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 at, how to get the services delivered to people in ways that they can access it and use it in ways that prevent the kind of problems you described with the 12-year-old that actually extend through adulthood for many. >> absolutely. i look forward to working with you. thank you. >> thank you. senator isakson is next. congratulations on your nomination. congratulations to your family or condolences to your family one way or another. hearing before the health

committee, i brought up an issue i already discussed with the chairman. in that meeting i told you i had no more responsibility as a member of the united states your -- noluding more pressing responsibility as a member of the united states senate, including your the harborthan project. i wanted to bring clarity before you were gone from omb to make sure we had a road forward to make that reality. to confirm what dr. coburn said about responsiveness, without -- in an hour that hearing, your arranged a meeting with your chief legal counsel, your deputy director, and your chief liaison and the under secretary the army corps of engineers where we reached a way forward, which i just want

to memorialize with this hearing today. we need to pass the authorization, which is in the final conference agreement. i've seen that. second, the court has to initiate and begin a public ownership -- partnership agreement and the state needs to agree to forward fund initial construction moneys, for which it will receive credit. do i have a correct representation of the steps forward and collect -- and pleading this -- completing this project question mark >> senator , you have. i hope that the word will pass quickly and we can move forward with this important project. >> thank you on behalf of the people of georgia. and really the united states of america. thank you very much for your responsiveness on that. i was a real estate guy, but i had a little insurance agency in

my company. group healthsmall policies, for which independent agents received commission. when the affordable care act passed, it put the medical loss ratio for small group plans and large lands at 80%, and 85%. and your department determined the commissions were part of the administrative cost of the plan, which meant you would have to pay the commission and administer the program out of 15%, which basically put all of the independent agent selling health insurance out of business and was the reason we had to hire navigators to help people find their ways to the exchanges. when you become the head of the department, i would like you to look at that decision and revisited in terms of efficiency for the plan, to allow smaller -- and large group sale people to get back into business. it will save cost on the government in terms of not having to have as many navigators, put people back in business who i think were

unintentionally put out of business by the affordable care act. >> senator, if confirmed, i look forward to looking into and understanding that. of an been on the board insurance company, i understand the independent agent issue, as well as the issue of how we think about premium issues, which are number of people have brought up today and how we -- i look forward to that if confirmed, how to think about that issue. by theit was brought up chairman, and some of the members -- i had the occasion to watch you and access for eight successive weeks at the white house when i with the group of eight had dinner with the president and denis mcdonough and yourself, trying to find a way forward on deficit reduction and reducing obligations over time. i do not want to get into a long question, but i would like you to consider leaving all options on the table in terms of fixing

.he sgr as you'll remember, some structural forms of medicare can bring tremendous savings without hurting beneficiaries. we talked about those and those meetings. that could be part of the equation that will help us find a way to pay for the sgr and never have these one-year renewals again and again. i appreciate you leaving all of the options on the table for discussion. >> senator, >> senator, i welcome all opportunities and as is reflected in our budget, we have a wide range of opportunities, and the type you're talking about as well. all on the table. >> thank you. senator roberts. >> thank you, and -- mr. chairman. when we spoke during the senate health committee, i asked you questions about the independent payment advisory board, ipad is

the acronym for it. thathat could happen if came into being and in your response, you said that you were "hopeful that ipad never needs to be used and the necessity to do so would never be triggered." would you simply support its appeal? also important to reflect that ipad, as currently written, would not affect beneficiaries. that is an important part of the law with regard to how it is implemented. as regard to the appeal on the things thate of the is hopefully a hopeful thing is to helpthings in place

us all get to where we need to with regard to reducing health care costs. >> may be barbed wire would be a better way to put it. i would echo my colleagues comments to you, regarding your responsiveness and willingness to work with this committee and all members of congress. i would also like to add relevant medicare takeovers to that list. just this last week i had the kansas hospital association in my office sharing their frustration over the lack of responsiveness from hhs. this is the same letter that they said your predecessor in january. they have yet to receive a response regarding the medicare recovery audit contractors, what we lovingly call the rac. they don't want to be put on the rac. they are still awaiting a response. have returneds

savings to the local trust fund. it is important that providers have timely access to the appeals of these audits. 65 lawtalking about judges and now 350,000 claims, which i understand is the reason for the delay, or the suspension. it is rather incredible. we have gone from impending appeals in just two years of 900 -- 92,000 claims to 460,000 claims. when the weekly operation of about 1250 up to 15,000 per week. the reason is obvious, and that , hospitals win 70% of the time. which means these independent hospitalrs come into a and many times they have never seen them before. they are being find for regulations they know nothing about. and if you are in a small hospital, you have a problem they doing out whether you're

going to appeal or not, and now we find that the appeals are suspended. i would add to my list -- what can be done to better balance the need to recover improper unduets without imposing administrative burdens on providers? particularly those in our rural areas. >> senator, with regard to this issue of the rac's as well as the balancing of having hospitals be able to process things quickly, at the same time we are providing -- trying to prevent abuse of medicare, if i am confirmed, this is an issue i think will require a quick look, a fresh look, and to think about how we can get the balance and what processes can be used to balance the two interests. i think you are appropriately reflecting -- in terms of the speed and the processing, it is not where we want to be in terms of the system. perspectiveyear's rule, asystems role --

