burwell. before i go to my questions to her, i would like to bring to your attention and the committee's attention that a very dedicated staff member of this committee for 13 years who has worked for -- was respected by senator specter will be leaving. worked for the committee for 13 years will be leaving to go to the executive branch. leaving to go to n.i.h., not for a clinical trial, but help dr. collins. i would like the committee to give adrian a round of applause. i'm glad to see you. so many of the great federal assets of h.h.s. is in maryland. n.i.h. f.d.a. and they have a tremendous impact on our economy. the jobs they provide and the jobs they stimulate. we couldn't have the robust biotech community we have in maryland without you. we will be talking about those issues, but i'm going to a maryland issue in a part of the state that is very familiar to you. my mountain counties up in appalachia i have a situation where due the census, they are telling me that allegheny county has lost t

burwell,. secretary burwell, i know continuing to make our healthcare system work better is a top priority for you. the role of your apartment is absolutely essential in this effort. the programs administered by the department department impact families and in important ways from supporting biomedical research the fighting public health threats to expanding access to quality health care coverage for millions of workers and their families. each of these investments and others is necessary if we want to continue to improve our healthcare system and ensure it puts patients 1st. i am disappointed the budget resolution passed in the house and double down on the harmful sequestration cuts set to kick back in. last congress, as you know i was proud to work with democrats and republicans to break through the gridlock and dysfunction and reach an agreement that rollback those harmful automatic sequestration cuts for two years. i believe that we have got to build on that agreement and with the so we can

schatz. >> thank you secretary burwell. i have a question about telehealth. i'm a.i'm a big believer in telehealth telehealth and i believe the va has been -- has done a lot of good work. private health care providers are expanding their services. it's a way to improve clinical outcomes in a way to save money in systems. i just want to know what medicare in particular is doing what you think you can do additionally within the confines of 1834m and whatever statutory restrictions you may have been could you just sort of divide the question into those two categories, where you think the law needs to be changed and what you think it could be doing within the confines of the statute that you are not quite doing at? >> i think the places we can do more art in our innovation centers of the funding we receive for the innovation and i was part of the affordable care care act that we have been given there we are seeing and doing a number of innovative projects that are including telehealth pray that's one place where we are acting. we have several of the things we have funde

yes. >> senator cassidy. >> hey, secretary burwell how are you? >> good morning. >> a couple of things. you had mentioned -- this question has bugged me for a year. when you mentioned the the effort cms has made for those unaccompanied children coming to the border. when i was at the house there was an oversight hearing. as i recall, cms had $800 million in the regular budget to care for the expected surge of unaccompanied children and there was a physician there and she had the public health service uniform on, and i was a little critical because the response have been so poor. and she said, well i'm the first doctor and i was just hired two weeks ago, and this is like july. now i don't expect you to have the answer as to the $800 million was spent now with you. but a question for the record. cms, or hhs had $800 million, and the first doctor was hired in the middle of summer when they had requested a bump up in anticipation of asurge of unaccompanied children. and you can follow up with that because i don't expect you to have that. when you ment

sasse: in the kingsley burwell -- king v. burwell case those decisions were made in the treasury department's tax policy division? mr. koskinen: those interpretations of the policy issues are up to the treasury. we participate, getting our view of how it would be for tax administration. but the policy calls are ultimately the responsibility of treasury, the white house, hhs and ultimately, the congress. sen. sasse: going back to the chairman's opening issue with his constituent. if a decision was made, how will the decision be made about the timeline of repayment of that. i understand you want to do -- do not call a penalty. mr. koskinen: they will have the $11,000 back that they all or if they have difficulty with that they will contact us. we keep encouraging them to do that. they can work on an installment agreement. you can develop an installment agreement online, which is one of the new things we built over the last year. i think they have substantial difficulties and they can work with us on a compromise. sen. sasse: on

