well. so now it is my great pleasure to introduce the person you have come to hear, ambassador susan rice. she is, as you know, the president's national security adviser. she has been in this position since july of last year. before that she was ambassador to the united nations and of course a member of the president's cabinet. during the clinton administration, she served as u.s. assistant secretary of state for african affairs, and prior to that, as senior director for african affairs and the director of international organizations and peacekeeping at the national security council. between her two cents in government -- two stints in government, she was a senior fellow at the brookings institute. i could go on and on, but we want to leave time for questions, so please join me in welcoming ambassador susan rice. [applause]

>> there are so many areas of the world getting a lot of attention right now, it's hard to know where to begin. maybe that's how you feel every morning. but just to start with something i know has captured everyone's attention the last couple of weeks and that is nigeria. what right now is the state of the search for these young girls who were kidnapped, objected from their school, and this -- abducted from their school. and the u.s. has now joined the search with the nigerian government. >> i appreciate you asking about it. this is such a horrific situation. for those of us who are policymakers but also those of us who are parents, as i am, it is heartbreaking to imagine your teenage girl taken away and

potentially at risk of being sold into captivity or worse. this has gripped all of us in the administration and across the country. we are doing all he can to support the nigerian government's efforts to recover the girls, which is obviously -- job one is to try to find them. they are now missing in an area that is roughly the size of the state of west virginia. that is a large territory. the united states is very actively involved. we have a team now of up to 30 people on the ground cooperating closely with the nigerian government. our team consists of diplomats, military advisers, intelligence experts, law-enforcement experts and even development experts all coordinating closely with the nigerian government and now, increasingly, with representatives from the british government, the french government, and the israeli government, all of whom are

there in search of the girls. we are also applying aerial assets including manned and unmanned aircraft to do what we call intelligence surveillance and reconnaissance over this large area so we can maximize the resources devoted to trying to locate the girls. as i said, that's job one. >> i think everyone has observed how long it took the government in nigeria, the government of good luck jonathan, to get started on this. >> we're certainly pleased that now they have accepted international offers of assistance, including that of the united states. we indicated early on our readiness to help in whatever ways they felt necessary.

it is late, but hopefully it is not too late. the good news is that the best efforts of the countries that can provide the most sophisticated support and surveillance are now on the scene. the government is working cooperatively with us and others on the ground in an all hands effort. >> he will not be surprised to know that there are already voices on capitol hill being, if not critical, at least questioning the administration. john mccain is saying that not only should there be troops, but they should be sent in even if the nigerian government does not want them. [laughter] >> well -- [laughter] let me say that obviously in this sort of situation the responsibility rests with the

government of nigeria to provide for the security of its people and to protect the citizens. to the extent they make requests of us or others to provide support, we are open to entertaining those, but obviously, as we said at the asset, the most important thing now is to locate the girls. there is no point in sending in additional support if we don't know where they are. that has to be the first order of business. >> but you're not ruling it out. >> frankly, in all likelihood, if we were to do more, it would likely be in an advisory capacity, which is what we are doing now and could potentially do more of if we had better information on where the girls were located. >> there are so many parts of the world to ask you about. i next want to turn to ukraine. there are roundtable talks about ukraine decentralizing the government in some way, potentially shifting power to

officials outside of kiev. do these talks, in your view, have a chance of success since at this point the government is still not including any representatives of the pro-russian separatist? >> for folks that have been following this closely, they began the day, as judy said, in the parliament building in kiev. it is quite a broad cross-section of ukrainian society, folks from the east, south, west, former politicians, groups of all sorts supported by the osce -- an international organization that has been integral in trying to reduce tensions inside the ukraine. it does not yet include elements from the armed opposition. the government has taken the perspective that if they are to

