there's a lot of anemia cms that -- people in cms that wear black hats. it's in the way the royal health care deliver system has been treated. and as most important when you say cms, the line used by many providers there's a new acronym. it's a mess. it's not nice thing to be saying about an theation is supposed to be helping folks. that's the way it is. we have talked about this. i appreciate you coming in. you have been through the chairs which makes that exceedingly important. i express my concerns with the current process. we discussed the deviation from the traditional process and notice of comment. the lack of stakeholder info as it relates to the comment period and through the use of something called regular will story guidance, posted, e-mail, and something called faq, frequently asked questions. nobody has any time to read the stuff or be aware of this until somebody contracted out knocks on the door with a fine. that's not right. so during our discussion, you mentioned these are all issues that cms is aware of, and that you expect to be addresse

ahead of cms has a great responsibility. cms administers health coverage to roughly one in three americans. that includes 50 million medicare patients, 56 million medicaid patients and more than 5.5.5 million children through the children's health insurance program. 167,000 seniors and 8300 no to retirees in montana rely on medicare, the largest program you will oversee at cms. these montanans are my employers, and they are employers as well -- excuse me, they are my employers and they as well as millions more across the nation are your employers as well, this data. so i encourage you to never forget that. you were working for them. it's also important to remember who works for. the administrator of cms overseas 5800 employees. if confirmed, you must demand from these employees the utmost efficiency. spread throughout 10 regional offices across the country, see this -- cms employers are responsible for distributing more benefits than any other federal agency. benefit outlays for fiscal year 2012 totaled $819 billion. the age

how much is attributable to cms. during your time at cms during which hca provisions -- while you served there, what affordable health care provisions has cms used to reduce fraud, and can you provide quantity fiebl results for the specific actions undertaken? even though the $4.2 billion sounds like a lot, we know there's a lot more fraud than that, and we know we're just beginning to go after that frauding of the taxpayers so if you could answer that for me. >> i'll try to talk a little bit about how we worked. the affordable care act gave us several tools to work with. we went through an implementation period, starting first with the work done around providers, making sure we had legitimate providers in the system, and some of our early proposed and final rules dealt with that, and also assigning categories of risk to those providers because i think not only do you have a system that's probably outdated, but it didn't find varying degrees of risk based on what we knew to be facts so we've done that. if you're in a

cms is taking an important step to stabilize medicaid advantage. a number of the carriers might have pulled out of medicare advantage for next year which would have left seniors with fewer options and most likely higher costs. it's more stable. they'll continue to provide it next year. >> so the bottom line is it's good news for medicare advantage participa participants? >> good news and good news for the insurers as well if you look at humana shares a couple of months ago. they went down, but today they rallied again. >> coming up as the market strengthens investment clubs are making a bit of a come back. we're showing you how they approach the conditions. but first a look at the international markets today. >>> stephen a. cohen is a wall street legend. he runs one of the largest and most successful hedge funds, but the arrest friday of a top cohen deputy on insider trading charges refocuses attention on how federal authorities are building a case against cohen himself. we have the very latest. how is s.a.c. capital reacting to this arrest? >> the

cms has been trying to get the administration of drugs to not be a profit center for oncologists any more. the real problem here is how we reimburse medicare. we should not be reimbursing medicare by treatment or by procedure or drugs we ought to be reimbursing medicare with a fixed price per patient per year. >> doctor, do you agree? >> not necessarily. what we're seeing is not limited to oncology. we're seeing this problem of cut reimbursements going through every specialty, some specialties that's overrepresented like radiology, cardiology and my estimation of all of this is the goal of the administration through cms is to shunt care away from the private outpatient provider like the oncologist we just spoke to and towards the hospital which makes no sense whatsoever. why? because the hospitals get paid far more, $6,500 per treatment for patients for oncology than the private outpatient facility would. you ask yourself request would they want to do that? they want to command and control the distribution of care. they don't want mom and pop doctors out in the community not going by

