that? >> it is a good move. it is one that we've certainly encouraged and supported. because the tensions in the region that go well beyond saudi arabia and iran but are being played out including in places like syria can best be addressed by enhanced communication and we have supported that. whether it happens and what comes of it we will have to see. >> you came back from a trip with israel and met their leaders and you met with the palestinian leaders. any hope for serious peace talks in the coming year? >> any hope? i think those of us who work in my business always have to have hope. and i do. but i think that we are clearly

at a point of pause in the direct negotiations that were going on for the last nine months. and we have made clear and my message to both sides was that the only sustainable solution to this tragic conflict is yet a negotiated two-state solution. that is our view. that is the position of both sides. but they are not yet ready to take the steps, i think, to actualize that. and also we have underscored in the meantime as we manage this moment of pause and as they manage this moment of pause more precisely they ought not to take steps either of them that make the circumstances more tense or more fraught. >> what has happened the last several weeks is that some of the u.s. officials involved in

those negotiations are now saying that it was the israeli government's expansion of settlements, specifically prime minister netanyahu to build 14,000 more housing units that sabotaged the peace effort. >> i think you have heard american officials say quite directly and what i have said and what others have said is, look, first of all we are disappointed that it wasn't possible to continue the negotiations. that has not been, in our judgment, the fault of one side rather than the other. both sides, in our estimation -- we said this very directly -- took steps particularly in the latter stages that were not conducive it a positive atmosphere and those steps included the israeli government's decision not to release prisoners and to continue settlement activity, but it included quite notably the palestinians' decision to accede to treaty bodies which is

something they previously retpraeupd from doing and was very upsetting to the israeli side. and the very surprising and untimely announcement of a bid to reconcile with hamas that came at the very end. so our view is both sides took steps that were disappointing and not conducive to progress, but both sides have the ability, should they choose, to resume the negotiations. >> but the israelis will continue to build settlements, so how do peace talks get started again under those circumstances? >> well, judy, if there were a phopbl wand we would have waved it and we would not have 60 plus years of conflict. i don't have the ability to sit here today and say here is our silver bullet.

i think both sides should have the responsibility to look at their circumstances, look at their future, look at their children, and ask themselves how do you fortunately a future of peace? both sides will have to make very difficult decisions to do that. we think it is in their interests to do so. israel has the prospect of becoming a secure recognized jewish state that has the recognition of countries throughout the region. that is something that it has sought and wants. the palestinians want a viable state of their own. they both say they want to live side by side in peace and security. that is a future we want for both but we can't want it more than they do. >> there are a couple other countries i want to mention.

one is china and what happened recently between china and vietnam. china is faulting the u.s. for encouraging provocative moves. now we have rioting going on in vietnamese cities purportedly against chinese factories but i guess other plants are involved as well. what can, if anything, the u.s. do to resolve what is clearly a growing area of tension in that part of the world? china has issues with japan and now vietnam. what constructive role can the u.s. play there? >> the u.s. has been very clear the only way to resolve these territorial disputes are through

the mechanisms of international law and peaceful resolution. whether it is the law of the sea convention or other international legal instruments. we have not and never have taken a position on the sovereignty of these disputed territories but we've been clear provocative action and steps to create facts on the ground that complicate the prospect for diplomatic resolution are unhelpful. that was the message the president took in part during our recent trip to asia, and it won wide support from each of the countries he visited where, in fact, what we are seeing in southeast asia are countries that want good and constructive relationships with china but are increasingly unnerved and put off by what they view as provocative and aggressive actions by china. we have been clear that what china has done vis-a-vis this latest incident of putting down

an oil rig and both sides employing shows of force to react in response to that is provocative and unhelpful. and what you saw behind closed doors at the azian meeting last weekend was a great deal of anxiety which doesn't serve kind well. china has every interest in the countries of that region wanting to partner with it. not talking behind closed doors of how to counter it. china wants to be welcomed and accepted as a major player, not just in its own neighborhood but on the global stage. to the extent it is becoming more isolated and the subject of

concern and opposition within its own neighborhood can't be a welcome development. >> i was just handing a card saying the chinese seem to be getting ready to build a structure on a johnson reef which is in the economic zone of the philippines. who handed me the question? where did it come from. i think that touches on the same thing you were saying. >> yes, it is very much in the same vein. we see the ambassador here from the philippines. we were just there a couple of weeks ago. the philippines have approached us, we think, in a very responsible fashion by taking their concerns and case to a tribunal of the international, the convention of the law of the sea.

that is the type of mechanism that we think can and should be utilized to resolve these kinds of disputes. >> ambassador rice, you are aware of the criticism that has been leveled at the president, the administration, for not being sufficiently strong -- i could quote other adjectives -- not being sufficiently outspoken, not projecting american strength and presence and values in the world. the president himself addressed this briefly at a news conference when was in asia several days ago. how do you see that? how do you address the frustration that there are so many parts of the world now that both look to the u.s. for guidance and leadership and help, military or otherwise, and on the other hand parts of the world, so many parts of the

world resent the u.s. role and don't want the u.s. involved? as you sit back or lean forward how do you see all of that and what do you want this audience to know about that? >> first of all, there is no country on the planet as powerful and strong as the united states of america, whether it is the size of our economy, the strength of our alliances, the power of our military, nobody matches us across any dimension. so the notion that the united states is we can or withdrawn is counterfactual. having spent time recently in asia and europe, where we were in very close consultation and communication with some of our closest allies and partners, our asian allies and partners and european allies and partners, i can tell you that they all continue to look to the united states as their principal partner, friend and source of strength and protection.

and those alliances are mutually reinforcing and beneficial. i was just in israel as i mentioned and prior to that on a separate trip into the gulf region. and each of our partners is looking to the united states and grateful to the united states for what we provide in terms of our security cooperation, our global leadership on issues across the spectrum, and the fact that there is nowhere else for them to look on the planet where you have the moral leadership, the economic strength, the security might, not to mention our technology, you know, the power of our culture and our society. the united states is very much viewed with -- in a very

positive light in all those parts of the world. >> finally, what is your one or two words of advice to young women here? >> why is that final? not that the time is not up. that should have been an earlier question. >> you can take as much time as you want. what is your advice to young women? >> i thought that was a large part of what we were doing here. >> to young women who are thinking about making a career in foreign policy and national security? >> do it. two words. first of all, i want to be quite frank and say i believe very deeply that young women and young people, not just women, ought to follow their passion. you should not do what your parents tell you to do when it comes to picking your career. you should not do what you think

is going to make you the most money. you should do what you love. and i hope for many of you that will be public service. that is what i love. and i -- when i was 20 years old i cover gone either way. i didn't know if i was going to end,in foreign policy, domestic policy, law. things happen the way they happen. but i knew from the time that i was 10 years old i wanted to be a public servant and i think it is a huge privilege to do so. i hope that many others will view it that way. we need the best and the brightest women and men to want to serve their country in one way or another. and there are many ways to do that. by the way, it doesn't mean only in government. i think public service encompasses the nonprofit sector, and it encompasses journalism and in many respects it can be accomplished in the

private sector if the work one is doing serves a larger goal and larger group. so, i hope that folks will follow their passion. i love being in foreign policy. i think there is incredible complexity, incredible challenge. it is never boring. i get to work with very smart, committed people and obviously in my case now for a president for whom i have enormous respect and i find intellectually incredibly challenging to work with and for. but i do hope that all of you who are thinking of these sorts of careers will look carefully into it and i hope you would find it as rewarding as i have. >> even with the political polarization? >> it would be better if there weren't.

for sure. you know what? since you mentioned that, going back to your prior question about america's role in the world and our leadership, the one weakness that our friends and partners point to, and the one thing that undermines our strength around the world is our political polarization. is the fact that when countries look at us, they wonder and they worry if we will have our collective internal act together. whether it is over our budget, whether it is over how we engage in the world. that is what undermines us, if anything, in terms of our international standing. >> it is also the strength of our democracy. >> but we have had the democracy for 230-plus years. it hasn't always been as dysfunctional as it can be now. >> on that uplifting note, let's thank the ambassador.