participate in a national dialogue or roundtable, they need to lay down their weapons. the separatists, for their part, have refused to participate as well. this is something we hope can be inclusive as possible. clearly, a national dialogue is not the place for armed elements, but if they wish to participate and do so on a peaceful basis, i think the government of ukraine would be open to that and we certainly would be supportive. the osce, an organization we are a member of, has committed itself to supporting this process. there is an internal dialogue within ukraine to deal with the very real issues of language that need to be resolved. rex do you think a new form of government in ukraine is inevitable given what we have seen in the informal elections? some have called it a

referendum. others are not recognizing the legitimacy of it. clearly there is dissatisfaction on the part of a significant minority, if not majority, in parts of eastern ukraine. >> i would not say anything is inevitable in this context. first of all, there will be elections in a couple of weeks time. these are important elections that the vast majority of ukrainians are committed to participating in and taking seriously. we hope very much that security conditions will be such that those elections can be held throughout the country. it is a small minority that has resorted to armed tactics in the east, and the ukrainian people, having been through a huge

political and social transformation, want very much to have the opportunity to determine for themselves the future form of government and their constitution. there is clearly a need to have a roundtable dialogue to work through the ease issues that are so divisive, including decentralization. they will do so, i think, with the opportunity to chart together what their new form of government will be. i don't think there is inevitably going to be an external dictating of the russian government. >> in crimea, it seemed quick -- a quick move for russia to come in and annex crimea.

does that say to you that resolution of this is possible and possible in the near term, or do you look at this as a long, drawnout slog, in effect, that will mean rising sanctions and continued tensions with the russians. they have arty said americans can't use their rockets for space exploration. it seems like every day there is something else. which explanation do you see. >> the true answer is one cannot be certain how this is going to unfold. first, to be clear, what happened in crimea is completely illegitimate. nobody in the international community gives that any credence. that itself is something we need

to be firm about and recognize that there are costs that have already been imposed for the illegal annexation of crimea and nobody is excepting that. beyond that, what the russians choose to do and what they will risk for themselves going forward is really the tension we are dealing with. on the one hand, russians haven't seen -- have seen significant cost to their economy already. in terms of flow of capital and private businesses being very reticent to get involved in what was already a weakening economy. we have been very clear that if russians move forces in or take actions that cannot be held in a credible faction, that will trigger much more significant sanctions, including, as we have indicated, sanctions on key elements of the russian economy. i think that prospect has been heard and understood. i would not say definitively.

he has to weigh the very real risks to this country and this economy of further destabilization. >> let's turn to the middle east, where there is a lot to look at. starting with syria. yesterday you and the president met with the leader of the syrian opposition at the white house, reaffirmed your political commitment to a solution. but there are new developments. a designated meteor quit his job. among other things, he criticized the rest of the world for failing to agree on humanitarian aid, much less assistance that would bring this crisis to an end.

the administration's statement says that the bishara assad -- bush are all assad regime -- says that assad regime has lost all legitimacy. but he holds the upper hand. he has called an election. his military seems to have the upper hand. what can anyone on the outside, including the administration, due to change the situation on the ground in syria? >> we had a very productive meeting yesterday with the syrian opposition. it was not just the leader of the military side of the opposition. the meeting lasted over two hours. we had an opportunity to hear from them what they most want from the united states and the international community. it was a very interesting discussion in several respects.

first, what they explicitly do not want his u.s. military intervention. what they do want is increased support, which is exactly what we are doing. a large part of the discussion focused on their desire to be able to stand up hospitals and schools, and the institutions of civil authority in the areas they control. they're very concerned,

obviously, as we are, about the humanitarian situation. the united states is the largest provider of humanitarian assistance, 1.7 billion dollars worth, which they are very appreciative of, and obviously want to see continued. the problem on the humanitarian side, which we discussed at length, is really twofold. there is a denial of access across borders that the government is substantially responsible for, and the use of barrel bombs and other weapons of terror that are increasingly a tactic employed by the government. they have asked for support to deter the use of aerial bombardment, particularly barrel bombs, along with increased humanitarian, civilian, and of course they want military assistance.