i know i definitely would never like to be in cm. >> cm is the close management unit where some of theproblematic inmates in the entire state of florida are housed. >> keep it quiet, you understand? no talking. >> among them is anthony cruzado, whose most recent problems have involved sending death threats to the president and cutting himself. now he has taken things to a new level. and we warn you, what you are about to hear is graphic and disturbing. >> we heard kicking on the door. i went ahead and i come up to the wing and i went to his door. and he was standing there and he had blood on him. and i look down, and he said, "look." and i look down and he had his testicle out of his scrotum. i ordered him to submit to i ordered him to submit to hand restraints, and he cuffed up. we took him to medical staff. >> staff believe that he peeled off the casing of a battery and used that to cut himself. he was treated at a local hospital. after returning to prison, cruzado underwent three days of psychological evaluation. >> you can imagine officers and nursing seeing that for the first time

>> cms takes all of this seriously. we did receive your letter. we have initiated an internal review. and it will be extensive. >> now, simon, marilyn taverner also told the senate today that she's invited the ig, the inspector general of cms to get involved in this investigation as well. we've got no details yet, obviously, of what is an investigation in its very early stages here, but this is going to be an answer that might impact a lot of investors who are trying to mine washington for information. as the government has gotten more heavily involved, the information that starts here is increasingly moving markets around the world, simon. >> yet the pressure is clearly on eamon in washington. thank you. >>> the u.s. navy is about to deploy a knew weapon. it can take out enemy aircraft with the cost of $1. how are they doing it? and who is behind it? will it change the face of air defense forever? if there's one piece of financial advice, who better to get it from than the oracle of omaha. get ready to step into warren buffett's lecture hall. mor

the person said cms should set a deadline. ten years from now 90% will no longer be fee-for-service. it will be based on -- aco and payment or whatnot. but felt strongly that somebody needs to light a fire under cms. they are not moving fast enough. >> chairman bacchus, that's interesting. i hear of the opposite concern, needless to say from consumers in the take measured approach. we made more changes and the affordable act gave us a lot of authority to do so to get away from fee-for-service and move more to whether payment for quality or avoiding the readmission. i think a lot of work has gone on in the last three years. and i'm proud of that work. there's no question there's a more to do. and we could probably move faster in some areas, particularly if you look at our current growth and spent, it's kind of move the some from the work that we have done around hospitals to more the outpatient sector. there's probably targeted things we do in the -- to move a little faster. maybe the target was a wrong target. if you don't set

tavenner, the nominee ted cms, stated in written comments that they will not be implementation of -- delayed implantation of stage two. i asked given the question the lead to interoperability is not possible from the already existing requirements for stage two to stage three, what are your plans for stage three that ensures taxpayer dollars are beingisely used to invest in interoperability? >> again, we haven't gotten to implementation of stage two yet so you may be come you're reading the final chapter before we launch it. januar 20 is when the portion of stage two that deals with meaningful use will be up and running. and i think we have fl plans and the timetable to then moved to stage three, but we don't right now have a plan about what could or could not happen. because we need to fully implement stage two. >> but aren't the rules final for stage two? >> are the final? yes. yes. >> well, if in turn -- >> but it's not up and running get. the timetable hasn't been reached. >> the thing i guess i would say, i'm concerned about, and this is the read from the current stage two requir

karen ignani, the president and ceo of the insurance lopby praised the decision yesterday saying cmshas taken an important step to help stabilize the medicare advantage program at a tight when the program is facing significant challenges. those challenges include rising medical costs and also the fact that next year, kelly, we will see new insurance taxes on plans in order to help fund the affordable care act rollout, otherwise known as obama care. but certainly a very positive ruling for the insurers, a lot of folks praising it. though not a huge surprise after the lobbying effort. >> bertha is supporting health care stock here in europe which is up about 0.6%. bertha coombs from the ny -- or from the cnbc global headquarters this morning in new york. >>> eurozone manufacturing activity contracted further in march hit by ongoing trouble in spain. north korea fuels war fears, saying it will restart its nuclear reactor despite warning from the incide from the international community. >>> and here is a look at today's other top stories. carl icahn is back ate. the billionaire investor

