadline after deadline missed. it says if the agency is in disarray trying to meet the october 1 deadline, the final market rules and regulations was

missed. the payment notice rule was missed. the business rules for information technology, that's two months delayed. you recently announced a delay in the choice option for small businesses. you've also delayed the basic health care plan for year five of it. and so these delays are having real impacts. real people are concerned about these delays, and the failure by the agency to meet these deadlines raises real concerns. so my question is, do you have a plan b? do you have contingency if the exchanges are not ready, up and running with a fully physical -- fully informed public, by october 1? >> as i answered before, congressman, we will be open for open enrollment october 1 of 2013 and we will be enrolling americans across the country january 1, 2014.

>> so at this point you've had no discussions within the agency on contingency plans? >> well, we have lots of contingency plans -- >> for meeting the october 1? >> no. we are determined and on track to meet the october 1 deadlines. >> so you can assure this committee there will be no further deadlines missed, no further delays in the implementation of the exchanges? >> we are on track to meet the october 1 deadline. >> the question again, because i think we're all concerned, republicans or democrats, you can assure us there will be no >> congressman, i can only tell you what i am telling you. we are on track to meet october 1. i can't tell you what exactly will happen at every step along the way but i can tell you that is the determination. we are on track to meet it. we test it -- >> well, you're not on track to meet it. that was the question. >> pardon? >> you're not on track -- >> we are on track to meet the october 1 deadline. >> so again, there will be no further deadlines missed?

no further delays? >> i -- again, i don't know quite what that means. will a rule or reg be a week later than it might say on the paper? it could. we will be open for business october 1. >> so no delays. that's great news. no further deadlines policed. that's great news. we're still waiting at small businesses on the business information notice that's two months late. is that being delayed again this week? next week? are we seeing another ongoing delay there? >> i think, sir, that is not ours, it's the labor department's notice. but my understanding is it's imminent. that is not an h.h.s. rule that's coming out. >> ok. thank you very much, madame secretary. mr. rangel is recognized. >> thank you. thank you so much, and again thank you for your service. i'm concerned about the american

people that are now doubtful as to whether or not they would have health insurance and also the fact that i don't know whether history will record such political opposition to any president with a national plan. all of my political life i had hoped and dreamed that we would have universal coverage, and now we have had -- it and for some reason it's become a political issue. 40 attempts, or 39 attempts have been made by the republican party just to repeal it. not to substitute it, not to improve it, but to repeal it. and of course they substitute that with just confusion that it's not going to work, it's going to fail, as though there were only democrats or potential democrats that were going to be the beneficiary of the

program. so we have to find some way to bring truth to the american people no matter what their political persuasion is and i hope that you can do this by telling me exactly how many americans would be affected since we've got to assume that we've already -- the president has won. the supreme court has sustained this. and the first question is, is obama care here to stay politically speaking? is there anything you can think of besides withdrawing the president, having a recall with the president or another case in the supreme court? the supreme court has sustained this and the first question is obama came here to say politically speaking, is there anything you can think of besides withdrawing the president, having to recall with

the president, or another case in the supreme court. obamacare is here. you suggest that the best we can do is to improve it, if we don't like it, instead of just opposing your efforts. my question is how many americans are going to be affected anyway? those who have insurance are not going to be impacted, right? >> i would say in terms of the new marketplace, a fairly small number of americans will be impacted, about 41 million eligible folks who don't have insurance at all and another 14 or 15 who are in the small individual market. >> do you know the political persuasion of these 41 million people who have no insurance at all? >> do i know, no. >> republicans or democrats. >> they are americans. >> right. what could the congress do to make certain we provide -- to help you provide universal coverage at the least cost and

the best quality? what would you expect this branch of government to help the executive branch to do this for all americans? >> i certainly think a huge step forward was the passage of a comprehensive health reform, which has been proposed by republican and democratic presidents for over 70 years. we finally have a framework to work on. you asked how many people were impacted and i gave you the answer for the marketplace, the new insurance fees. i think every american will be impacted and benefitted by the delivery system change, better care, better population health, more effective ways to deliver care and making sure we no longer continue to be the -- spend the most with immediate

mediocre quality. thanks to the innovation center, that could change the profile and make us more competitive in a global society. >> since you're unable to give us assurances that these programs are going to be open on time, is it safe to say that your assurances to say we are on track depends on some cooperation from the congress? is it possible that we can legislate something to avoid you following the guidelines that you have been planning? >> again, sir, i don't know how much more specific i can be. i think we're definitely on track to implement the law as it is anticipated.