rule that you signed off on at omb, hhs payment clarification requires submitting a patient into a critical access hospital and certified that the patient must be discharged or transferred within 96 hours. this payment clarification, which is not in line with the critical access hospitals condition for participation with medicare, in my view. and in their view, is crippling the ability of many of these communities to provide rural -- toommunities communities. one doctor said i usually met 12 minutes and now it is three minutes because of the 96 hour role. besthen they decide on the course of action for their care. it is another example, in my opinion, of having to tell cms that if it is not broken, there's no need to fix it. if confirmed, will you do all you can to see if we can reverse

this payment issue, so that rural seniors can continue to receive care at their local community academics the issue of critical access hospitals and care in rural communities -- at local communities? >> the issue of crigler access hospitals and care in rural communities is something that we need to get the right intent on. in terms of how to get to the place where the original objectives of the rules and be achieved in the way that they do not have the unintended consequences that you are articulating. >> thank you. my time has expired. >> senator warner. >> let me thank you again for your service. looks like you're coming around the bend and close to being done. i have a number of things i want to get on the record. first, i want to add my voice to the comments made by senator isaacson and senator roberts. i think the displacement of agents and brokers with a challenge and a mistake and i hope you will review that

process. let me also add my voice to what senator roberts said. i hear repeatedly from rural rac audits.bout the e we do need to make sure that we get rid of waste and fraud, but we want to look at that. moving on, one, the treasury department recently finalized the employer rules dealing with individual mandate. there's a lot of complexity about these rules and some of these complex -- complexities were highlighted by the american bar association. this is not just a treasury-ir wretcs issue. are implementles it, -- i have raised this with you before. i introduced legislation with eight cosponsors that is endorsed by a number of employee and employer groups, which would basically allow employers to

respectively rather than have a one-month -- once per month reporting. upfront require an collaboration between hhs and treasury that might remove one of the administered to burdens that we here in enormous amounts about around aca. my hope is if you are approved, and i hope you will be, that you will help work with us on it of this legislation or other ways we can improve this reporting requirement, and again, with this perspective action rather than just doing it retroactively. >> if i am confirmed, the it ministration and the president has said that we welcome the opportunity to think about things he can do legislatively and otherwise to improve it. >> i will take that as a yes. it is my understanding that there were agreements with the number of web-based entities to allow private exchanges to

enroll tax subsidy individuals pursuant to regulations issued by hhs in march, 2012. again, something we talked about. this effort was stymied due to in -- insufficient technology integrations. i understand there have been some small steps taken by hhs, but not a lot has taken place. to my mind, this should be a no-brainer. if we can get some of the sites, perhaps more user-friendly as an additive to help that, i hope you will work with me and these web-based entities to make sure that there is better technology integration this area. >> i welcome the opportunity to think about the best way to do distribution. and harkening back to senator isaacson's russian and your comment, the dissolution mechanism in terms of how people can easily access and receive health care. >> and clearly, there may have been sites that were private

sector sites that had a better reputation than the federal exchange. if we can find ways to utilize that and integrate that technology, to me, it seems like we want to expand that. i hope we can work together on this. again, an issue that i raise you, au -- raised with little more, kitty, about cms changes recently in the hospice benefit. i think as this is being rolled out, it is confusing and lacing a lot of unnecessary burdens on hospitals, patients, and families and providers. hospice should not reject can shown unless it why should be covered by the part d plan. if it is related to the terminal illness, and her stand. but if you have glaucoma and a

terminal illness, glaucoma is not related and the hospital provider should be reimbursed for that. my hope would be that we can dig down to earth relators of difficulty with this issue and that you will work with me -- dig down two or three players of difficulty with this issue and that you will work with me and others on this. >> i look forward to working on that issue, in terms of how we can figure out how to pay for the right things and do things that are implement. >> with four seconds left, as a former governor, to me just say that -- let me just say that one of the things we often try to do as state is to look at innovative programs, to try to get a waiter, whether it is medicaid or chip. but a lot of these programs never move from innovative test models to actually becoming permanent parts of a state program. this, to me, is an area ripe for administrative review.

at some point, you have either proving your case and should be accepted as part of the state program, or rejected. again, i hope you will work with me on this. >> i will, senator. >> thank you. chairman, andmr. this burwell, thank you for your willingness to step forward for what will be a very challenging tax -- task. you will be among folks who have had the worst job in washington. i congratulate you on seeking a promotion. [laughter] but i do think you come at it, therefore with a different perspective than other hhs secretaries have had in modern times, which is that of a budget cutter and someone who has had the possibility for oversight and trying to find efficiencies. i think that is really important right now. i hope you will continue to have that attitude at hhs. , will focus on medicare

because i think you would agree with me that when you look at not just the health care issues, but also the fiscal issues, if we don't figure out a way to reform this incredibly important, but unsustainable program, we will have a difficult time today our fiscal house in order. and as you found out when you were at omb, this is not an easy task. there is obviously a lot of difficulty in touching any aspect of medicare. but the reality is, the trust fund, which is the trust fund covering hospital care and skilled nursing and so on, is expected to be insolvent by 2026, according to the most recent trustees report. even if that were not true, we know that medicare as a program currently offers three dollars in benefits for every one dollar in taxes that a retiree contributes. that is your typical family in cincinnati or in washington, d.c. program already that is

heavily subsidized by general revenues. and heading toward this , even with the general revenue contributions. .y question to you is this in this confluence of omb and hhs that may well come together here with your confirmation, what are your thoughts about it? and let me ask you a very specific one that i think you should be able to answer in the affirmative. in the president's budget in the past couple of years, he has inluded a change in the way which the recipients of part b and part d benefits pay their premiums. he said there ought to be additional premiums for folks -- whoe around $170,000 make a certain amount per month. in retirement. in the president's budget, it was $56 million over a 10 year budget.