[applause] >> ambassador rice, thank you for a scintillating discussion and helping us understand what president obama faces every day. we would like to present you with the women's foreign policy group award called celebrating women leader for being a role model and encouraging support women worldwide to be part of foreign policy. thank you very much for being here. judy, thank you for being here. we hope to see you at another event soon. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2014] >> on the next "washington

>> tonight, the confirmation. the reporter who broke the nsa story. later, susan rice. journal,ashington michelle pickles looks at bothnic voters and how

local parties are trying to understand the priorities. the former ambassador to nigeria on the recent induction of girls. gina from the christian science monitor will discuss the changes after the recent elections. live.gton journal is >> i was looking at real estate listings for distractions. the most expensive house in connecticut was priced at $34 million in march down. what a deal. charmer.cozy

52 acres and a river. i was curious who owned it. i imagined it would be the chairman of general electric. i looked at the town website and zoningote in the records. the house has not been occupied since it was ought in 1951. it did not seem possible. i went over to see it. .he caretaker asked me i had not seen any clark's. i get paid every month by a lawyer. no one has ever lived here. there is no furniture in the house. i take care of it. it seemed more like a bird sanctuary. as i was leaving, he asked me a question. do you suppose she has been dead all of these years? on saturday.tch

steve vogel on the critical months of the war of 1812. john ross on missing soldiers. day, marked on washington and dan on the 2012 election. club selection. it calls you back. join others to discuss the book. >> you can take c-span with you wherever you go with our free c-span at. listen to all three channels any time. each is a schedule of network so that you can tune in whenever you want.

we have shows from our signature programs. take c-span with you. app to download the free your iphone, android, but very. namedsident obama has sylvia to replace kathleen sebelius. at a senate confirmation hearing, she answered questions about implementing the affordable care act. this is two hours.

>> finance committee will come to order. the finance committee meets today to discuss the nomination of sylvia burwell. she will be the secretary of department of health and human services. if one thing has become clear in the months since the president announced her nomination, it is that she is tremendously well respected. ledonly by those she has

and worked with in the administration, but by democrats and republicans in congress as well. that should not come as any big surprise. last year the senate confirmed her nomination to be the director of the office of management and budget by a vote of 96-zero. that was a big and well deserved bipartisan endorsement. ms. burwell's background of results shows why she has earned that respect. she is a graduate of harvard and oxford where she was a rhodes scholar. in the clinton administration as a top economics adviser to the president and the secretary of the treasury. she has years of experience in the nonprofit sector. first, as chief operating officer of global development at the gates foundation, she led

efforts to summon the most pressing global health challenges of our time. as the head of the walmart foundation, she was a tireless advocate for the veterans hiring program. she was a leader in the fight against hunger. ms. burwell has also been a steady hands as an effective leader at the office of management and budget. thehelps navigate difficulties of the government shutdown last fall. in the year that she served as deficit, the federal has continued to plummet. there's one other important fact he keep in mind. the committee considers her nomination. you said we cannot leave this generation's office of management and budget without being thoroughly steeped in health care. health care is simply the biggest structural challenge in

the budget and an essential part of the job. everyone understands the task ahead for ms. burwell. the affordable care act will be your central focus each day she serves as secretary. my view is that there are plenty of ways both parties can work andther to improve the law ensure that america does not go back to the days when health care was just for the healthy and the wealthy. there is a great deal promising from ms.t medicare burwell. medicare's rate of spending growth is slowing. according to the latest data, spending went up by 1.9% over a two-year period. that is slower than the overall economy and it is far behind the

store great. and ae of lower premiums stronger future for medicare, it has been significantly boosted by these developments. with the bipartisan support of this committee, there been many improvements to medicare transparency. the largest single purchaser of health care will lead the way in making sure that all taxpayers have the information they need to get the best value for their dollar. we look forward to working with to once you are conference continue that effort. next congress has never been closer to repealing the medicare physician payment system and replacing it with bipartisan reforms. that would reward the quality of care. i am looking forward to working with you again once you are confirmed.

the committee looks forward to working with you on what i view as the single biggest challenge for medicare's feature. that is dealing with chronic disease. the committee will have to maintain a close relationship with the hhs secretary on various social services. i will wrap up by congratulating our nominee and thank her for joining the committee today. has clearmation vote evidence that you are a respected and committed individual. i hope to have your nomination approved by the committee as quickly as possible and with equally strong bipartisan support.

thank you. i appreciate you convening this hearing. we have asked ms. burwell to serve as the secretary and i'm very pleased that we have one of my long-time favorite senators here to testify for you to stop is a doctor in the senate who has certainly done it very well. i want to think director burwell for her willingness to serve. somethingrt by saying that i think you already know. if you are confirmed to this position you will have your work cut out for you. the health and human services department surpasses any other cabinet level department. the budget is almost a trillion dollars. that makes it larger than the department of defense. it is double the department of

defense. hhs touches the lives of hundreds of millions of people. from cradle to grave, it receives more grants for improving and finding new diseases for those who have run out of other options. it includes the national institute of health, the fda, the center for medicare and medicaid. cms is the largest health insurer with an annual budget of 800 billion dollars. i believe you have the qualifications to do the job, but there is much that you will need to do in order to assure members of the committee that hhs is heading in the right direction. it is a turbulent time that lies ahead. one of the greatest challenges shoring up the

exchanges and making sure that they are operating efficiently. recent reports of the numerous issues faced by the state exchanges at something to implement the law have been cause for great concern. states are required to have a health-care exchange where citizens can go and shop for health insurance. they have the option of starting their own exchange, using the exchange provided by the federal government, or in hybrid will stop they are determining what type of exchange to implement. were given innts two stages for those days who were building all report -- all or part of their own exchanges.

they quickly decided to build their own exchanges. in total, they spent $4.7 billion on their exchanges. what is troubling is that seven days from the district of columbia failed to build a successful website. received more than $1.25 billion to build these exchanges. that is the huge amount of taxpayer dollars. it was apparently spent with little or no accountability. many are looking to rebuild their systems. introducing the state accountability act. it would be a state-based exchange and they decided to grants it and repay the

that they receive from hhs. in addition to overseeing this massive expansion of benefits, you also be charged with the longevity and the sovereignty of the existing medicare trust. it is projected to go bankrupt in 2024. between now and 2030, 70 6 million baby boomers will become eligible for medicare. the factoring in dallas, program will grow from 47 million beneficiaries to 80 million beneficiaries. that will be 2030. maintaining the solvency of the program and continue to provide basefor an ever-increasing will require creative solutions and a good secretary at the helm. i'm counting on you to be there. one of the most important responsibilities you have on this committee is to be responsive.

several commitments were made by nominees about providing timely responses. more often than not, i have been deeply disappointed. that youray commitment will stand the test of time beyond your confirmation. words and promises matter a great deal. i hope you will be up to that challenge. overseeing the conflict infrastructure of a department like hhs is not a job for the faint of heart. naturally, i wish you the best of luck as you learn to address these challenges and as you both through the confirmation process. you will need all the luck you can get. i am grateful to people like you are willing to take on these top responsibilities. we are grateful that you are willing to serve. thank you.