>> that's the assumption you're going to have positive support from the united states congress to do this? >> it would be helpful. >> thank you. for the final question of the morning. >> welcome. it's great to have a buckeye here with two michiganers here with the chairman. i would like to send you an article from last week or the week before to his point of a small business owner who has less than 50 employees that was planning to grow his business beyond 50 employees. he said in the article he's not doing that because of the affordable care act. it is a problem i've heard about from lot of employers and this one was willing to say it to say it to a reporter and explain

why. i'm not trying to be political about this. but mr. chairman just asked about the political persuasion of people without insurance today. i was on this committee when we passed this bill and i like you a lot. there's a lot of concern from everyday people out in my district regarding the implementation of this bill. the president over and over said, if you like what you have you can keep it. let me tell you a story from my district. from a company that i met with a couple of weeks ago, self- insured employer. the h.r. person was looking at this and trying to implement this law with their employees. they have a great plan.

their employees love their plan. their employees think they can keep their plan. through their ability to look at this implementation, they found out that their plan with no added benefits will increase by 10% at least. the $60 fee that they are going to be paying alone will cost over $1 million with absolutely no, no change in their policy because they already participate in what is called the -- just so i'm clear on this, the plan that covers people with pre-existing conditions and in order to take care of their employees through the early retiree subsidy program.

they don't get a penny from that. they are trying to figure out what to do next. what is clear is they are going to have to increase cost if they keep what they have to those employees. those employees don't know that yet. i'm not trying to be difficult here. i'm trying to explain the concern that members on our side of the aisle. i'm not going to defend the old system. they are super concerns about the new system. what may happen -- again i'm not trying to be difficult, they may choose to put all of their employees into the exchange. so their employees may not be able to keep what they like, which was a promise of this committee, when the majority was in the minority's hands. their employees don't know that yet. the satisfaction surveys that they have received from their employees from the plan they have are overwhelmingly good. this is a company who have prided themselves on health

coverage, deal with obesity, dealing with cancer, dealing with pre-existing conditions. the choices from nonpolitical h.r. people there -- i could see it in their eyes how troubled they were with where they were going to have to go and asked me is there any sort of opportunity to change this for folks like us? i said i don't think so. you might want to contact mr. brown. he might have more luck doing it. i'm not trying to be political. i think ultimately, these are my constituents and they are democrats, republicans, and independents, nonpoliticals. their health care is going to change, according to their experts, for the worse. i know your history and i know you care about this. maybe you and your team can be

more engaged with some of these employers who are very, very nervous about the future of the benefit they have provided. they were not ones we're trying to get at in terms of access to health care, if that makes any sense. >> it does. and trust me we are trying to be very engaged. i meet with employers in varies various parts of the country as i travel around. i think as we move into full implementation, i'm hopeful some of the projected fears will be relaxed a bit. it's very difficult until -- the case you're talking about, congressman, is a self-insured plan. so they are looking at some certainty in terms of what fees there may be in the market versus the penalty they would pay if their employees are then

tax eligibility and they can do some calculations. i'm hoping in the long run that employers who have been in the market voluntarily because they find a benefit to their employees will move forward with that benefit. that's what we hear from folks and the people who are locked out of the market because they did not have any affordable options, they did not have an ability to provide those benefits will finally have some choices based on private plans in their states who have to compete for the first time with a new set of rules. but i will continue to do the outreach and we would love to have a chance to talk to some of these folks about what they are looking at. >> thank you very much. that concludes today's hearing. i want to thank you for your time this morning and your testimony. with that, this hearing is adjourned. >> thank you. [captioning performed by the national captioning institute]