from the u.s. point of view, we have for quite a while been not only the primary provider of humanitarian assistance, we have been ramping up our support to the opposition both in terms of the armed opposition in the civilian opposition. we have been very careful to try to vet the aid we provide. that is increasing and they acknowledge and appreciate that is -- it is increasing. they are very concerned about getting into the wrong hands, two. they are in fact fighting a two front war, on the one hand against assad regime and on the other hand against the extremists, the al qaeda elements. they are very focused, frankly, on the need to eradicate the

radical threat as well as dealing with the assad regime through the negotiating table. they view the military at that -- military effort against assad as a way of getting to the negotiating table. >> the french foreign minister said there is evidence the syrian government has used chemical weapons more than a dozen times after it signed a treaty banning them. he went on to say france had been prepared to use force last year as part of a us-led coalition, but has not wanted to act alone. he said of the strike had been carried out, it would've changed many things. do you or the resident have any -- president have any regrets at this point about not moving into syria? >> the credible threat to use

military force was to deal with the threat of chemical weapons. i think there are no number of airstrikes that might have been contemplated that would have done what has been accomplished, which is 92.5% of the declared chemical weapons are out of the country. that last eight percent, we are determined to get out. we made more progress in that regard in the time that has expired than many would've thought possible. i was in israel last week meeting, as i do with some regularity, with my israeli colleagues and counterparts. they have obviously for many years been deeply concerned about the chemical weapons inside of syria and the risk that poses to israel and other neighboring countries. they thanked us profusely for our approach and our success in helping to get those chemical weapons out, which has substantially increase their

sense of security even as they are dealing with the very difficult environment. i want to thank ambassador rose and our undersecretary for arms control, who has been the most active person and to work with the united nations and the russians to get those chemical weapons out. i think that is a huge success. i think it is important that we recognize that had we not had a credible threat of force the serious would not have a knowledge they had these weapons much less shipped them out. in terms of the recent allegations, that is something we are quite concerned about. the allegations, by the way, are that the syrian government might have used a form of chlorine gas, which is not the same substance as sarin and the other lethal banned substances that are on the chemical weapons list, but they used chlorine, which is an industrial chemical, even though it is not on the

chemical weapons prohibited list. it is a crime. it is against the chemical weapons convention if it is used in combat. we are looking very seriously at that through the oh pw, which has launched an investigation on the ground. they are the ones doing the removal. if in fact these allegations are verified, we will deal with them accordingly. but i want to be clear that there is some confusion in the public domain. these are not the same weapons that were meant to be confiscated previously.

it changed and 92.5% of the chemical weapons are out of area. -- syria. there has been discussion, and you are very familiar with comments you made in the time when he served in the clinton administration. samantha power, the u.s. ambassador now, quoted you as saying that after rwanda, 20 years ago, i swore to myself that if i ever faced such a crisis again, i would come down on the side of dramatic action. >> some would argue that i have. [laughter] >> isn't syria is equally horrible a humanitarian crisis is wanda? -- as were wanda?

>> it is not a genocide. one million people have not been killed with machetes in a door to door massacre. as human beings and policymakers, mothers and fathers, we feel these tragedies personally and deeply. i visited were wanda -- rwanda six months after the genocide. that is the kind of experience that will never leave me or any other individual who experiences. when you see a situation like syria and the cost in lives is extraordinary, one feels passionately about it. what are the tools available to us? syria is now a civil war. it is something that is for effect, -- horrific, but it needs to be distinguished from

the type of genocide that we saw in rwanda. there will be in since is where -- instances where the tools we have can be up lloyd with greater or lesser effect to prevent the continuation of the conflict. this is not the only one. what is happening in other areas has cost many lives. it is profoundly disturbing. if you visit there, you see the huge human cost. you can see these -- say the same in places like somalia and south sudan and the central african republic. in each of these instances, i think our consciences are tested. in every instance, it does not mean that the obvious answer is international military intervention. sometimes it may be. but not always.