-- $56 billion over a 10 year budget. that it willicated be over $400 billion in the next 10 years. budget.fast-growing it is what we ought to be focusing on here in congress and with the administration. my question is, one, i assume you support the president budget proposal. but, two, would you be willing to support it as far as means testing under medicare to be able to deal with -- we talked about sgr. my question is really about deficit reduction to come together to deal with a problem that has been difficult politically for us to handle in the past two years in congress. would you support a proposal as a stand-alone measure? >> senator, i agree with you. i think one of the real benefits of the premium income testing -- income testing for premiums has to do with the fact that it is a structural change and you get

those benefits in the out years that are important to the members and the deficit space also when i think about the omb,its and the my role at i think it is important to understand that the driver is the issue of health care costs the medicare system. but it is also our demographics. and because of that, the magnitude of the problem when one gets to the specifics of what you're going to do to resolve that issue, i think it actually takes a combination of things to do that. i think it takes things as you are discussing, that are on the beneficiary side. it takes things that are on the provider side. it takes things like revenue. >> but as you know, we have already done a lot on the provider side already. my question for you is, in the president's budget, i assume you support the policy. would you be able to support a policy initiative, whether in the context of sgr, deficit reduction, or tax extenders, or whatever it is? do you support the proposal? >> i support the proposal in the context that the president's budget presented it.

and as i said before, all things are on the table. >> why does revenue have to be part of the conversation with regards to means testing? >> with regard to means testing, it is strictly via 2 -- the issue of deficit reduction in the long term. thingse looks at overall, you get to this is specifics. you get to a premium perspective, beneficiary perspective, the perspective of providers. that is where you get to with integration as well. >> a few moments left. you were saying that with regard to means testing on premiums that there have to be tax increases. let me ask you this. when someone pays you a higher premium, aren't they paying the government more? is and that a taxpayer over a certain income paying for a benefit that they would otherwise not have to pay? >> these do affect high income, but what is important is when

one is looking are talking about a package, i think it is important to see what it -- what is in the package. what is it you are paying for and what are the offsets that you use. but mr. chairman, please indulge me. you are saying that you insist on raising taxes on wealthier individuals, in order that wealthier and visuals could pay more to the government. and by the way, the congressional budget office says it is also revenue, which is premium being paid to the government. is that the logic? >> in the president's budget as presented, there are a number of different elements that do everything from corporate tax reform to other things. that is why i actually think it is important to look at a package in its entirety and to understand those ramifications for it, whether it is high-income people or other beneficiaries. >> time is expiring here. let me make the obvious point that it will be very difficult to make the babysit -- baby steps on deficit reduction when people cannot agree about paying more to the government, that it is something that can be done outside of them having to pay more to the government.

the logic does not seem to fit for me. i'm hopeful that we can make progress on this issue. i'm hopeful that despite what you said here today, given your background at omb, and that you would be willing to work with us on the steps. >> thank you, senator portman. senator schumer. >> thank you, director burwell. i'm delighted you are here. were just a fabulous omb director lew and i think you'll make a great secretary. i'm enthusiastically in support and i think you will be passed by a large majority. the only superlatives that i my gooden concede -- friend senator coburn in praising you on this issue. i have two issues of concern. the first is about something called powdered alcohol. recently in april, the treasury department's trade and tax

approvedb -- ttb, powdered alcohol. it is not in stores yet. it is just as it sounds. it can be mixed with liquid or even started. once the amount of powder in each package is resolved, alcohol makers -- powdered alcohol makers indicated they will seek labels for their product to be approved. it is on track to be on shelves in the fall. it is troubling to me. obviously, you can drink a lot more alcohol in powdered form than in liquid form, just because of the volume. you can put it on food. kids can sneak it into dances, concerts, sporting events, in their pockets, in their shoes. is really troubling. the only hope we have of stopping alcohol from getting on the shelves -- and mothers against drunk driving is very

concerned with this -- is the fda. and you will oversee the fda. i believe that the fda should get involved. it is our premier consumer agency. and i hope they can investigate this new substance just as they ,id with four logo -- loco which was alcohol and caffeine makes, and they banned it. that was proven unsafe and i believe this will. all i'm asking is whether you will commit to having the fda look into this new how call product -- alcohol product for health and safety reasons. >> this is a new issue. it is one i would want to understand better and i would want to know which jurisdiction and exactly why. as far as it being a tax issue, understand that, but why it has not been previously looked at by fta. >> they haven't looked at it, and i urge you to do them -- to do so. >> i will look at it further if

i'm am confirmed. >> thank you. the other issue of concern is a hydra, where the fda has been worse. we have opioid abuse all over the country in urban and suburban and rural areas. powerful version of hydrocodone was approved for the market without the same temper tamperproof preventions in place for things like vicodin and oxycontin. the fda approved it even with opposition from many centers. and lawddiction experts enforcement around the country alarmed. there are ways to make it tamperproof and ways to make it you cannot turn it into a powder and stored it or inject it. you know the problems we face in

every part of the country with prescription drugs. would you review this decision by the fda when you are in office? >> the issue of ,rescription drug abuse is one being from a world community in southern west virginia, where i have seen his issues firsthand in terms of how damaging they are to both the health and the economy. an issue i take very seriously. one of the things i want to do when i am confirmed is that i work with the da on science-based decisions. if i am confirmed, this is something i would want to understand how the decision was made. >> thank you. again, i hope you will be actively involved. i understand the necessary caution when sitting at the table. but i know who you are and i think you will get involved. medicare advantage. senator crepeau talked about this. i don't want to get into details. i only have 27 seconds left. there are some measure against rips that are abusive and

off the federal government. there are some that are great, many of which are in upstate new york. we have a ton of them in rochester. i think 65% of all medicare recipients are on medicare advantage and most of them are very happy. i would urge you to separate the wheat from the chaff. some people on my side of the aisle, the minute they hear medicare advantage they say this terrible. it is just not true in my spirit. i hope when you look at medicare advantage, you will give it a careful look and not take one broad brush and say the programs are all bad, because they are not. >> thank you, senator. >> thank you, senator schumer. let's see, next is senator carper and then senator to me. >> -- senatortoomey. yourngratulations on nomination. with mixed emotions.