before i do, i want to thank you secretary burwell for being here and share with the committee that i'm hopeful that we can find relief from the budget control act to allow this sub committee to draft pa bill that provides the funding that we need for the critical programs and to carry out its mission and serve the very people that we all represent in our home states. and as another side note, as someone raised by an nih funded scientist, my grandfather, i am certainly a strong supporter of our research and nih budget but in particular, knowing the impact that our scarce funding has had on young researchers, i'm especially concern that had the budget control act continues to put our next generation of researchers at risk. but as i said i want to focus in on the prescription initiatives that are in your budget. and this is an issue that obviously impacts many of our states. i would dare say all of our states. and so i'm interested in hearing a little bit more about the cdc's plan to develop prescribing guidelines and in particular, i want to ask some specific questions about that. number

burwell ase. as many as 8 million may lose insurance and costs may increase. according to the kaiser family foundation pulling, most americans expect a negative outcome from an adverse ruling on this and twos. in light of these findings, which you think are the consequences of the supreme court ruling in the short term which prohibits subsidies in exchanges. rep. alma adams: i can tell you that 450,000 people in north carolina the advantage -- took advantage and went out to the marketplace. we are one of those states which did not choose to put our own in place, nor did be expand medicaid. we might talk about that later. it would be devastating. we're talking about folk who now -- hundreds of thousands of people -- who now have been enjoying health care, many for the first time. to have it taken away. more than that, i think we're talking about people who were probably not able to afford it. it means it's gone and it will not come back for them. i think in our state in particular, estate which has very high unemployment, high poverty, we needed the opportunity

burwell, and where your role will be once that decision is made. if it goes the way i think it should go, then we will have subsidies that have gone to states and to individuals that shouldn't have gone to those individuals. but what do we do, and maybe you have thought about this, in a hybrid situation. there are a handful of states in which iowa is one. it is a hybrid exchange, neither state or federal but a combination of both. have you thought through that and what role the irs might be playing? commissioner koskinen: basically, there is no way for us trying to predict what the court will hold and what it will decide in terms of how to parse through all of this and what the responsibilities are of states federal government, the congress. much like potential tax extenders, we basically play the hand we are dealt. the court will make a decision and then we will respond. the policy issues, back to the earlier question, about what the implications are beyond tax administration will be decisions made by the treasury department and the administration

this is working the burwell -- the decision that the court comes doubts with -- comes down with -- you know -- then the two sides will have to work with one another if there's going to be a resolution here. i think that it is fair to say republicans are not going to accept a mandate. as you can tell now, and the secretary spoke about some of the attributes of health care cost, listen, it is early. health care costs are somewhat attributed to the fact that they have not gone up because we have not had the economic growth that we would like to have. historically since world war ii, the growth has been 3.2%. so i am not sure sure that right away we can say it is aca that brought about all these savings. but i would say that if the two parties are going to come together, the one thing that republicans are going to say is that they are not going to be for mandates. i mean honestly, you have a light enforcement of some of the employer mandates or some of the individual mandate. you have the employer mandates for the midsize companies, if you will. that is put off till next year. because of t

the during his visit to washington, we met with the secretary of health and human services sylvia burwell and started gain human momentum for this steve glieson act. this bill again reinstates long-standing medicare policy medicare policy that was solid and true to these patients until recently to offer immediate relief for patients experiencing incredible difficulty accessing this important technology and equipment. and this act expands access to advancements in technology in a fiscally responsible way. michelle glieson steve's wife, summed up the story of a.l.s. patients and their loved ones -- quote -- "what causes me the most pain is the loss of his voice. i love hearing his voice. i want him to talk to me and to our son river. this disease takes his body. to take his voice just seems unfair." well, mr. president, we can offer a voice -- maybe not the same but a voice -- for these struggling patients. this was their lifeline. this was due to them until recently and now it's not because of this medicare change. i urge all of my colleagues mr. president, to come together around this bip

beginning of when physicians for the first time will see an adjustment and building on the process sylvia burwell, the secretary of health and human services, recently announced that medicare would aim to tie 90% of their medicare fee for service payments to quality or value initiatives by 2018. so this is tying half of all medicare fee-for-service payments to an although payment model and helping us move -- alternative payment molt and helping us move forward and once again help us focus. so i want to thank my colleagues for participating in the colloquy, the ongoing analysis that we need to continue to do in our health care system and congratulate him on the significant success of getting this bill done, it means that we can spend more time really focusing on efficiency, on quality, on the best way to compensate physicians but also to keep the focus on the patients and making sure that they get better outcomes. i thank the president. i yield the floor. the presiding officer: the clerk will call the roll. quorum call: mr. cornyn: mr. president? the presiding officer: the majority whip. mr. corny