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this week, the centers for medicare and medicaid services - cms - says it will hire and train "navigators" to guide the public in choosing a health plan in four catagories of coverage and cost, dubbed platinum, gold, silver and bronze. "right now, the premium prices are unknown, but people who make up to four times the poverty rate will get help on a sliding scale." one delay has already been announced - small business owners will choose the level of coverage but had hoped to allow workers to choose plans within that level. instead, for the first year, workers will be limited to one plan within that coverage level. in cyprus, unionized bank employes plan to stop working for 2 hours today. it's in protest of an international bailout that could mean large losses to their pensions. under terms of the deal, their retirement money may be heavily taxed. yesterday, the international monetary fund agreed to contribune $1 billion to the bailout package. the rest of the $9 billion will come from the eurozone. that's if cyprus officials sign off on strict budget measures by the end of the month. in

but the cms is a readiness hollowing of the force.although we find lessons each time, it's been a different challenge and i think it's a layer above are time. we have incredible young men and women so the personal site is good. our equipment has been recapitalized instead overtime. equipment is adequate although it cecchini we don't want to start modernizing. where we are suffering now is in readiness. we are not training because of sequestration and it mechanism. the other factor in terms of the three different -- the three different drawdowns is each time you start from a much lower start point. a million men in uniform in vietnam down to 781 by the end of the 70s. you drive down in the 90s to roughly 500,000. today we're starting up 490. will be active as a result of the budget control act for 87. that's where you start to observe sequestration. i think we've got to remember that. >> thank you offer your testimony. >> thank you very much, senator king. one quick reference to article lx. i believe it's understood what you are consid

yes. >> is cms encouraging that?>> we are. >> i have another related question but i will so that for the record. on the top of your previous -- we had concerns about the increase from the affordable care at concerns that there will be healthier young men who will pay higher premiums under the affordable care act than they pay in the individual market. if you could tell us how rates are structured for different groups in the individual market now based on factors such as aids, sex and health? >> the market today issuers are allowed to vary rates depending on health status of a person and if they are sick they would have higher costs and there are large chewed -- allowed to charge women -- >> so older and sicker people pay more and women pay more for health care right now? >> that's right to speak how would the rates be structured under the affordable care act going into affect? >> the health status will be able to be used as a factor in gender will be a factor. age can still be used as a factor but the impact is limit

we've did get that very positive cms data. >> it was positive, but there's a couple other issues you have to look at. there's going to be a premium tax put on. because when all obama care is implemented, they can actually make less money. so, this medicare advantage number that everyone thinks was a lot better could actually turn around and be worse, they can make less money off this though the headline risk was for those ratios. >> what's your top pick? >> i would be selling on all -- i used to own aetna, i'm out of the name and the space. >>> coming up, while coal could be one of your best plays, even as the market stumbles into the weekend. >>> the biggest stock movers of the week. >>> and later on, "fast money" madness. today's faceoff will determine the last stock to move to the championship round. back right after this. ♪ ♪ s ♪ ♪ the new blackberry z10. with time shift and blackberry balance. built to keep you moving. see it in action at blackberry.com/z10 to appreciate our powerful, easy-to-use platform. no, thank you. we know you're always looking for the best fill price. and

not with any of these cms waiver programs.ere is no example where you decrease costs, you increase access and you get better outcomes. so if you can prove us wrong on that, then, you know, feel free to bring forward an example. do you have an example? >> congresswoman, i think for the person today who doesn't have health insurance coverage and doesn't know how they're going pay tear medical bill -- their medical bills and worries about going into bankruptcy because their child is sick, i think for that person a lot of this discussion is really irrelevant. and we -- and that's what we're going to change. >> okay, let me ask you this, i want to ask you a question about the navigators. is it true that the navigators cannot have health care or health insurance experience? >> no. >> that is not true? >> that's not true. >> okay. because that been part of the understanding that is out there. also on your increased competition theory, i've got to tell you what we've seen in tennessee, when you have government control, when it is gove