>> thank you, senator hatch, and as we have ever since senator baucus went to china you and i will be working in a bipartisan way on this. it is a tradition to have the nominee introduced any family members who are here today, so why don't you do that? .> thank you, mr. chairman i would like to introduce my husband, my sister, and at 2 very good old friends. thank you. >> we are glad you are here, and as senator hatch noted, public service is not, for family, for the faint hearted. we are glad you are here. iousever-grac rockefeller is here to introduce some west virginians, and dr. coburn is on a tight schedule, so why don't we hear from you

and then we will hear from home state senator rockefeller. let me say what an honor it is to introduce ms. burwell to the committee. i have worked with her for the , and prior too her confirmation as omb director , and i actually look for people who have strong trade -- strong traits, and the fact that she is willing to make this family sacrifice, and it is a family sacrifice, is reassuring for us as a country that we would have somebody -- i thought i would talk about 5 areas of sylvia burwell that not everybody else knows will stop the first is that she is competent. says something, because so often we have people placed in positions in washington that aren't competent for the task at hand.

the second is that she has outstanding character, and i have experienced that over the past year working closely with her and the people at a one b on the problems we have seen both at home and security -- homeland security and cyber and other areas. when you have somebody that is competent and also a strong , you find a way to get past your differences to solve problems. finally, as senator hatch mentioned, responsiveness is a key for congress. i have to tell you, i found her remarkably responsive. my partner and homeland security, tom carper, has as well. that comes along with her commitment. she is going to be committed to do the right things and keep hungers involved -- keep congress involved. double make her an outstanding secretary, and that is she is a great listener.

even when she has her mind made up, which sometimes happens, she will listen to another point of view to gain information that she might not have. that is a characteristic too often that we don't see as members of congress and membe -- in members of the administration, whether they are republican or democrat. finally, because she is west virginian, she comes to washington with a lot of common sense. is avorite quote is there symbol half full -- thimble and a half full of common sense in washington and she is the half. i will support her nomination on the floor and do everything to help her be successful at if she is sot hhs, given that responsibility. i thank the committee. >> senator coburn, thank you very much for those powerful words and focus on competence and common sense and

accountability. that is really quite of the realm in terms of the nominee. i know you are on a tight time schedule. chairman rockefeller is here for another west virginian. too, want to thank senator coburn. burwell, it is not usual to get introduced by him in such terms. judge -- hestrict is a very strict judge of character, strong moral aspect to everything he does. i am very happy that he has introduced you. me toan easy thing for do, but first i have to point out something of interest. on the commerce committee we were going to have a really interesting hearing in this room ncaa and the

student athlete, it or is that really athlete student, and what are we doing, what is the ncaa doing, what are universities doing to make sure athletes are getting the academic training they need to. i think it is going to be an interesting hearing. the reason we were going to come it wasroom is that going to be packed because it is a subject of great controversy, but no, pushed aside by a higher order. but the order is that this room is an even half-full. -- isn't even half-full. what makes me happy about that is that there is a general understanding in this somebody and certainly on this committee that you are that really competent person who relishes challenges and can balance challenges with family response abilities. you are just that way, and that is one of the things about

growing up in a small community. i introduced you for the first time 16 years ago. we were becoming deputy director of omb at that point. more recently, i introduced you again to become director. that was easily done. could not be more proud to speak for you and to present you to this committee. i have done this a lot with people but i don't think i've ever been as proud as the person as is sure of my feelings have with my feelings about you. respect for your intelligence, your integrity, what i would call a ferocious integrity, a work ethic beyond contemplation, but all the while, you are relaxed, andappear as senator coburn said, you do

listen. you are a very good listener. it is terribly important. and the business of writing letters you will do not because you have to do it but because it is in your interest to do and you will find a way to do it. i think you are going to be a superb secretary. the department is absolutely gargantuan in its size. it's millions and millions of americans, food and drug supply, protection of our country from outbreaks of attacks, theerror medical research we rely on for cutting-edge treatments, but andh we are underfunding, federal investments in global health, which i don't think most people know that much about and don't necessarily associate with your position. i think it is impossible to overstate how important the secretary of hhs have that degree of organizational

intuitive skill. not that they have to work at it hard, but it is just born with them and it is part of how they do things and people come to understand that and they draw people to them because, in the words senator coburn used, competency. competency is a cherished commodity, and when people are in a high position and have that, you go want to work for them, people want to work harder for them. and the country feels prouder of them and maybe even the press is nice to them. so anyway, here you are, a proven manager, public and private, and so much the right person for this job that it is just a cliché to even say it. are ahe fact that you proud native of west virginia is very important. it is very important in character formation. and one's worldview.

in that case, not a large worldview. i have known sylvia her entire parents, her wonderful cleo and bill, family, friends. i have attended church with your family. i was at your wedding reception. you interviewed me -- i think you told me when you were 6 years old, county courthouse steps. i have no idea what the question was, but i probably didn't answer it very well. i was probably terrified. i just have a deep and abiding , and because you of you, your family. i think family and you come together in a perfect way in american life. you are brilliant.

you won't say that so i will have to do it for you. and as has been indicated, a harvard, rhodes scholar, and yet somehow you remain humble, always hard-working. again, this word "ferocious integrity," which means everything to me, and the central devotion and your purpose in public services to help people better their position in life. you don't focus on just one group, but everybody has to have a better shot in life. you are possessed by that public passion. partly fromo come your grandparents, because they got here and somehow helped instill that in you. you could have made a fortune when you graduated from harvard, and onto any place in the world,

any law firm. you didn't. you headed directly into public service. you spent the majority of your life in public service, which is filled with controversy and not enormously high wages, and a lot of frustration, a lot of sleepless nights. that, hadn't been doing you were working for organizations doing that -- the , out inndation bentonville, that foundation. in both cases you are working on a worldwide basis. office, we in my talked about one of the things i want to work on after i leave the senate, baby teeth, the health of teeth, which most people overlook, but which is absolutely essential in the moral self-confidence,

development of any young person, and appalachia it is a real problem. you spent a great deal of time at the walmart foundation doing exactly that. when it comes down to it, you want people to have health insurance, you want them to have that peace of mind. i don't need to do this, but i am going to do it because i so enjoy doing it. your service in federal government is absolutely unmatched. the clinton administration staff director for the national economic council. wow, that is context stuff -- not that anybody can tell you what goes on there, but the future of the country depends enormously on what does go on their. chief of staff to secretary robert rubin. deputy chief of staff to the president of the united states. deputy director of the office of management and budget, and then the director of that. you are central to crafting the clinton budget in the 1990's

which led to budget surpluses for 3 years in a row, something i'll most impossible to imagine -- something almost impossible to imagine, and enormous growth economically in our country. hereearned -- i have found through your work with the clinton administration -- you just work because of the way you are work across the aisle with other people. it is your instinct to try to find common ground. you are very, very tough. i'm thinking about the example we just talked about -- dust in underground mines. i wanted it to be one it is now two. i apologize to the audience for not going into this. ms. burwell did the right thing and came down at 1.5, the first time in 41 years that the united states government had addressed the problem of breathable dust, dust, leading to

black lung. it was a remarkable decision. you make that decision. because of it, it is now in effect. your philanthropic works speak for themselves. you are going to be speaking for yourself. think of anybody more perfect to do hhs. there were so many bumps in the road -- i think that is innate, and we have discussed that. enormous programs of the vast consequences. i don't think it ends. it is 15, 20 years before things settle out, and the various decks and crannies are taken care of, and people -- various nuts and crannies are taking care of, and people feel comfortable. and you just get down to the care.ss of doing health so we need you, sylvia mathews

burwell, very, very much. i think you gathered from a statement that i am probably going to vote for you. [laughter] but you're not just about budgets. you are about people, and you are about fighting for people that other people will not fight for, and you are fighting for people who could use a little help, and you are fair to people who don't need any help. you are just a fair person. a tough manager. probably the smartest person in the city. mr. chairman, i am proud to present you sylvia mathews burwell. >> thank you, chairman rockefeller. that was a wonderful introduction, and i will tell you, director burwell, i'm curious what you interview to rockefeller on when you were 6. [laughter] perhaps we will learn those secrets one day. at this point we would like you to deliver your testimony, and then we have 4 standard questions for nominees and we will be able to you with quickly