but could you give the audience here and the students a quick summary of what's at stake in the burwell case in these five words, and what you think might happen if the supreme court comes in and says you can have these exchange is funded the way they are funded. >> that's actually for words established by the states. those are the keywords, and the plaintiffs have put forward an argument that suggests that only states that set up their own help exchanges are entitled to subsidies for those constituents. and i would be 17 states. so in 34 states if the plaintiff prevails in this case the subsidies, which make insurance affordable for now about 8 million people who have signed up for coverage would cease to exist. but that's just step one. the subsidies would go away. the affordable care act all ready has a provision that if you fall below a certain level if insurance still is not affordable even with the subsidy, or is the requirement that you purchase interest. for instance, in a state that has an expanded medicaid who are at poverty level don't have to buy insurance in the private mar

the impact of a possible supreme court ruling against the obama administration in the king versus burwellse on federal health insurance subsidies. new york university host of this hour-long discussion. >> welcome back, everyone, part two of our forum. i just want to begin by wishing everyone a happy public health week. i think for the 1st part of our evening here with sec. and sibelius and leader cantor was very illuminating. illuminating. we heard themes around access, cost, quality, equity i think we would hear more around that as we move into our panel and discussion. our roundtable we will provide diverse perspectives and what that means importantly for the health of public health in the united states. knowing the public health feels the factors that proceed in the car outside the walls. can we look can we look at how we might leverage the innovations? also go under the water and really look at the deepest actors and get. to help us live in we have a wonderful and distinguished panel. first, i would 1st i would like to welcome newly elected congresswoman from north carolina congresswo

we now stand at crossroads with a pivotal supreme court decision anticipated on king versus burwell inlate june and election on horizon in november will we stay the course, if we doesn't e don't what are the implications? for that discussion we've turned first to two people who may arguably no more about the aca tan most people on planet. first i'd like to welcome secretary kathleen sebelius who served as the 21st u.s. secretary of health and human services from 2009 through 2013. she also served as governor of kansas from 2003 through 2009. secretary sebelius is staunch supporter of the aca. we're honored to have her with us tonight. we're privileged to have with us former house majority leader eric cantor. he served the 7th congressional district of the state of virginia in the u.s. house of representatives from 2001 through 2014. congressman cantor has been a strong voice in opposition to the aca. on a sad note, congressman cantor's father, eddie cantor, passed away just over a week ago. congressman, all of us here convey our heartfelt condolences to you and your family. finally, it

country, for this culture, for what we need now it's a freedom-based alternative to obamacare because burwell is going to be decided by the right wing supreme court. we should go to the american public and say if you love obamacare, keep it. if you don't love it we have a freedom tern foralternative for you. find a policy that meets your demands for your family and your kids across state lines. guess what? obamacare will be no more in a few years. an immigration bill born of sovereign ty sovereignty and security. remember the president's speech about the southern border? hey, what are we going to, build a moat down there? republicans want to build a moat. that's an unserious way to look at one of our most serious issues. what happened to sovereignty? what happened to voter identification? why is it racist to require your driver's license? i have seasonal allergies. i blame my mother. they know who i am in maryland. when i go get claratin d. guess what i have to show? that! that. they say, hey, governor show me that. yet when i go vote exercise a franchise in the greatest country the world's e

burwell where your role will be once that decision is made if it goes the way i believe it should go, then we will have subsidies that have gone to states and to individuals that shouldn't have gone to those individuals. but what do we do? maybe you've thought about this in those hybrid situations, there's a handful of states of which eye i. is one, it is a hybrid exchange. it's neither state nor federal. it is a combination of both. have you thought through that? and what role the irs might be playing, commissioner? >> no, we haven't. basically, there's no way for us -- we don't spend any time thinking about it -- trying to predict what the court will hold and what it will decide in terms of how to parse through all of this and what the responsibilities are of states federal government, the congress. and much like potential tax extenders, we basically, as i say, play the hand we're dealt. the court will make a decision and then we will respond. the policy issues, back to the earlier questions, about what the implications are, beyond tax administration will be decisions made by the tr