[captions copyright national cable satellite corp. 2013] this documentary comes from students from knoxville, tennessee. their message for the president looks that foreign-policy in the middle east. they are third prize winners in this year's student cam competition. >> the problem with war is that you know when it starts but you

don't know when it finishes up. it's completely unpredictable. we don't know what the other side is going to do. ♪ >> dear mr. president, iran is capable of developing nuclear weapons and threatening israel. my family is from israel. >> what unites everyone in the political system in israel is a deep concern about iran's nuclear program and a strong assumption by international bodies in the united states that iran is pursuing a nuclear weapons program. but the preference among me israeli elite is that

international community led by the united states, and others, will do with this problem as an international problem. >> this will not only affect the student and her family but also have worldwide repercussions. for the saudi's to get a nuclear weapon if iran does. then we could have a nuclear arms race in the middle east. the turks, egyptians, everybody is going to want a bomb. was -- wouldbomb ite the whole middle east -- is very dangerous. about how much it will do to the nuclear

capabilities. some people estimate that it is only a year or two worth of setting them back. >> is of an, a problem, a threat that the israelis have been thinking about for a very long time. they have spent a great deal of effort trying to figure out how to develop a military option to disarm iran. >> israel would very much like to stop the iranians before they become too much of a threat, but they would like help from other countries, specifically the u.s. however, an alternative to the --ctions >> i think the most important sound the bell to the world about this in a way that has led the united states, european allies to take

seriously this problem and to impose on iran that sanctions should become very severe in an attempt to persuade the iranians they are better off without nuclear weapons than trying to acquire them. >> the eu put an oil embargo in place in july, and we have certified that every single one of iran's oil importers have either significantly cut or completely ended their purchases of iranian oil. we have been able to put unprecedented economic pressure iran while on minimizing the burden is on the rest of the world. quite the best option -- >> the best option is some kind of deal, a deal that would verifiably stop the nuclear weapons program. without nuclear activity. it would give iranians some

respect from the heavy sanctions. >> mr. president, some people, including israel's president netanyahu must say that the work that you have done has done nothing to stop iran. >> for nearly a decade, the international community has tried to stop the iranian nuclear program with diplomacy. that has not worked. iran uses diplomatic negotiations as a means to buy time to advance its nuclear program. >> the problem with using force to stop iran is the damage it will have on our economy and the loss of lives that will come from a war, especially a nuclear war. >> especially a war like this. iran is a very large country. israel is very small, but it has very large military capabilities. a conflict between the two countries, if it were full- blown, would very likely involve

other countries in the region. the countries do not border each other. >> many people say that to prevent war, we must take all possible efforts to stop iran. >> it is essential. [indiscernible] winston churchill said it is aw van to war a j war. before there is any resort, there needs to be a major diplomatic measure. it is possible to resolve the differences between them, to direct negotiations, and if that

but if it is not we can say that we tried in every way to avoid the deal. and that is essential. >> mr. president, this means that in order to protect our allies, the u.s. needs to make a decision regarding how they will respond to iran's threat. would like to stop israel from attacking your laterally, -- unilaterally. it is in a difficult situation where needs to do two things at once. -- comment as to critically one, it has to critically convey its resolve not to let a nuclear weapon program in iran. , there the u.s. resolve

is very little that will stop them from doing it. >> on my annual visit to israel , i visited a member of the israeli parliament. >> our target is very clear -- recognition, respect, trust, from that we need to make he's between nations. >> congratulations to all of the winners in this year's student cam competition. to see more winning videos go to student cam.org. >> next come live, your call and comment on "washington journal." in a discussion and house hearing on the keystone pipeline project. after that, some of the speakers at wednesday's immigration rally on the national mall.

>> orphaned at age 11, she lived with her favorite uncle, james you can appeared years later, he becomes president, and because she is -- because he is unmarried, she served as white house hostess. hasis so popular that she friends and chill -- ships are named after her. along with your questions and comments on facebook and twitter. first ladies, monday night, live i 9:00 eastern on c-span and c- span3, also on c-span radio and c-span.org. >> this morning, radio and tv talkshow host armstrong williams discusses republican efforts to reach out to minorities. then bloomberg business reporter talks about students loan rates. and then dr. per tricia quinn