next on january 1, 2013, cms increased the maximum out of pocket costs for program enrollees by $2250, and mandated greater use of mail order pharmacy. finally on february 15, 2013, cms announced that it was suspending enrollment in pcip altogether, due to financial constraints. all of these actions were taken despite the fact that enrollment in the high risk plans was less than 30% of wanted and expected. original estimates were that 375,000 people would sign up for the federal high-risk pools. in fact, only, approximately 110,000 individuals have joined. cms is now trying to stretch what is left of the additional $5 billion to cover the those already enrolled in the program until january 1 of next year. what will happen to those people who have pending applications for pcip when cms cut off new enrolled that? what about those, by some estimates, 40,000 people, who would have enrolled during the remainder of this year? they are left without options and without coverage. on march 5, speaker boehner, leader cantor, conference chair rogers, chairman upton, dr. burgess and i sent a lette

despite the fact that cms did approve a rate inkrees crease. >> there is a lot direct to consumer marketingilestone here where the industry . >> would you have robotic surgery? >> based on my research,procedu. more than picking a robot, a theme that comes through no matter who you talk to, it's not the robot, it is the surgeon. i want to make sure i'm backed up. i think a center for a specialty is something. you can talk about this with general surgery as well. >> always good to know there is a human behind it. we will check it out on cnbc.com. coming up next. >> he is going to talk about pepsi and mlps and what he considers perhaps the smartest guy in energy. he has got a lot to talk about. how do traders using technical analysis streamline their process? at fidelity, we do it by merging two tools into one. combining your customized charts with leading-edge analysis tools from recognia so you can quickly spot key trends and possible entry and exit points. we like this idea so much that we've applied for a patent. i'm colin beck of fidelity investments. our integrated technical analysis is

one of the chief concerns is that the program was not thoughtfully planned and that cms and the office are insufficiently focused on the issue of interoperability. i'm also concerned that the office of the national coordinator has a philosophy that is focused on simply pushing federal taxpayer dollars out the door and using sort of the dollars out the door as a measure of success of the program without sufficient oversight of those payments. i am wondering if you agree with that. >> i do not. >> well, it is noted in our report that providers simply self-report, that they have met the necessary criteria to receive federal incentive pay schmidt -- payments for adoption of it. your agency's office of the inspector general h has warned that this could have problems. medicare "does not verify the accuracy" of the self reported information by providers claiming the incentives will -- prior to the payment. the next question is -- do you self at it -- self testing of a problem in terms of them identifying a problem. >> we take the adoption of electronic health records very seriously. i cannot

the legislative body in tennessee and could not reconfigure it because it a partnership because cms. >> medicade over care. >> that's right . between the office of the governor in the state of the tennessee and done underain 1115 waiver. it quad ruples in cost. everybody has their card . they have acess to the queue but back to the first point, they couldn't get to the doctor and so they were having to wait and you were having to drive hours to get a pediatric dentist or specialist and when people can't get acess to the care they are frustrated and we saw with our providers and hospitals, i had in my state senate district people who got 26 cents on the dollar of care delivered. not what was billed but care delivered and so indeed the governor came in amid twint're 2000s reed the program because 35.3 percent of the state budget. >> mike: good heavens. you saw it up and the four-year fight that i led of the imposition of the state attacks. something had to pay for this because the state couldn't afford it >> mike: i want to give credit to the governor who is a democrat but an able admi

cms went from a proposed negative 2% to a positive 3.3% growth assumption after changing calculation are due to fall 20% this year. but congress will once again find a fix and doctor rates whether be unchanged. humana surging to two-month high here. though the ceo warned in a filing that new health reform, risk rating and tactics will still have a negative impact in some markets. but analysts say the reversal marks a real victory. >> that's good because obama has always said that he wants seniors, if they're happy with the insurance plan to be able to keep that option. >> h>> along with the big names we get a lot of revenues from ama united, cig na and etna all hitting two-weeks high. the 14 million seniors on the private plans were really worry that had the insurers may exit them for 2014. back to you. >> it's been tough going on some of these names. they're up, down, up, down, but this is a decisive move. thank you so much. the dow hitting a new high. the s&p 500 making another run at hitting the all time high. our next guest says we have had a great run but are right for a correct

but overall, the real issue is, the cost back to cms which we calculated at about 6500 dal per patient so what we see if the net effect of the see question questionstation -- sequestration cut, 1 1/2 billion dollar increase cost to cms by what we see to the shift of care. lori: here is the frustrating aspect of all of this our federal government, doctor, as you know is grossly overspending, in your case we're finally seeing cuts but they're cuts to services or medications saving or extending people's lives, right? do you have any thoughts how legislators can get it right when it comes to budgeting? >> the only thing i can look at is oncology care. i can't solve all their ills but in terms of what we do, there are certain things that need to be protected and first and foremost we should protect our cancer patients rights. they should be treated where they feel comfortable, where they're safest and actually where i is the most efficient and that is the community cancer setting. lori: well, we appreciate you engaging me on that last question. doctor, keep us posted. good luck to you. >> t