if you are confirmed for this position, we lose you at omb. the president is going to nominate tom coburn to be head of omb. and my colleagues said, we cannot confirm her. i just want to say, that's not the plan. we love working with you at omb. we love working with the team that you have put together. one of the things we have focused on is how to get better results for less money. and most things, in terms of being successful in government, academia, business, whatever it might be, the key is leadership. why thef the reasons department of homeland security, which for years was kind of a laughingstock when it came to managing finances -- actually, wonder of wonders, last year they had a clean audit.

and after 20 something years, department of defense still has not gotten that. dhs has done that. the key is leadership. progress and reducing improper payments, last year, $50 million in medicare, in probably $20 million medicaid. talk to me about what you have learned omb to make further progress at the department of health and human services. learning in your current job that will allow us to get better results for less money with some of these very eccentric programs? we need to save money. >> one of the things i've learned is being very specific about what you want to achieve. and very cooker, getting to what the him most important levers are -- what the most important levers are. getting into the conversation today, actually, there are conflicting interests. it is important as a leader to

weekly get to the problem-solving in terms of the interest and how you go forward. in order to make the progress we need a medicare fraud, it comes back to the issue we were discussing with regard torac's. and continuously thinking areugh the core objectives and where we will improve. there was -- those are some of the results we have seen in the reduction of improper payments, which have gone down for the entire federal government. this medicare and medicaid issue will be a large portion of that. left acoburn and i secure briefing from the secretary of homeland security. talk about border security. we talked about all the folks going up across the border not --m mexico, but hundreds,

honduras, el salvador, guatemala also the reason why as they are bad lives and they will do almost anything to get appear. i said commits not enough for us walls.d stronger we have to look at the underlying causes, the compelling reasons that make people want to risk life and limb to get appear for a better life. i want to talk about underlying causes with respect to obesity. underlying causes with respect to medication adherence. a -- obesityit is is a huge driver for medical costs in our country. diabetics, the money that we spend on that sort of thing. and if you look at medication, if people comply with the directions and take their medications, how much money would that save you from -- would that save?

the pace program, for those who are medical -- medicare and dually, talkible about medication adherence, programs like the pace program, and how those can be helpful. >> it comes down to the fact that prevention is such an important part of reducing costs. if we can get in front of these things, it is actually a similar concept to what we were talking about earlier with regard to instead of pay and chase, you get in front. things are generally cheaper, better, and easier if you can get in front of them. some of the things we need to do our, we need to help make sure we have the analytics at show what works in terms of whether it is obesity and diabetes prevention -- i think there are models and we need to make sure those analytics are rigorous. we need to also ensure we are educating and indicating. whether that is in regard to prevention or in the face of making sure people understand the rules of the road with regard to medicare. the question of educating and

making sure people have the right information. the last thing is about tools. and in my experience, in working on some of these issues with the walmart foundation with regard to how people use healthy eating, you can provide the food . on the company's site, reduce the cost of fruits and vegetables. but even with the communities and populations, it actually took educational programs to teach people. when you are shopping and you are a mother or a father and you are in the grocery store for a very short time and you need to get home and fix that meal, in terms of serving things you've never used before, there is an educational component in order that you can actually use the tools. and share our strength is an i think working through is necessary to make the progress. service soor your far.

>> inc. you very much for being here and for your open and cooperative discussions we have had leading up to this. i have a couple of questions. the first is alzheimer's or a good over 500 americans have been diagnosed. 33% of all americans over the age of 80 five have alzheimer's. if you live long enough chances are very high you are going to get it. is 100% fail. we have no cure. we have no meaningful treatment, onlyn fiscal year 2013 1.7% of the budget went to alzheimer's research.

does that strike you as to the challenge? >> our overall plan there were but i think you know for anything to get increases is a difficult to do. >> i am talking about the $30 billion a get. they control where that goes. 1.7% sound right? >> i think the question is something i would want to spend time on how they think about distribution. it's one of the things you and i discussed. a lot of it is done based on history. when one does something based on history there are changes one may want to re-examine. >> i appreciate because the history has changed. come mores has he

serious and grave a threat. i do find it troubling what i understood you to be saying. be ifea seems to republicans and the president did have felt it was appropriate forsk americans to pay more the benefits they get, if as proportionate to ask them to painful more for medicare. -- to pay more for medicare. it's common sense. it has to come at the price of raising taxes. >> some of the revenues are not

like that. there are revenues in the plan. there is overlap. that's why i think what is important is to look at the to actually put together plans. out we try to take a piece that becomes difficult. >> i am in favor of a broad comprehend the reform. if that remains elusive the idea of asking wealthiest americans to pay more for the benefit strikes the as a reasonable inc., and i would hope we don't have to raise taxes to get there. want to follow-up on a separate issue. that is the budget reclassification.