-- able to deal with quickly and then we will have questions from the senators. we will make the prepared remarks part of the record in their entirety. please proceed. >> thank you, chairman wyden and ranking member hatch. inviting thank you for me here today. i am honored that president obama has nominated me for secretary of health and human services, and it is a privilege to appear before this committee. i want to thank senator rockefeller and dr. coburn for their kind words. i am honored to be introduced by numeral to such extraordinary public servants who have both spent their lives helping others and delivering for the american people. i am especially grateful for my husband and our children, for their tremendous support, and while my parents couldn't be here with us today, i want to recognize them for their instilling within me and my sister the enduring value of public service. as a second-generation greek

immigrant, i was raised to be thankful for the tremendous opportunities this great nation offers and to appreciate the responsibilities that come with those opportunities. westghout my childhood in virginia, my father an optometrist and small business owner, and my mother a teacher set a great example for me and my teacher through their engagement in service through our community and our church. it is that example that is an important part of why i am here today. whether in the public or the private sector, working across a range of issues, i focus my work on it 3 things -- the link strong teams on a strengthening relationships, -- and building strong teams, strengthening relationships, and delivering results. in my role as omb director i worked with numbers of this committee and others to support efforts to return the budget process to regular order and drive towards progress on issues we all care deeply about. toinfirmed, i look forward

working alongside the remarkable men and women of the department of health and human services to build on their work to ensure that children, families, and seniors have the building blocks .f healthy and productive lives these issues are fundamental to all of us, whether it is the chronic condition of a child with love or the safety of the food we eat every day. i respect and appreciate the importance of the challenges before us. as we meet here today, scientists and researchers at the national institutes of health are working to find cures for some of the world's most serious diseases, and experts at the centers for disease control and prevention are working to prevent them from spreading. the fda is protecting the food the medications are doctors prescribe us. parents and grand parents rely on the centers for medicare and medicaid services. millions of children benefit from and start.

millions of americans are living with dignity in their own communities. the department work to ensure accessible affordable quality health care through the elimination of the affordable care act is making a difference in the lot -- implementation of the afford will care act is making a difference in their lives and committees while strengthening the economy. all of this work promotes the foundation of a stronger middle class and healthier communities. mr. chairman and members of this committee, thank you again for the invitation to speak with you today. i have a valued the conversations we have had over the course of the past several weeks, and i'm hopeful that we will have the opportunity to continue to work together closely in the months ahead to deliver impact for the american people. with that, i would be pleased to answer your questions. thank you. >> director burwell, thank you. we have standard questions for all nominees so let me go through those now. is there anything you are aware

of in tobacco that might present a conflict of interest -- in your background that might present a conflict of interest the duties for which you are nominated? >> no, sir. >> do you know of anything that might prevent you from thoroughly and honorably discharging the duties of your office? >> i do not. >> do you know of any reason not to answer to any reasonable summons if you are confirmed? do. >> very good. now, colleagues, i will proceed with questions and we will go with a 5-minute round. start with amight, question about another priority of the committee. we will have many questions about the affordable care act. and that is fixing this broken down system of reimbursing physicians under medicare. what is happened is we have a

system that is poorly coordinated and doesn't reward quality. what congress does is put patch after patch after patch on it. senator murphy was in the chair when we were discussing this, and he is the youngest united states senator, and i looked up and said i don't want when senator murphy is eligible for medicare for us to still be patching and patching some more. the president in his budget made a commitment to working with congress to reform this, and particularly, repeal str and replace it with a system that would reward coordinated care and reward quality. our colleague senator hatch, in my view, deserves a great deal of credit for this effort. if confirmed, would you commit to repealing and replacing the current broken medicare reimbursement system for

physicians before the end of this year? >> senator, i am very glad that you raised the issue, and i'm very glad that income actually, my meetings, and is something that is my partisan, that this issue has come up will suck even though there is a fix that takes us until march, -- that this issue has come up. even though there is a fix that yous us until march, yourself are played a leadership role in proposals that will make a difference, and if i am i am excited about the opportunity that we can work together to get a permanent reforms,that has both what are important, and a permanent solution that helps physicians have predicted predic through time -- tablity through time. >> thank you. it is clearly urgent business, because we can get it right now at rock-bottom prices.

it is only going to get more and more expensive. we appreciate your commitment on that. let's turn to chronic disease. there is been bipartisan interest in this committee on it. i see my colleague senator isakson, senator toomey, senator bennett has had a great interest in this. medicare in 2014 is dramatically different than medicare when the program began in 1965. it is largely about cancer and diabetes and stroke and heart disease and all timers. -- alzheimers. the senior breaks their ankle, and we certainly hope that doesn't happen, that is something like 15% of medicare all about chronic disease. i would be interested in your thoughts about how medicare can step up and address this extraordinary challenge, because this is really going to be what medicare is all about. i'm very appreciative of my colleague from georgia. he and i have introduced a bill

which my colleague senator isakson appropriately named the better care, lower-cost act. in another body have been supportive of as well, and as i mentioned, senator toomey, senator bennett, a number of senators have interest in this. what is your take on the next step to take on the premier challenge for medicare in the years ahead? >> the issue of chronic disease is one that i think cuts across the entire department. certainly, medicare is where it is being paid for, and a big part of the delivery of that service with regard to chronic, but one also needs to back up to ,ih and the issues of research and all through the issues of cdc and actual delivery, as well providers.rain our the issue of chronic disease -- this is one of the things, as we think about many health care issues, but particularly one as large and influential as this, that you need to think about it

across the pieces that are within the department, so that we are getting the right solutions in place, the right data and analytics that show us how we can work on these issues at the front end of them before they get to the point with they are costing us so much. we work on the delivery system in terms of how we in communities and directly within hospital systems and insurance systems are providing that care. medicare is an important part of it, and the tools we can use into medicare, because it is such a large and influential part of the system, but i think we have to think about it across a number of different areas, including providers. >> that me see if i can get one of the question in. -- one other question in. with the aca is about improving access and quality and decreasing costs. but as with any landmark law, there are challenges. since we are starting out, it would be helpful if you could just briefly outline -- you are going to get plenty of other questions, we know -- what are

going to be your priorities in terms of ensuring the success of the affordable care act? >> with regard to the affordable care act specifically, there are 3 main things that seem to be the north stars. one is access, the second is affordability -- that is affordability for the individual affordability for actually the government in terms of all that we spend, as well as affordability for our economy -- and the third issue is quality. when i think about the act and the implementation of it, what i want to do is, if i am confirmed, work to maximize across all 3 of those areas and think about the ways we can do better. >> senator hatch. >> thank you, mr. chairman. ms. burwell, one of the most sacred responsibilities that we as public servants have is to safeguard the hard-earned taxpayer dollars that the american families entrust to us. you rule seven states, including the -- numeral seven states,