as pained as we are by circumstance, i do not think that it is reasonable or wise to think that our military intervention is viable. >> do you have a yardstick for when it is appropriate? >> i do not think there is a yardstick. each circumstance is different. the approach of the international community may vary. the complexity of the situation may differ. let's talk about libya.

we were able to create some positive affect. on the eve of the un security council, qaddafi's or says ron the outskirts -- forces were on the outskirts of benghazi. he had said that he was going to wipe it out. he had a history of wiping out so many people. what distinguished libya was that the community was united. there was no great power for his government. it was not a situation in which you had al qaeda and other extremist involved. it was not a situation that had

regional dimensions. we were able to accomplish that in a coalition. it included arab states and countries. that is different from what we are dealing with in syria. >> since you brought up benghazi, [laughter] >> you are too smart for that. come on. >> the republicans have created a special committee in the house of representatives to look at what happens before ensuring the attack on the consulate. that was when the ambassador and three others were killed. is there -- what more is there? >> dang if i know. the administration has produced at least 25,000 pages of

documents or individual documents. they have supported, participated in, contributed to the investigation. we have had an accountability review board. it was a distinct group of outsiders. the house and senate committees have pronounced this repeatedly. it is hard to imagine what further will come of yet another committee. when i focus on is the national security advisor. what can we do? we must increase security around

the world. we have a budget request on the hill for $4.6 million. it is necessary in the administration's judgment to make the kind of upgrades and provide the kind of security that we need. let's focus on that. what is lost in all of that discussion about talking points is that we lost brave americans on that day. their families and those of us who work with them continue to grieve. the last thing we need to do is to lose anymore. looking around the world in any number of places where american diplomats and servicemen and servicewomen are doing what we asked them to do and be on the front lines of one policy, they deserve the support and protection that we can provide stop >> do you think it is legitimate -- the committee chairman said to look at whether the administration should have done more to make that conflict safe and make the ambassador

safe. >> absolutely. that is what we have done. that is why we have an accountability review or. dashboard. that is why we are seeking be resources that we need. there are risks that our personnel might face in other parts of the world. security and safety of american personnel is absolutely the top priority of the administration. to the extent that we are focused on that, i think we all agree that that is where the focus should be. >> several things i want to ask and i will incorporate other questions as i have been given them. iran, negotiations over iran resuming today.

do you think there will be a productive outcome? >> the negotiations for the comprehensive agreement have what we can say so far is that the interim agreement that was concluded in january has been substantially implemented by the iranians and the other side. that is a positive step. what it means is that iran will be ridding itself of its stockpile. it has 20% enriched in rhenium

-- uranium. it will roll back its program in meaningful ways. whether we will get to a successful conclusion of an agreement is to be determined. there will be a very difficult issues. iranians will have to take difficult decisions. >> a side note. saudi arabia invited iranian leaders to come -- that is remarkable. these countries have been archrivals. how significant a move is that? >> it is a good move. it is one that we encourage and support. the tensions in the region that go on and that are being played out, including in places like syria, can best be addressed by enhanced communication. whether cap and so what comes

of it, we will have to see. >> the israelis and the palestinians. you met with the israeli leaders. any hope for peace talks in the coming year? >> those of us who work in my business always have to have hope. i do. we are at a point of pause in the direct negotiations. we are going on for the last my months. we have a clear, and my message to both sides was, the only sustainable solution to this tragic conflict is a negotiated two state solution. that is the position of both sides. they are not ready to take the steps to actualize that. we have underscored in the

meantime, as we manage this moment of pause and they manage this moment of pause more precisely, they should not take steps that make the circumstances more tense or fraud. -- fraught. >> what has happened in the last several weeks is that some u.s. officials involved in these negotiations are now saying that it was the israeli government and the expansion of settlements. prime minister netanyahu's plan to build more settlements that sabotaged. >> you have heard american officials say quite directly, and it is what i have said, we are disappointed that it was not possible to continue the negotiations. that has not been in our judgment the fault of one side rather than the other.