my understanding is the payment that will come from insurers now that the federal government is that it has gone from what would have been its own account to a management account. my goal is to ensure we will have trimmed their and the. i am hoping you can commit that muchll be able to know how money came from insurers or goes through insurers or this account. -- for this account. or anr it is a surplus o expense. >> that is part of an executive order where i cannot discuss pacific's. this is something i want to work with you on with regards to transparency.

i think there is a fundamental andtion you are asked inc. one i would look forward to working with you on. >> does the rule that restricts you from commenting on rules forbid you from making commitment to having transparency? >> that in thing i think we have talked about throughout the hearing, which is transparency and accuracy are two things i want to do in a timely fashion. >> staying in the state of pennsylvania. casey. >> i know we are getting to the end. we are getting close to home plate. we are thankful for your patience, your willingness to serve again. i know we had a chance to discuss some children's health

insurance issues. foron't have a lot of time questions beyond the two i have. just some of the numbers have been pretty significant. have heard the national numbers. 8 million and rolled. almost 5 million in children's health insurance. i know senator rockefeller has een though much work. in pennsylvania a little over 18,000 enrollment. almost 360,000 people. some big numbers. i will move to at least two children's issues.

one is regarding child welfare. we have counties taking advantage of the wager working to make sure they are trying to invest in incentives for what andt we called group homes to try to get them into better but also to make sure as we do that we are using the evidence-based strategy. we have got five counties in our used that have waiver. i would ask you to work with us on to aspect. working for comprehensive reform and also tofare

help all children in that system and secondly to promote better outcomes. we asked for your commitment to work on that. fax i would like to work with these are issues i think are very important. was verye things i interested in was the psychotropic drug. 17% of all children in the system are on psychotropic drugs. i look forward to working with you across a range of issues. >> one area of policy that is

, theng some promise program where you have medicare innovation. i know a lot of the innovation is focused on medicare. what i hope is through medicaid enoughp that we can have so we can new models get some benefits for children in addition to the result and ask for your help on that. >> i think we do want to get the benefits for each system. we have examples where we are taking what is working and medicaid and trying to shifted

to medicare. in terms of what is cost-effective. >> i am out of time, but i wanted to make one final point. anyone who has had anything to do with child advocacy will tell us children are not small adults, so we need specialized strategies for kids that may be different from how we care for adult. we are grateful for your commitment. >> my six and a half-year-old and for natural roof that every day. -- proved that every day. >> thanks for your willingness 10 years at the head of the bill and melinda gates foundation. i am sure the time on the board will come in helpful.

i want to ask about two things and see how you plan to mend them. one of them i don't expect you to know. she might know that section. are talking about a formula that will reward providers for a low cost quality and penalize providers that don't and toentially move the nation an outcome based model. this is part of the implementation. the bill we were recently looking at had a provision that reform that. takesteps do you plan to to implement that system.

were you planning on proceeding , your philosophy on implementation. >> that is something i want to look at. the question of how we are going to be able to articulate well at the and connect payment to quality would be an important part of transition. that is government and also the private vector. we will have to work from the perspective of the government ride. thing because for your hip surgery isn't the front or the back. is it the end of the d.l. just ?- is it the anesthesiologist i think we can turn to the

private sector. >> they have already shown great results. can we ignore this? let's put a provision in that gets the rest of the country to start doing this but in a slow, incremental way. or do we go with the results , given what weg are looking at? we need to make these reforms. you are going to hear a lot from me. we don't want to go slow. we want to go faster.

i will note even in the affordable care act there were a lot of states that took us up for him rebalance and from nursing home care to community based care. these were governors who said they didn't even like the act. i hope we will run faster on this. the second is in the implementation of the basic health plan, which allows them to allah five for the medicaid coverage. this was something we gave states an option on. the state was late to get them done. they finally came out in september. they were supposed to be done previous lee. we want to make sure states that

shoes that will be -- choose that will be ready. want to go through the sequencing and the information as well as to have the technology we need to make sure the next years run smoothly. be one of the first things to find out who need which information. >> if you know enough you don't need to discuss it, that i need an answer. has ignored for a long time that row graham. i want to get a firm answer so ou can do that for the record. i guess i am 16 seconds over.

obviously graduate medical education and paying for medical education. i don't know what role you think the agent he is going to play and helping to identify the need .or filling that gap we are not going to get there if we don't have an expansion. >> the president's current proposal does some of that expansion. care andarget primary that we have shortages in vessel to use. in addition expanding the health out helps to get more prio in the field. expand who can

benefit. otherst physicians but physician assistants. it's a place we need to focus and use all the tools. we need to focus on primary care. hopefully it is a good start but we will have a discussion on how big the need is and why we need to focus on moving forward. thank you for your willingness to serve. >> just a couple of matters. then we are going to liberate you. appreciate your answers.

we have focused on the health care portfolio. that's why i thought it was good that senator casey continued to focus on the human nervous as us backed and foster care, temporary assist the and. load.ve an expensive work can you give me a sense of what your priority would be on human services? >> with regards to setting they have, articulated some of those priorities. i would want to hear from the stakeholders and the department they are broad, and they are numerous. they include higher security to some of the issues we have been talking about.

the administration for community living talks about some of the hospiceith regard to and how we think about people in is thatunities. cost-effective? the rage of those issues is something i want to hear about. >> on the medicare advantage issue, i think you know the pacific northwest has some of the highest rate. you have been added for decades. -- at it for decades. we have heard senators on both sides of the aisle touch on it. point the premiums are down. up, and a number

of questionable operators is down. i remember some tremendous oversight. it was gross move the -- some of the practices. in response to the questions. you essentially said we ought to and to workfully through these issues to essentially continue on track. that is what i heard the -- senator say, and i think that is welcome. the last i want to mention is a aflection on the last two and half hours.