including the district of columbia, are having a dismal time. 2 of the states are abandoning their broken websites. based on the most recent reports, these states receive more than a quarter billion dollars to plan and build their exchanges. some of these states are waiting for additional federal funds to continue their failed experimentation, at least in my view. askve 2 simple questions to you and i would appreciate a yes or no answer, if you can. first, do you believe that these states which have so negligently should beir funds required to reimburse taxpayers for their failures/ >> will with regard to the , we need of each case to understand where the federal government and the taxpayer have had funds misused, we need to use the full extent of the law to get those funds back to the taxpayer. >> the second question is could

you give me and the american taxpayers a public commitment today that hhs will not give any more dollars to those of failed exchanges for more failed experiences? >> senator, with regard to the specifics of how those funds go forward, what i would do now comes because i'm not familiar with the specifics because i am not there, there are 3 things. we have to understand what went wrong. 2, when we do understand that, we need to go to the full extent of the law, if there are contractors or others who have misled through contracts or the things. 3, we need to make sure that we learn from the mistakes in the exchanges that are not working and learn from the exchanges that are, such as washington state, where senator cantwell is from. >> your first and foremost responsibility as an appointed official is to be accountable to congress and the american people. one important way congress fulfills its obligation to taxpayers is by asking for information about your department's activities. over the past year, we have sent

at least 5 letters to hhs that have gone unanswered. responses to questions for the record takes months. it forces events like this confirmation hearing to get answers, which are often incomplete. i have 2 straightforward questions. do i have your public commitment today that he will respond to inquiries with no more than 30 days? >> senator, you have my commitment. hopefully you offered from colleagues that have had a chance to work with me over the past year, but that is something that i prioritize in terms of communication. >> i was very impressed with what senator coburn had to say and i agree with that. what, in your opinion, should be the records as the committee if

this public commitment -- should be the recourse as a committee if this public commitment is not kept? >> i hope that you would pick up the phone and call would hope yu would pick up the phone and call me. one of the things that i think is a very important part of working and getting to a resolution -- as dr. coburn said, we don't always agree. if we can have hundred stations and those conversations can be specific, i think that is something -- if we can have conversations and those conversations can be specific, i think that is something where we can work things out even if we do not agree. >> the administration has made at least 22 unilateral changes to obamacare without consulting congress. most recently, hhs announced it medicare fund to forestall benefit cuts. i asked secretary sebelius

whether there would be any more and herto obamacare answer in my opinion was not very reassuring. i have to go -- i have two more questions to our. will you commit to limiting changes in the future? >> senator, with regards to implementation, i think the core objective is common sense, implementation, and improvements within the context of the law, in where one needs changes the law, seek back. the president's budget does look for changes in the law. we need the support of the congress in order to do that. >> ok, my last question. expect more changes with obamacare, what will they be? regard to something that

is such a large part of this if i cani do not know predict. the important thing is listening and learning as you go and whether the changes require legislative changes, to work with congress to do it. system in thee united states is a large, complex system. the law itself hopefully will improvements,king but it is a complex system that i think will be evolutionary as we learn. one of the things that i am hopeful, if i am secretary, that listening and learning and making changes when appropriate is something one would want to do. >> thank you. >> senator rockefeller. ll, there is anwe wish to lower

costs. i'm not sure if you remember -- when he was in your position and he came before congress to talk about the runaway costs of health care. he was sheet white. he disappeared for about a week. that was the impression. he was sheet white and he just predicted -- he had this horrible dire protection for the cost of health care, quashing other good programs. which leads to my question. in making things cost-effective, cutting costs, lowering costs, which democrats love to boast about, when sometimes -- let's -- when example sometimes you run into the providing of adequate and good care, and that is sort of a sloppy philosophical thing to

are becoming very difficult decisions. where it is more expensive to take care of certain kinds of people, certain kinds of illnesses. we lifted the annual cap and then the lifetime cap, that procedure was quite the opposite. that was to spend more money because having good health care for people is what we are here for. those things are in conflict with each other. i wonder if you have an operating philosophy? think thererd -- i are difficult choices. a key and operative word is "choices." at the office of management and budget we have had the opportunity under the tight budget levels, our current 15 levels, when you take into and grossa receipts veterans benefits, your levels

are the same as last year. when i think about difficult choices, what i think about is getting as many of the facts as one can and making sure you lay out the different choices as best you can. some things are hard to compare and choose between but that is part of putting budgets together and part of the choices we will have to make in the health care space, understanding quality as well as understanding cost. >> you have been director of omb, which i think one could also say as one of the most difficult positions around. your life is full of choices. some are ones that only you can make. so, you have your experience. it it is your inclination, when you have difficult situations, you devour that. the nuances of difficult problems, to try to solve them. with your omb experience, as you

large, thererit have to be some things that occur to you, impressions, and how over the years -- i do not just mean the recent years, but over the years how things have not gone as smoothly as we would like. have impressions beyond the affordable care act and the department as a whole. one of the things i believe about setting priorities and a new agency when i go to something new, and it reflects one of the comments that dr. coburn made, and that is listening. i appreciate your time. having the time to speak with each of you. the second thing i need to do is speak to stakeholders, which i the senatene since has to move forward. and the third thing is having the correct information to set

priorities, which i think is an important part of managing any situation. >> i have 44 seconds. one of the things that has always interested me, and as a norzen, neither liberal conservative, it has always amazed me in very large and powerful organizations with a lot at stake, people with stars on their shoulders, people with reputations built up over a lifetime, but they become , and they probably know it. you would probably know it. the question of people never being held ultimately accountable. for strange reasons, not always kind reasons, the only thing americans will settle for is if someone has been fired. because that shows "the administration really means it." do not necessarily walk away from that action at all, but there are other ways of

disciplining people. but they somehow have to radiate out to the american people as well. the symbolism of reining in and controlling your department and how you do it is important. what say you? important.it is i think it is important having people around you that tell you when you are wrong as a leader. that is a very important thing, making sure you create a culture where it is reported for people to actually question you in .erms of your leadership with regard to creating accountability, one of the most important things you need to do is verify what the goals are, are,at what people's roles and articulate that responsibility. by setting that out at the front end, i think it makes it easier to check yourself at the backend in terms of how people deliver.

>> thank you. >> thank you, mr. chairman. , i appreciate you being before us today. i also appreciate the good working relationship we have had. i want to use my time today to talk about medicare and particularly medicare advantage and specifically some of the implementation concerns i have with regard to obamacare in general. with regard to medicare, back during the debate over the affordable care act, the remastered cuts in medicare and the acts. we debated that at the time. i'm not trying to go through that debate again. many of us pointed out there advantages tont medicare and that was probably the most popular part of medicare among seniors. we are seeing the cuts to medicare advantage are real, they are occurring, and in

addition, the administration seems to be pushing to additional cuts to medicare advantage, beyond even those contained in the affordable care act. i will not go through all the statistics about how the cms analysis shows one thing and other analysis from independent sources show other things. the bottom-line is, from all the analysis i am seeing, what we are viewing coming down the pipe with regard to medicare advantage is the program will be facing double-digit reductions over two years. in idaho, we are already seeing the effect of this. of the counties and ido a no longer offer medicare advantage. in adams county, where beneficiaries have chosen medicare advantage plans, they saw their options go from 25 plans down to just five plans in 2013. my question to you is, do you understand the dynamic happening

in medicare advantage? are you agree with the observations i have made? do you believe it is responsible to implement additional cuts in medicare as we see this dramatic impact with regard to the downsizing? >> this is an important question. i will start with something, medicarei think vantage is an important part of the system. >> good. and health care costs are an important part of achieving fiscal responsibility and a lowering our deficits in the coming years. two priorities to keep our eye on. when i think of medicare advantage, i think of the starting point, where those initial changes were put in place in the prediction of what would happen with those changes. i know these are two different sets of changes you're talking about. we had a complex situation. we thought it would make things cheaper. however, we saw 14% cost