both sides took that's that were not conducive to a positive atmosphere. those steps include it the israeli government and their decision not to release prisoners. it also included the palestinian decision to the feed -- acede to treaty bodies in the late page of decisions. man previously refrained from doing that. there was the surprising announcement of a bid to reconcile with hamas. all you is that both sides took sides that were disappointing -- steps that were disappointing and not conducive to progress. both sides have the ability to resume negotiations. >> the israelis will continue to

build settlements? how do peace talks get started again? >> if there were a magic wand, we would wave it. we would not be in 60 years of conflict. i do not have the ability to say, here is our silver bullet. i think both sides have the responsibility to look at their circumstances and their future and their children and ask themselves, how do you forge a future of peace? both sides will have to make difficult decisions. we think it is in their interest to do so. israel has the prospect of becoming a secure and recognized jewish state. it has the recognition of countries throughout the region. that is something it has sought.

houston is want a viable state of their own. they say they want to live side-by-side. that is the future that we want. we cannot want it more than they do. there are a couple of other countries i want to mention. one is china and what happened between china and vietnam. china is faulting the u.s. for encouraging provocative moves and what they call the south china sea. they say that the dispute should be resolved by the parties involved. now we have rioting going on in vietnamese cities. it is reportedly against chinese

boundaries and other plans are involved as well. what can, if anything, the u.s. do to resolve what is clearly a growing area of tension. china has issues with japan. now vietnam. what role can the u.s. play? >> the u.s. has been very clear. the only way to resolve these territorial disputes over sovereignty is through the mechanisms of international law. peaceful resolution is desirable. there should be legal instruments. we have never taken a position on sovereignty of these territories. we have been very clear that provocative actions and intimidation and steps to create a presence on the ground that complicates the prospect for diplomatic resolution are

completely on help old. that is the message the president took during our recent trip to asia. it had widespread support from the countries he visited. what we are seeing in southeast asia is countries want good and constructive relationship with china. they are increasingly unnerved and put off by what they view as provocative and aggressive actions. we have been clear that would china has done vis-à-vis this latest issue of putting down an oil rig shows a forced to react and respond. it is provocative and unhelpful. behind closed doors at a meeting last weekend, there was a great deal of anxiety. it does not serve china well. china has every interest in the countries of that region wanting to partner. it should not be talking behind closed doors. >> is there any evidence that

the chinese are listening or responding? >> one thing that can be said about china is that it wants to be welcomed and accepted as a major player. not just in its own neighborhood, but on the global stage. it is becoming more isolated and the subject of concern. that cannot be a welcome development from the chinese point of view. >> the chinese seem to be getting ready to build a structure within the app canonic -- up in -- economic zone of the

philippines. >> that touches on the same thing. >> it is in the same vein. the ambassador from the philippines -- we were just there a couple weeks ago. the philippines has approached this in a very responsible fashion. they are taking their concerns to a tribunal. 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 in the administration for not being sufficiently strong. i could use other adjectives. not being sufficiently outspoken or projecting american strength and presence in the world. the president address this. it was a news conference when he

was in asia. how do you see that? how do you address the frustration that there are so many parts of the world's that look to the u.s. for guidance and leadership is on the other hand, there are sony parts of the world's that resent the u.s. role. as you sit back or lean forward, how do you feel about that? what do you want the audience to know? >> there's 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, no one matches us across any dimension. the notion that the united states is weak or withdrawn is counterfactual.

having spent time recently in asia and in europe where we were in close conversation with some of our allies and partners, our european allies, 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. those alliances aren't mutually reinforcing and mutually beneficial. i was just in israel on a separate trip to the gulf region. even there, each of our partners looks to the united states and is grateful for what we provide in terms of our security cooperation and global leadership on issues across the spectrum and the fact that there's is nowhere else for them

to look on the planet where you have the moral leadership, economic strength, security, might, not to mention, our technology, be our of our culture and our society. the united states is viewed with -- in a positive light. >> what is your one or two words of advice to young women here? >> the time is not. that should have been an earlier question stop [laughter] >> that should have been an earlier question. i thought that was a large part of what we were doing here. >> do it. two words.