we have been added for something , andtwo and a half hours from the beginning where you had this i partisan sendoff from dr. coburn and rockefeller, who has d.t budge. what you have done is try to respond to challenges in a way that ought to bring people together. that is why i referenced your part with respect to part d. we now know it has come in at costoss in terms of projection. mu they voted

senators said, we are going to try to make this work. think you can be a powerful agent once you are confirmed. you can be a powerful agent in terms of trying to bring people together. trying to bring people together regardless of how they voted. that is my take away that you can help cut through some -- wezation we have ian, have seen. is there anything you would like to add? only that in the senate so

full of toxicity and wasnership, i think if it two and a half hours it was two and a half hours. listening, your knowledge, your ability to defer -- youyou have in done have not done because you are still in another job because you are anxious to get to these isblems is what the chairman saying. how do you begin to take down the walls on the subject so -- ands lay important enormously important as health care? interesting in the position i am sure you are going to have.

you seem to fit comfortably. baking myclose by colleagues on the other side of the aisle. been very helpful in allowing us to move forward. they have indicated members can have until 6 p.m. on their stay. on thursday. it is my intent to work to report your nomination after the answers are received. we thank you, and with that, the committee is adjourned.

[captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2014]

>> today, veterans affair secretary will be on capitol hill to talk about veterans healthcare. live coverage begins at 10:00 a.m. eastern on c-span. and share your thoughts on facebook and twitter. also the senate health committee holds a hearing on e-cigarettes.

you can watch that hearing live on c-span beginning at 2:30 p.m. eastern. >> you know, a lot of times you would say, look, this is not for at bution. this is for background. you can attribute it to the white house source or something like that. you can't do that with live cameras. you can't say i'm just giving you this now for background but this is not for publication. >> did you do that at the white house? >> sure. not a whole briefing. >> let me just give you something on background so you'll know it is coming. >> fatal mistake that i made and his is in the -- for the audience. interesting for some of you. i did not put the restriction that we had at the state department, which was that it is

not available for live broadcast. it is available for use as part of stories that you would produce because the briefing is not a news event. it is part of way in which people gather information, put their stories together, test other source, get other information, put together a comprehensive report and deliver it to your consumers of news. >> you know, i once had to do i think it was like 56 questions on what is universal healthcare. would that be 98%? what about 97%. what about 96.5%. 6 questions in one briefing. someone said dede meyers looks like she might be a nice person if you take her out for a beer and ask her a question. >> the white house press secretaries sunday at 5:00 on c-span 3.

>> for over 35 years, c-span brings public affairs events from washington directly to you put you in the room of congressional hearings, offering complete gavel-to-gavel coverage of the u.s. house all of a public service of private industry. brought to you as a public service by your local cable, satellite provider. watch us on tv, like us on facebook and follow us on twitter. >> president obama visited tarrytown, new york, yesterday. in his remarks, the president called on congress to restore the highway trust fund. he is introduced by new york governor andrew cuomo. this is 25 minutes. [captions copyright national cable satellite corp. 2014]

[captioning performed by national captioning institute] >> thank you very much. good afternoon, westchester. it is an honor to be confused with mario cuomo. let me tell you that, chris. let's give a big thank you to chris horton and all of his colleagues who are doing a fantastic job for us. [applause] i have been out there during the winter months when they have been working on this bridge and i can tell you those are really rough and tough conditions and they are doing a great job. they are on time. they are on budget. let's give them another round of pplause. good afternoon to all of you and welcome, mr. president, to the great state of new york and let's give the president a great

new york welcome! [applause] which me is the bridge was built in 1952, intended to be a temporary bridge at the time. today over 140,000 vehicles go over it, which is more than twice the capacity and design of the bridge. it has been outdated. it has been unsafe. it has been in need of repair for many, many years. the state has said on many occasions that the bridge had to be replaced. in fact, we spent $80 million and 10 years talking about replacing the bridge. but we just couldn't get it done. it was seemingly too complex. it was too big. we couldn't even get it started.

to me, it was a metaphor for what 45d happened to our state. political gridlock, paralysis, fear and indecision had taken control. but that, my friends, is not the new york way. we are the state of the bold. we are the state of the daring. we are the state of performance. we are the state of skyscrapers. of sbrickate transit systems. we are the state of public works that challenge the imagination. just 120 miles north of here, straight up the hudson river, canal.find earie people said it couldn't be done. clinton set out to build the canal. thomas jefferson said the governor was mad, letterly. to think that he could build the canal 350 miles through the

wilderness. well, we built the eerie canal. we built it on time. we built it on budget and the rest is history. it opened up state new york and it opened up the west to the nation. that was new york ingenuity. we moved forward with our new bridge. we said we were done talking and we were done procrastinating. we forged new partnerships. we challenged ourselves to do it faster and better than ever before. we're using a new development method that combines the design and construction phases in one step, saving time and saving money over $1 billion saved from the original estimate by this new construction method. [applause] the federal government agreed to fast track the project and

d.o.d. and d.o.t. exceeded all expectations in making government performance. i was saying to secretary fox on the way up, it is incredible how quickly this federal government moved and moved this complex project. let's give secretary fox a round of applause. [applause] the united states department of transportation provided the largest loan ever awarded under the transportation infrastructure and innovation act, $1.6 billion. thank you very much. [applause] and we owe a special debt of gratitude to our champion in securing that loan, our congresscome. let's give her a round of pplause.