burwell case we'll have a ruling in june, when those decisions were made about credits in the states that didn't have state-based exchanges, those decisions were made at the -- in the treasury department's tax policy division? >> yeah. those interpretation of the policy issues are treasury we participate as i say in those issues giving our view as to how it would be for tax administration what works or doesn't work, but the policy calls ultimately are, in policy calls in the development act to begin with the responsibility of treasury, white house, hhs, and ultimately the congress. >> okay. going back to the chairman's opening issue with his constituent, if a decision was made, what was the number? $11,000, chairman johnson, of tax bill? how will the decision be made about the time line of repayment of that? you call it a penalty but that obligation that they have -- >> to repay the premium that went to the insurance company, that's tax administration. and so the taxpayer will either file their taxes and add the $11,000 back that they owe, or if they have difficulty with that, they w

up next, health & human services director sylvia burwell on her department's budget and hydraulic fracturing deep underground to release natural gas. and later, a discussion on iran nuclear negotiations with former iranian and u.s. administration officials. tuesday on "washington journal," brian brown on the national organization for marriage and evan wolfson discuss the oral arguments on whether states can ban same-sex marriage. after that more about those cases with david savage of the l.a. times and chicago tribune. he'll examine what a ruling either way would mean and the status of

at the department of health and human services, the secretary sylvia burwell released her opiate initiativet week and she said we're going to focus on three main areas, on overdose prevention by expanding access to the rescue drug naloxone which works like a epipen and if someone is overdosing it is an anecdote and want it in the hands of first responders, police, family members peers to make sure we're able to save lives as effectively as possible. she's also calling for more use of medications, assistant treatment for prescription painkillers and heroin. if you become dependent on these drugs, we want to connect you to the standard of care that we have the best evidence will work for you. that's medication treatment for treatments like methadone or others and in short supply and need to expand access and she is also calling for work on prescriptioning guidelines. opiates are painkillers and if they're being overprescribed or misprescribed, can we get better guidelines to support the people who have chronic pain problems and needed help to make sure they don't get diverted or start people

burwell. republicans are looking at a variety of options.ver republicans are talking about, they have a number of major categories that overlap. a van diagram, if you will come of republican plans that have significant overlap. first of all, we talked about the ability to purchase insurance across state lines. if you live in new york, new jersey, states with heavy mandates, you should be able to look elsewhere to purchase insurance in a different state that doesn't necessarily cover, let's say, some kind of cosmetic surgery, if that is something that is required under law. you should have the option to look at other states where you get the product that works best for you. second thing they talk about his tour reform. -- is tort reform. the cbo has said that some kind of tort reform to rein in out-of-control medical lawsuits could save the country $50 billion. i actually think the number would be higher because it would not only reduce the lawsuits, it would reduce the cost of malpractice insurance, but it also might curtail the practice of

burwell is going to be decided by the supreme court, we should go to the american public and say if youe obamacare, keep it. and if you don't love it, we have a alternative for you. you can go find a policy that meets your demands for your family, and your kids across state lines and guess what? obamacare will be no more a few years. [applause] >> and immigration bill born of sovereignty. and security. whenever the president lost speech -- remember the president's speech about the southern border? republicans want to build emote. -- a moat. that's an unserious way to look at a very serious issue. what happened to sovereignty? what happened to voter i dedication? -- identification? why is it racist to require a driver's license? they know i am in claritin, -- when i get claritin, have to show my id. we don't want to see that. it's racist. what?? if you want to see eric holder take your drivers license. you can't get into the department of justice without one. [applause] >> it's 50 years sensing of moynihan -- since daniel patrick moynihan had the sense to say the black families in troubl

beginning of when physicians for the first time will see an adjustment and building on the process sylvia burwell, the secretary of health and human services, recently announced that medicare would aim to tie 90% of their medicare fee for service payments to quality or value initiatives by 2018. so this is tying half of all medicare fee-for-service payments to an although payment model and helping us move -- alternative payment molt and helping us move forward and once again help us focus. so i want to thank my colleagues for participating in the colloquy, the ongoing analysis that we need to continue to do in our health care system and congratulate him on the significant success of getting this bill done, it means that we can spend more time really focusing on efficiency, on quality, on the best way to