overruns to regular medicare patients. have we think about that within the system question -- how do we think about that within the system? seen medicare advantage premiums drop by 10% as changes have been implemented. the other thing we have seen is an increase in quality. question of the additional changes being put in place need to be monitored and watched with regard to, i think, everyone's objectives are to keep that quality access and premiums in control. the proposals that are in place are things that we believe could work and we need to understand and keep monitoring if we see things that are not working. things youome of the have started to describe. >> i appreciate that. i think if you monitor, you will see we have done unnecessary damage to the program. i hope that your commitment to

keeping the program strong and viable will work out. i have one minute left. one quick question. changing quickly to obamacare in general, a recent mckinsey survey found that only 26% of patients who gained insurance under the affordable care act were previously uninsured. if this statistic is accurate, it means the vast majority of those covered previously had health insurance that was canceled due to mandates in the law. first of all, the administration has allowed noncompliant plans to continue through 2014. do you support allowing this continuation of noncompliant qualify, or can americans expect another round of cancellations this fall? >> with regard to where we are in terms of the current plans and what will be continued or not, i think we are continuing through, have made all of the decisions and announcements that will take us through the next enrollment season. with regards to what we want to do, i think we need to watch and

manage. one of the things, like medicare advantage, one of the things i think is important is how do we do common sense implementation that works for people? the system needs to work for individuals? work forstem used to individuals. it needs to work for providers. >> they give. my time is up. i will submit more questions in writing. >> thank you. >> congratulations on well-deserved support and praise. i'm looking forward to working differenton some many issues. let me follow up on my friend and colleague's statement on medicare advantage. i sure the process of writing the affordable care act. i will never forget the budget office telling us he even if we cap the payments to medicare 50%ntage at 150 -- at 100 50%, we would save money.

i believe it was the right thing save cost overruns. clearly there were cost overruns. the good thing is, we brought down the cost connected with medicare. we are saving money and at the same time, we have annual checkups with no out-of-pocket loss. -- out-of-pocket costs. -- $1200 back in pockets to pay for medication. all good news. in general, i want to ask on the affordable care act, because the good news is we have more than 8 million people who have been able to sign up for a better plan at better prices. in michigan, over 270,000 people , which was way more than we thought, over 100,000 people more than we thought, have signed up. even though michigan did not

start until april 1, medicaid expansion, we have enrolled the blue are eligible. that means people working minimum wage, 40 hours a week, finally will have the opportunity to see a doctor, take their kids to the doctor. my question is, related to the aca overall, when we look at the fact that it was announced last month that due to lower-than-expected premium rates the affordable care act will reduce the deficit another over the next 10 years -- i know in michigan we are seeing pioneering organizations showing savings. a big piece of this will bring down costs for our businesses, for our families. what you see as the opportunities to continue to use the tools and the affordable care act to really bring down costs the right way, not by service -- taking away

come of it dealing with the cost question mark >> i think continued implementation -- service,taking away but dealing with the cost question? >> i think continued implementation. there are a number of tools and opportunities. they are related to the delivery system and moving the delivery system into a space where it is about quality as well as cost reduction. there are a number of organizations. you mentioned the accountable care organizations. the other thing is looking at the innovations. i think there are innovations state-by-state. one of the things i had the opportunity in the conversations that i had with a number of you was to hear about specific examples of things that were focused on quality improvements, readmissions,l salt other issues, or actual cost improvements. and those come together. i think we need to look at those

models, figure out which of those models deliver the greatest impact with regard to cost and quality, and figure out which ones are scalable. that is the issue. sometimes you can get things to work. my experience in grantmaking is cost at at things to level, but the question is can you stay let -- scale it? >> i agree. we just committed -- we just critical expansions of care and mental health. i understand talking with you that your mom worked in mental health. i feel much better now because no we have a secret ally. i am looking forward to working with you as we implement this ate effort.ant 8-st finally, alzheimer's disease. one out of eight people are diagnosed with alzheimer's.

for us in thisnt context is that one out of five medicare dollars -- that is a medicaree out of five dollars are spent on someone with alzheimer's. i do not know if you have had enough to focus on this yet. one out of five medicare dollars and yet we have less than .25% that goes to research. i know the president is focusing on the brain research effort and so on, but we certainly want to work with you on more effective ways to address what is clearly a disease affecting every family in america. i don't know if you have any comments or if you have had a chance to look at this at all, but certainly want your commitment. we would appreciate it, to really focus on it. yournter, thank you for leadership in the mental health space and alzheimer's. -- senator, thank you for your

leadership. important, both in terms of research and delivery, care for those who are caregivers. we need research to treat and prevent the problem, what we do to treat haitians who are currently suffering, and also how we treat the family -- treat patients who are currently suffering, and also how we treat the families. that is important as well. >> i look forward to working with you. >> thank you. senator grassley. >> congratulations, ms. burwell. i have two questions. i want to start with a very function i have that is oversight. i take that job very seriously. i have done that with republican and democrat administrations. will you commit to answering the letters i sent to your department promptly, fully, and without reservation?

>> senator, i will work to make sure we are giving you the tools you need to do the work you need to do. >> i have a long lead and before my next question. so please be patient. when you were nominated, i said anyone put in charge of obamacare would be setup to fail. the thing with this law has really been by any means necessary. the legislative effort was by any means necessary. implementation has operated similarly. the department has ignored the plane read of the statue whenever was considered necessary. needed to be creatively reinterpreted to make the program work, the department did so. as i said on the day you were nominated, you have a fresh start with congress and the public, but if you are going to make the most of that opportunity, you are going to have to do things differently than they have been done. marilyn tavener as an

example. set in the same and share a few months ago. she committed to do things differently. now it seems that she has gone into the witness protection program. it has been so long since she was last in the chair or at my door. i hope you do not disappear into the same bunker. but this is what you face moving forward. the department is supposed to implement the important mandate. it is a year overdue and significantly altered from the statute. the department is supposed to implement risk orders. this year, the illegal authority funds isbute questionable. and speaking of things that will be kept quiet, hunger is is going to want to know what the premiums will be for next -- congress is going to want to know what the premiums will be for next year. i always considered to be one of

those states where we might have the highest premiums spike. the department will want to use any means necessary to hide the premiums until after the november elections, unless of course the numbers are good. then the department will shout from the rooftops how low they are. much as i think was done in the case of enrollment numbers. we can be very cordial today, but if you want to change the relationship your department has with congress, you are going to have to be willing to break the by any means necessary mindset we have seen for the past five years. my question is this. do you think it is possible for you to change the by any means necessary culture at hhs that some of us in congress of you as bordering on lawless? , thank you.

harkening to my experience at the office of management and budget, there are challenging issues. ais, iook around this d have had the opportunity to talk with you on a number of things that are positive and difficult. that is something i consider it my responsibility to do. i hope people feel in my role at omb that i have done that. whether that is moving to more timely responses, the regulatory agenda is sometimes a controversial thing. since i have been the director of omb, we have been on time getting that out in the spring in the fall. the midsession review, a document with a lot of numbers and some may use this way some may use another. it came out a week early. that is something where i did not wait for congress. i hope that there will be direct communication if there are concerns. >> i yield back my time, mr.

chairman. thank you. >> thank you, senator grassley. senator nelson is next. surenator grassley, i'm as that anyone from hinton, west virginia, population 5000, is going to do ok. and i would assume you can tell a lot about where a person is going by where they have been. and the fact that you have had such accolades from no less than senator coburn and the same from me as the way that you have in a veryur self difficult department that is as hardheaded from this senator's perspective as is hhs, and yet, you were there. you were responsive. appreciateto know, i it.