i want to thank new york state legislature and many of my colleagues are here today. both houses and both sides fover aisle, democrats and republican -- of the aisle, democrats and republicans. i want to thank them for breaking the political gridlock that paralyzed this state. we just passed our fourth on-time budget in a row, not done for 40 years. [applause] and we approved this project in record time. this bridge will create tens of thousands of jobs. it will speed commutation. it will increase safety. it will open the region to new growth. like never before. but mr. president, we want you to know that to new york, we are not just building a bridge. from rockland to westchester. this is a bridge that symbolizes

what was and what can be. this is a bridge from gridlock to bip. this is a bridge from paralysis to progress and this is a bridge from yesterday to tomorrow. [applause] and mr. president, we owe you a debt of gratitude because without your leadership and without the assistance of the federal government, we would not be building this bridge today period. ladies and gentlemen, please join me in giving a big welcome to the president of the united tates, barack obama! hail to the chief] [applause] >> hello, new york! [applause]

hey. hello, new york! it turned out to be a beautiful day. well, it's wonderful to be here with all of you. take a seat, take a seat. relax. first of all, i want to thank governor cuomo for that great introduction and the great job he's doing. i want to thank mayor fixell for having me in tarrytown. [applause] where's the mayor? where'd he go? here he is, right there. t this is a gorgeous part of the world and i am lucky to be here, and i'm going to be coming back soon. in two weeks i've got the honor of delivering the commencement at west point just a little bit urther up. but today, i'm here, along with ur secretary of transportation anthony foxx. [applause] to talk about one of the best ways to create new jobs and spur

our economy, and that is to rebuild america's infrastructure. it's been about five and a half years since the financial crisis that rocked wall street and then ultimately spread to main street. thanks to the grit, the determination of the american people, we've been steadily fighting our way back. in just four years, our businesses have now created 9.2 million new jobs. auto industry that was flatlining is now booming. a manufacturing sector that had lost a third of its jobs back in the 1990's is adding jobs for the first time. troops that were fighting two wars, they're either home or coming home. rather than creating jobs in other countries, more and more companies are recognizing it makes good business sense to locate right here in the united states of america with outstanding american workers. [applause] so we've made progress, but

here's the thing. we could be doing a lot more. we could make the decision easier for businesses to locate here in the united states, here in new york state, if we do a better job rebuilding our roads, rebuilding our bridges, upgrading our ports, unclogging commute times. the alternative is to do nothing and watch businesses go to places that have outstanding infrastructure. and behind me is the old tappan zee bridge, the longest bridge in new york and one of the busiest bridges around. as any commuter will tell you, it is crowded. [laughter] it carries a lot more traffic than when it was built back in 1955. at times, you can see the river through the cracks in the pavement. now, i'm not an engineer, but i figure that's not good. [laughter] but right now, thanks to the

efforts of governor cuomo, thanks to your outstanding congressional delegation led by nita lowey and including eliot engel, and sean patrick maloney, and jerry nadler, all of whom are here today. stand up, congressional delegation. we're proud of you. [applause] thanks to their outstanding efforts, workers are building a replacement. the first new bridge in new york in 50 years. it's called the "new" new york bridge, which is fine as a name, but for your next bridge you should come up with something a little more fresh. [laughter] now, here's the thing -- this never happens. you are building this bridge ahead of schedule. three years ago, after

republicans in congress refused to pass multiple bills that would have put construction workers back to work, i took action on my own to fast-track the permitting process for major projects like this one. normally, it would have taken three to five years to permit this bridge. we did it in a year and a half -- in a year and a half. [applause] that meant we were creating thousands of jobs faster while doing right by workers and tending to the environment. and the vice president is in cleveland today at another project that we fast-tracked. a rapid-transit station that will make life easier for a lot of residents there. so today, we're releasing a new plan to apply the same strategy to other major projects all across america. we're announcing 11 more projects to accelerate, to get moving faster -- from boston's south station, to pensacola bay

bridge, to new light-rail projects north and south of seattle. we're cutting bureaucratic red tape that stalls good projects from breaking ground. we're launching a new national permitting center to implement these reforms. we are aiming to put every major infrastructure project on a ublic dashboard so everybody can go online. hold us progress, accountable, make sure things are coming in on time, on budget, make sure your taxpayer money is being used well, but also make sure that we're putting folks back to work rebuilding america. that's our goal. [applause] now, all these steps we can do without congress. and all these steps mean more good jobs -- because nobody was hurt worse than construction workers by the financial crisis. the housing market plummeted,

and a lot of guys in hard hats and a lot of gals in hard hats, suddenly they were off the job. and that's why the recovery act back in 2009, 2010 included the most important public works jobs program since the new deal, jumpstarting more than 15,000 construction projects around the country. over the past five years, american workers have repaired or replaced more than 20,000 bridges, improved more than 350,000 miles of american roads. four years ago, when we were just starting to clear away the damage from the financial crisis, the unemployment rate for construction workers stood at 20%. in fact, it was over 20%. today, we've cut it by more than half. but we can do better. we can build better -- and we have to. we've got ports that aren't ready for the next generation of cargo ships. we've got more than 100,000 bridges that are old enough to qualify for medicare. [laughter] we've got leaky pipes that lose

billions of gallons of drinking water every single day, even as we've got a severe drought in much of the west. nearly half our people don't have access to transit at all. and i don't have to tell you what some of our airports look like. building a world-class transportation system is one of the reasons america became an economic superpower in the first place. but over the past 50 years, as a share of our economy, our investment in transportation has shrunk by 50%. think about that. our investment in transportation has been cut by half. you know what other countries are doing? european countries now invest wice as much as we do. china invests four times as much s we do in transportation. one study recently found that over time, we've fallen to 19th place when it comes to the quality of our infrastructure --