[inaudible] cms. he made friends with a german consul and wrote letters and lots of letters with drawings but he wrote these letters home to his wife and he settled and was living in a boarding house and doing okay and then he got sick. he literally laid down in the hammock and within one week he was dead. >> we have a final question. no? >> thank you very much. thank you. [applause] >> up next for mesa arizona we sit down with valerie adams. in her book "eisenhower's fine group of fellows" she examines eisenhower's use of civilians in helping craft foreign and domestic policy. see what role do civilians play and domestic and international policy? >> well, for advising purposes for presidents and important law and i think eisenhower, president eisenhower did an excellent job in utilizing the resources of civilian advisers. the 1950s was a time of tremendous technical change and with the tensions of the cold war eisenhower had to rely on those experts in science, technology, in government and politics

. >> your recommendations for cms as well? >> your recommendations for cms as well? >> yes, cms should occur just prior to participation in medicare and medicaid, to make sure the training they are responsible, accountable for training the hospitals and nursing homes to train their staff in a balanced way. one more thing, which i didn't get a chance to say. >> quickly, i'm running out of time, but go ahead. >> just quickly. when we encounter through our contact with providers, the patients who object to having a family member involved has nothing to do with privacy. it has to do with that i want to worry my daughter. i don't want her to have any responsibilities. >> mr. kelley, who observed a fear provided one of the facilities. how does this impact decision-making by facilities passed to taking care of your son. >> it's more than one hospital commissary. essentially we are not in a position to prevent horrific things are not a myth that candid discussions with staff and doctors were they acknowledged they used the word her hands are tied to hippa privacy rules. we t

scott bauer in the pits of the cm -- okay, we got qualcomm earnings reports coming in right now. i believe adam has those numbers. go ahead, adam. >> that would be dennis but we ll look-alike. qualcomm in a beat. it matches earnings per share, $1.17 is what wall street wanted, what they got non-gaap. revenues instead of colling in 6.09 billion as wall street wanted came in 6.12 billion. that is beat on the upside. earnings are coming in and beating low expectations but we see a number of times they cut costs so earnings were up but revenues didn't grow enough and that bothers wall street. to see a good top-line number about, better than what wall street wanted from qualcomm a great sign. that could auger well for the broader cell phone market. remember qualcomm makes chips inside mobile phones that run on android and windows and apple and new blackberry. that is sign perhaps of good wireless demand for devices. the company lifted a quarterly dividend recently by 40%. there will probably be no action on that. look what they did on the modem chip numbers. see what they did on the s

cms knows that. they tried hard to get rid of it. it's extremely difficult. there are more doctors, more clinics, more nurses and hospitals than there are people watching them or governorring them. so i think was, fraud, and abuse exists and extremely difficult. i think probably the president just, like we were thirty years ago, was overly optimistic about how much can be in a short term cutout. >> host: let's go to the new jersey and hear from mark on social security and medicare. high, mark. >> caller: hi. how are you? >> host: good. >> caller: hello to you, steve. one thing i noticed quick, my insurance supplement for medicare has gone up over the years and, you know, the cost of living is not kept with that. and in the past the cost of living hasn't kept with up the cost of living increase hasn't kept up with you know what we really need today. and i've heard that the -- chris brown that social security other program you tune in to you gate different thing. it's good it to thirty years. i have to used va. they can't an appointment. i have to use medicare.