first of all, i want to be frank and say, i believe deeply that young women and young people need 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 will make you the most money. you should do what you love. i hope for many of you, that will be public service. that is what i love. when i was 20 years old, i could have gone every -- either way. i did not know where i would end up. i knew from the time that i was 10 years old, i wanted to be a public servant. 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 to serve their country. in many different ways -- there are many different ways to do that. public service encompasses nonprofit sectors, and it encompasses journalism. in many respects, it can be a competent private sector, if the work you are doing serves a larger goal and a larger group. i am hoping that folks will follow their passion. there is incredible complexity and challenges. it is never boring. i get to work with very smart people. in my case, the president, for whom i have enormous respect and find intellectually challenging

to work with and for, i hope that all of you were thinking about these sorts of careers will look carefully into it. i hope you will find it as rewarding as i have. even with political polarization. [laughter] since you mentioned that, going back to your prior question about america's role in the world, the one weakness that our friends like to -- and the one thing that undermines our strength is our political polarization. when countries look at us, they wonder and they worry if we will have our collective act together, whether it is our

budget, how we teach in the world, that is what undermines us. >> it is also the strength of our democracy. >> we have had the democracy for 230 years. it has not always been as dysfunctional as it is now. >> on that uplifting note, let's thank ambassador susan rice. [applause] ambassador rice, thank you for a scintillating discussion. thank you for helping us understand what president obama faces every day. we want to present you with the women's foreign policy group award. we want to celebrate leaders for being role models and encouraging women 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. [applause] hhsoming up, a hearing for

secretary nominee sylvia burwell. visits new york to talk about infrastructure spending. and a seminar on regulating national marketss. on the next washington journal, hispanic voters. and how to attract them to their side. then former u.s. ambassador to nigeria on the recent reduction of girls. how the u.s. is working with other nations in the search for --m to read than the changes search for them. then the changes in iraq. live aton journal is 7:00 a.m. eastern on c-span. convergence, you use that word throughout your book.

>> it means that throughout the country, there is a convergence of left-right agreement on important things. is being pushed down by the corporatist grip on both the emma craddick and republican party and their leaders. we start with public opinion around the country. doesn't matter red state, blue state. they are upset with patriot act restrictions on privacy and civil liberties and free speech. big convergence. they don't like subsidies, handouts, giveaways. especially the wall street bailout. where were prosecuted. where no crooks where prosecutors and. versus wall street street. they don't like empire. right, left, they do not like empire. they do not like us pushing around all around the world and

into countries and losing our soldiers and they come back traumatized. all the people around the country see public -- crumbling public works. we need repairs and we are blowing it up with joins of dollars overseas. that is a convergence issue. >> ralph nader on creating group -- on creating left-right alliances. on q and a. >> c-span's newest book, sundays at eight. interviews with the nation's top storytellers. >> i can't say with the moment was because i have been looking at all my life. my parents migrated from the south to washington dc.

i have lived with the all my life. i grew up with people from north carolina, south carolina, georgia. thes surrounded with language, the food, the music. the ambitions. from the south. a lot of competition about whose child would go to which school. the school across the part. it has been with the all this time. one of 41 unique voices from 25 years of our book notes and q&a conversations. sundays at eight, now available at your favorite bookseller. >> president obama has named white house budget director itvio birdwell -- edison information hearing, she answered questions about implementing the affordable care act, preventing medicare fraud, and funding or nickel. this is two hours 40 minutes --

funding for medicare research. this is two hours 40 minutes.

>> the finance committee will come to order. the finance committee meets to of sylviae nomination to be the secretary of the apartment of health and human services. . , 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 thingthat 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