i think there are a lot of other folks here. i just want to ask you quickly about medicaid and medicare. we -- if our governor and legislature in the state of florida expanded medicaid under a, it would cover an additional 1.2 million people that otherwise, when they get sick, they are going to end up in an emergency room and all the rest of us are going to end up paying for them through our insurance premiums. not even to speak off, it is the humanitarian thing to do for people to have access to health care. but the state legislature and the governor have so chosen not to do it for two legislative

sessions. them thatied to show there is a local tax base that is paying for a lot of things for low income people already. , what the legislature's position has been, they want you medicaid waiver so that they can continue offering -- medicaid through an hmo, but they do not want the population upthat to 138% of poverty. in an have shown them ingenious way that you can utilize, if the state doesn't want to pay their 10% in the fourth year and the future years, they can actually utilize what is already being used in a

local property tax or sales tax for these low income people. so, what i would ask, if the state chooses not to expand , what wouldto 138% you think the department would plan to handle be state's rick state's request to continue with business as usual? >> senator, with regards to the specifics of the discussions thaten hhs and the state, is something in my current role i am not familiar with. what i can talk about is the philosophy of how to think about these issues in terms of medicaid and medicaid waivers. there are a couple principles. i think it is important starting the conversation to be clear

about what the fundamental core principles that are essential to implementing our, whether that is the affordable care act or state waivers other states may be applying for. i think the second thing that is an important principle is flexibility. differentates have situations and we need to consider that. bringing both of those things together something we need to do at the beginning of the conversation as one works through how to get to a potential yes. >> ground zero for medicare .raud is south florida just yesterday, there was another bust. law enforcement took down 50 more people. the problem is, in the past, when you take them down, they have already fleeced the system. you got any thoughts? >> a couple things. i think we need to work to a system that is not pay and

chase, but it in front of the system, where the dollars go out. that is where we need to have a system. there are a number of tools we need to use. we need to use tools that we use in the private sector in terms of predictive capabilities, in terms of using technology. i think the department that did do the work you are referring to yesterday was an across the nation strikeforce with the justice department. that is important for doing that. in my current role as omb director, the issue of improper payments is one that has been focused on across the entire government. as we know, the numbers are very large and medicare. it is a place where we need to focus deeply. i would hope to bring some of the focus we have done on broad and proper payments across the federal government to the issues that are specific and medicare and medicaid as well. -- senatorgordon gordon -- cornyn.

>> thank you for meeting with me and my staff and my office and talking about getting away from pay and chase. there is not enough resources in the federal government or in the federal claims act or otherwise to go after all the fraudsters. the only way to get ahead of them is to screen who gets paid on the front end and there are a lot of very powerful and loud people who will complain to high heaven if you do that. but i appreciate your commitment and chase,h pay because it just doesn't work and it will work. so, mckenzie, who you once worked for in addition to other aspects of your distinguished career, has come out with a testament that about 22% of the 8 million people the administration was celebrating and rolling in the exchanges, people whore

previously did not have insurance coverage. which meant that only about one out of five people were newly added to the insurance rolls, who previously didn't have coverage. the president said when he sold the idea of the affordable care act, if you like what you have, you can keep it. down $2500ms will go as a family of four. and by the way, if you like your doctor, you can keep your doctor. hasoo many instances, that proven not to be true. which is been very damaging, not only to the president's credibility, but the credibility of anybody who is saying the affordable care act will work as advertised. -- to my knowledge there have been no official figures released by the federal government or by the administration. are you aware whether there are any figures available which withadicts or disagrees

what the mckinsey study estimates that only one in five of the 8 million people did not have insurance? >> senator, in my current -- senator, in my current role, i do not know. we have seen the mckinsey numbers. the question is, some people may have switched for quality reasons. i'm not sure if they divide out. the other thing we have seen, we the numberallup and of other organizations show the percentage drop of the number of uninsured in the nation and those provide different numbers. with regard to the specifics of the government, in my current role, i do not have access or no. the insurers are where that information will be provided. >> the distinguished senator from west virginia who earlier, whou

talked for 20 or 30 years -- i do not know if he was suggesting it would be 20 or 30 years before we got health care right or not. maybe we will have that conversation later. there are a lot of people who feel enormously discouraged. you in the short time i have remaining, my notes indicate that health and human services employees -- employees soughly 78,000 people -- employ roughly 78,000 people. there's another government organization in the news these days, the veterans administration, that has 278,000 employees. if the reports are to believed -- to be believed, they are having enormous problems delivering care to veterans who have earned that right. could you tell me how you would deal with an organization that

has these sorts of problems that are being reported in the va today? i realize that is much bigger than what you are getting ready to take on at hhs. i am not asking how to fix the how yourticular. but would approach an organization that size without many problems? >> first, i think you need to get into what is causing the problems in the magnitude of the problems. you quickly have to establish is the problem coming from? is it systemic? is it cultural? is it a targeted problem? once you understand what kind of problem you're dealing with, you have different types of solutions. if it is a cultural issue, you have to do change management. that takes energy, effort, leadership, by ian -- buy-in.

if it is a target of space, that is a different problem. is the problem, theagnitude of it, and other thing is sending culture, sending signals and important parts of doing this. the approach you just described to be appropriate for congress to take? or just someone in your position? >> with regard to -- i think there is a role that congress and the executive branch play together. there is an important oversight role that congress plays. that is a back-and-forth and a conversation. it is one of the places were working together is the way to get the greatest impact. i think coming up with a solution, listening and understanding their ideas that come from experience on the

ground -- i think one of the most important things in my business i hear is you represent what happens in your space. what i hear when i ask you, when i have a conversation and ask you about priorities, it is a means by which one hears from as directly people as one can. i think there is an important role in how one goes about that. >> thank you. senator menendez. >> congratulations on your nomination. >> thank you, senator. in my home state reported while 100 40,000 people were successfully enrolled in medicaid, at least another 125,000 have their applications waiting to clear the backlog and another 7000 are waiting for their medicaid cards. i know this is a problem. i know that cms has a wider role

in making sure states get all applications processed in a timely manner. will you commit to prioritizing this issue so families in new jersey and across the country can rest assured their medicaid enrollment has been processed and they are able to receive the workthey need and have cms to educate individuals and providers about their they wille rights so be able to receive health care while they're waiting for formal enrollment? >> if confirmed, i will commit to working with you and cms on that issue. >> if at the end of the day you do everything right and register and you qualify, but you're just not processed, that is really unfortunate. as you may know from our conversation, new jersey has the highest rates of nation area that

is why one of my top health care priorities is making sure individuals have the services they need to fulfill their god-given potential. one of the steps i took to try to achieve this goal was insuring autism services were required under the essential benefits package for plan sold on the health insurance marketplace. despite this requirement, however, i'm worried that plans are not living up to the standards i envisioned when i wrote this provision into the law, especially in states without existing state coverage requirements. specifically, i'm concerned plans are taking advantage of the regulation that allows them non-dollar caps on benefits as they no longer allowed to impose dollar benefits. the potential to deny access to care for families across the country. can you assure me under your

leadership, hhs will conduct the necessary oversight of planned benefit structures to ensure they are providing all of the required numbers? thank you. i appreciate your leadership in this space and our conversation about this issue. if i am confirmed, this is something that we will work to figure out how to make sure those children and adults are receiving the benefits and they health care they need. >> two less questions. one of the issues i have been involved with is the so-called rule which is show a beneficiary who spends more than two nights in a hospital is defined as a patient. however it fails to define if an individual needs a high level of inpatient care for a shorter time, even if medically necessary or appropriate. i am pleased that cms took the