19th place. i don't know about you, but i don't like america being 19th. i don't like america being second. i want us to be first when it comes to infrastructure around the world, because businesses are going to come where there's good infrastructure to move businesses, move people, move services. [applause] we shouldn't watch the top-rated airports and seaports or the fastest rail lines or fastest internet networks get built somewhere else. they need to be built right here in new york, right here in the united states. first-class infrastructure attracts first-class jobs. business owners don't want a crumbling road or a bridge because then they can't move out their stuff, and their workers aren't as productive because it's harder for them to get to work. they want to set up shop where there's high-speed rail and high-speed broadband, high-tech schools, self-healing power grids, new ports, tunnels.

that allows them, when they make goods here in america, to move those goods out and sell them all around the world. now, unfortunately, helping states and cities fund infrastructure is one of congress's chief responsibilities. and you've got some outstanding members here, but let me just talk a little bit about congress right now. if they don't act by the end of the summer, federal funding for transportation projects will run out -- will run out. there will be no money. the cupboard will be bare. and all told, nearly 700,000 jobs would be at risk over the next year. that's like the population of tampa and st. louis combined. right now, there are more than 100,000 active projects paving roads and rebuilding bridges, modernizing our transit systems. states might have to choose which ones to put the brake on. some states are already starting to slow down work because they're worried congress won't

untangle the gridlock on time. and that's something you should remember every time you see a story about a construction project stopped, or machines idled, or workers laid off their jobs. and that's why, earlier this year, in addition to fast-tracking projects, working with secretary foxx, i put forward a plan to rebuild our transportation infrastructure in a more responsible way. it would support millions of jobs across america. it would give cities and states and private investors the certainty they need to plan ahead and invest. and it wouldn't add to our deficits because we'd pay for it in part by closing wasteful tax loopholes for companies that are shipping jobs overseas that are in the tax code right now and that we could clean out and help pay to put folks back to work rebuilding america. [applause] now, so far, at least, republicans who run this congress seem to have a different priority. ot only have they prevented so

far efforts to make sure funding is still in place for what we've already got, but their proposal would actually cut job-creating grant programs that have funded high-priority transportation projects in all 50 states. they'd cut them by about 80%. and they can't say it's to save money, because at the very same time, they voted for trillions of dollars in new tax cuts, weighted towards folks at the very top. so think about that for a second. instead of putting more workers back on the job, they'd put those workers' jobs at risk. instead of breaking ground on new projects that would improve the quality of life for millions of people, they voted to give a massive tax cut to households making more than $1 million a year. instead of making investments that grow our economy by growing the middle class, they're still convinced that prosperity trickles down from the very top. if you want to tell them what you think about that, don't worry, because usually they show

up at ribbon-cuttings - [llaughter] -- for projects that they refused to fund. and here is the sad part: rebuilding america, that shouldn't be a partisan issue. my favorite president happens to have been a republican -- a guy named abraham lincoln in my home state of illinois. and it was lincoln who committed to a railroad connecting east to west, even while he was truggling mightily to hold together north and south. it was a republican, dwight eisenhower, who built the interstate highway system. it was ronald reagan who said that rebuilding our infrastructure is "an investment in tomorrow that we must make today." since when are the republicans in congress against ronald reagan? but that's part of the problem -- we've gotten so partisan, everything is becoming political.

they're more interested in saying no because they're worried that maybe they'd have to be at a bill signing with me than they are at actually doing the job that they know would be ood for america. it's time for folks to stop running around saying what's wrong with america? roll up your sleeves and let's get to work and help america rebuild. that's what we should be doing. [applause] we don't need a "can't do" spirit. we need a "can do" spirit. that's what governor cuomo has, and it sounds like the state legislature was willing to work with him on this. well, we need congress to work with us on these issues. it doesn't mean they're going to agree with us on everything. i guarantee you they will have more than enough to disagree with me about, but let's not fight on something we all know makes sense. after all, we're the people who,

in the depths of the depression, lifted a great bridge in california, and laid a great dam down in the southwest, and lifted up rural america. we shrank a sprawling continent when we pounded in that final railroad spike, connected up this amazing country of ours; stretched a network of highways all across america from coast to coast. and then we connected the world with our imaginations and the internet. a great nation does these things. a great nation doesn't say "no, we can't," it says "yes, we can." [applause] so the bottom line, tarrytown, is america doesn't stand still. there is work to be done. there are workers ready to do it, and some of them are here and they're already on the job doing the work. we're proud of them. [applause] there are people all across this

country that are ready and eager to move this country forward. so i'm going to keep on fighting alongside all of you to make sure that we're doing everything we can to rebuild america -- not just rebuild one bridge, but i want us to rebuild every bridge. i don't want us to just rebuild one school, i want us to rebuild every school that needs help. [applause] i want us to most of all, most importantly, rebuild an economy where hard work is valued and responsibility is respected and rewarded, and where opportunity is available not just to some, but to every single hardworking american. that's what i'm fighting for, and i know that's what you care about. thank you very much, everybody. good job, workers. i look forward to seeing this bridge. thank you very much. god bless you. god bless america. thank you. [applause]