initiative and is soliciting comments on this issue, but i am afraid that a year may not be enough time, and we will still be in the situation with the ruling as unenforceable. can you provide the assurance that cms will have policies in place that will ensure the reliability was the statutory enforcement delay expires next year? if i am confirmed, this is one of the issues i have heard about from a number of your colleagues in all of my visits. we need to continue getting the best ideas people have for implementation. that is something i hope, if confirmed, i can work with cms and others to get that input. >> ok. finally, delivery system quality and improvements. those of us who supported the affordable care act, we saw it having more

health care accessibility, country hadoss the health care, controlling costs, but changing the nature of care from a disease based to a preventative base, and changing the way we pay for it from alternative care to liberate models, performance and outcome -- i suggested multi-dosing where appropriate to reduce prescription drug costs. are you open to consider these types of initiatives as a primary effort to try and change the nature of how we pursue both our outcomes and how we pay for them? the delivery system reform issues are very important. i believe the way that we will takinghe problem is by examples and models we will see and figure out which to buy the .est quality and the best cost

it is important to get things in place, get traction on changing the system to one that moves toward what you describe as quickly as possible. >> thank you, senator menendez. congratulations on your nomination. thank you for taking time to meet with me. we have, of course, serious disagreements about the substance of obama, but as i conveyed to you in our meeting -- the substance of obamacare, but as i conveyed to you in our meeting, i am more concerned, very concerned with regard to the is going on about enforcement of obamacare. and the selective enforcement of obamacare with regard to certain groups. we have seen exemptions, delays, parts of the law ignored as they certain favored political groups. one of those was the health

insurance tax which was imposed on self-insured, self administered plans to help pay for covering people with pre-existing conditions. under your direction allenby, there was a rule issue that carves a lot of plans out -- your direction at omb, there was a rule issue that carves a lot of plans out of that tax. i wonder if that is appropriate and i wonder if that is fair. i want to read you something. "ask for clarification how the change would affect other plan rates for 2015 and many 16. health and human services officials said, it is true the fee will be higher for plans that do not have to pay the fee in 2015, because some plans are exempt." view is that an accurate statement? others will have to pay a higher tax, a self insurance tax, a tax because groups

like unions got carped out? >> senator, with regard to this specific provision, i think this falls under trying to improve and find better ways to implement the law. the specifics -- while this does apply to some unions, many unions it does not apply to and applies to other groups. it has to do with the definition of self administered versus third-party administered and in terms of what the law is trying to do. the question off, there are places that those are not synonymous terms and the reason they're not is, what we found this we were moving forward is, there are plants that are self administered not using third-party administered and creating that distinction was a way to provide better clarity. that is what we intended in terms of what was being done. it doesderstanding affect 25% of union plans and it is something i believe that they requested. require a lot of subjectivity.

it is a simple question of math. of whatnk the question was higher, what was lower -- it is a question of what was implemented and what your starting point was. what was the actual starting point? >> we know what the taxes opposed to raise. it was a finite amount. it will be paid by a certain number of people. the pool shrinks. the people left in the pool will have to pay more. that is simple math. i think the answer is yes and i would like to hear you say yes. >> i think what was intended was to implement the law any a better way that was common sense -- >> that his theory. this is mathematics. are people going to pay more? the answer is yes. that is what i am saying when it comes to this issue of selective

enforcement. and i don't think that's fair. you have had exemptions now twice for small businesses under the employer exemption. think, 20-some exemptions or delays under the law that have been waived sort of unilaterally. this particular provision is really problematic for people who still have to pay the reinsurance tax. all i am saying, as a matter of fairness, carving out favored groups should not be the modus operandi. we ought to be going about this in a way that treats everybody fairly under the law. i don't think you can argue based on the number of exemptions, the number of cargo, the number of delays issued already that that is the case. this was one issued under your direction at omb. with regards to implementation, i think one thing 16 to do, where you find a

place you can implement better on the law, you do seek to do that. they were having difficulty doing the reporting requirements they would need to do to do this accurately. with regard to other complex pieces of legislation, one of which is partly -- part d and others. youne moves to implement, do listen and try to implement in a better fashion. in terms of trying to hear, listen, and make the transition workable. on the individual side, what one sees as an opportunity for individuals to apply for hardship exemptions. >> mr. chairman -- in the ,ntrance of transparency though -- in the interest of transparency though, it in terms of waivers and delays, would you be willing to submit the insurance rates for next year? the enrollment date has been delayed until later this year.

getdate at which plans approved has been delayed, right before the election. which is very convenient. we know that there will be real-world impacts on this. in terms of transparency, which you have talked a lot about, will you submit to us those rates when you get them from the insurers? >> i think the issue of premiums and rates is one that we will all be interested in. with regard to the specifics of what hhs receives and when and how, that is something that i am not familiar with in my current role. is, ifwill say, senator, i am confirmed, that is something i will understand and work with you want. simply just very briefly, ms. burwell, i appreciate your reference -- >> just very briefly, ms. burwell, i appreciate your reference to part d. senator cardin?

chair burwell. thank you to you and your family. act sets uple care the right structure for quality health care for all americans. there are many divisions of the law i would like to see strengthened and improved and i would hope we could work together to do that. in the few minutes i have, i would like to go over a couple positions we have not had a chance to talk about. i want to get on the record -- establishes all of the to aagencies, elevated nih national institute. there are reasons for that. i gave you the example of baltimore, a study funded by the institute, where depending on where you live, it could be a difference of 30 years of life expectancy.

you know the statistics on individual diseases and differences among different ethnic communities. intended that the focus on minority health and health disparity would be a priority within our health care to deal withg previous failures we have had in trying to do with this. i was disturbed when i looked at the president's budget. there were a few of the , that were nih frozen, it did not get any increases. the institute for minority health was one of those that was frozen. could you share with us your commitment to implement the intent of congress to put a priority and spotlight on advancements to deal with minority health and health disparities? >> yes, senator.

thank you for your leadership in this space. the issue of minority health is important and one that is being partly addressed by the affordable care act and the president's budget. doctors looks at the being trained, the numbers is proportionally represent minorities. and think that is important are, getting providers to the communities where talking about. there is a program to actually promote researchers, minority researchers in the work that nih does. the whole across realm, there are other parts and provisions, whether that is preventative care or community health centers, thinking about how those entities and parts of implementation in care can help minority communities. important thats you put together a coordinated so we have the

confidence that we have made this the high priority it deserves. one area related to that would be the qualified health centers. one of the great stories of the affordable care act is the significant resources made available to qualified health centers. i have visited most of our centers in maryland. they have a hand in prenatal health care. low birth weight babies are down. infant survival is up. we have dental services in the community that were not available. mental-health expansion. all of that as a result of the affordable care act. women need your support to continue that priority. it is not just third-party coverage. it is access to care. i want to ask you one more question dealing with dental care, which is another problem with minority health and health disparities. maryland, we have the tragedy of the monte driver, who died, 12-year-old not being able to careccess to oral health

in 2007. pediatricded for dental. however you can have three stand-alone plans. we have got to make that as seamless as possible. that is, it is an essential benefit. families need to have access to pediatric dental without separate deductibles and limits. will you look into how we can benefit, asseamless congress intended, under the affordable care act? pediatric dental? >> senator, i know this is an issue that you have taken leadership on and senator rockefeller brought it up in his comments as well. having had an opportunity to work on pediatric dental in my foundation work, that is something i would like to look