cms, the sen trs fcenters for m and medicaid. a big reversal when it comes to rate expectations. a lot of the providers, like humana, are going to see their stocks higher. >> we'll watch tesla. shares are going to open at an all-time high, jumping 20% monday after that announcement. the company expected to turn a quarterly profit for the first time. once again, jon and laura, he had an even bigger announcement set for today. this guy, i mean, he shoots rockets to the space station. he develops electric cars. he is the new steve jobs, the p.t. barnum. every time something interesting happens, he says, that is not the big one. you have to wonder what could possibly come today. >> he isn't the boy that cried wolf. he better deliver. >> history shows he knows how to make a show. >> when to watch. while we are on that one, thank you very much. 5:14. meteorologist, christina loren is back. it felt kind of nice coming in today. the window down, enjoy the breeze blowing in. >> we have a good-looking day. you know what? it is one of those days where you want to get outdoors, today and tom

but i was at the cms might exchanging over 200 rounds of gunfire, improvised explosive devices and handmade hand grenades were thrown. this is that is almost unheard of. some of these officers were heroic, a courageous way protected the community a and each other when they responded to the scene proclaimed so proud. with the state and boston police has been an incredible team. >> [inaudible] >> i was told it was an exchange of gunfire. >> no miranda warning? >> it is a federal issue somebody else can explain that. >> there was no miranda warning given can we have an explanation? >> there is a public safety exemption with cases of national security with federal charges with an act of terrorism so the government has the opportunity right now so i believe the suspect has been taken to a hospital. thank you. >> is there a federal death penalty? >> i indicated earlier this is an active and ongoing investigation we will be reviewing all of the evidence before that decision is made in terms of whether or not to seek the death penalty. you review all of the evidence and it is a thoughtful, long pro

. >> jimmy: undertaker versus cm punk. >> yes. >> jimmy: the rock versus john cena. >> yes. >> jimmy:e's some. >> jimmy: i don't know -- i don't know fandango. >> he's a new guy. he's never had a match before ever in the wwe. his first match is in front of 80,000 people, millions of people watching against me at "wrestlemania," so a little bit of pressure on the guy. so i will do my best to put on the most entertaining match that i can, because that's what chris jericho does, dammit! >> jimmy: yes! yes! we're going with you all the way, buddy. you'll always win in our book. we love you, pal. >> always a winner. >> jimmy: chris jericho. "wrestlemania 29," goes down april 7th live on pay-per-view. ryan bingham performs next. come on back, you guys. [ cheers and applause ] ♪ [ birds chirping ] [ inhales, exhales ] [ announcer ] cigarettes are not just dangerous when they're smoked. [ rat squeaking ] they're dangerous long after. cigarette butts are toxic. they release chemicals that poison our water... and harm wildlife. and millions... are polluting our environment. [ sniffing ] [ seagu

phil streble in the pits of the cm. i want to start with you. surprising gdp numbers much slower than expected about 2 1/2%. some people thinking it would be over 3% that they didn't have more effect on this market. why not? >> i would have thought a market could take a nice little tumble back down but the reality is looking any kind of growth is good news. the second thing is, you still have the fed rockin' and rolling. they're pumping in 85 billion per month. doesn't look that will stop anytime soon until bernanke steps down. that has put an underlying floor on the market right now. liz: we had eric thorne of bryn mawr, has 6 billion in assets said the exact same thing. you can rationalize all you want, why it is dangerous and why it is worrisome if you fight the fed you may lose in the short term because this market simply wants to go higher, phil. >> yeah, fighting the fed is one of the worst decision that is a trader or investor can make. you have to go where the easy money is going. products like bonds have done so well recently and also t

>> cms takes all this seriously and we did receive your letter and we have initiated an internal reviewensive. >> now, marlin tavenner also said that the inspector general of that agency is now involved into the investigation as to who leaked that information out and whether or not that leak was legal or illegal under insider trading laws. and maria, as you know, there's been a lot of focus on this question in past years, but it's not necessarily clear that there was a crime committed here. in fact, a lot of folks say that it's simply good due diligence to figure out what's going on in washington and react as quickly as you can to that news. maria? >> we want to dig a little deeper into this story with ron gefner with us now and former federal prosecutor, steve ryan, now with mcdermott, will, and emory. gentleman, good to have you on the program. thanks for joining the conversation. ron, at what point do these leaks and scoops become illegal? >> it's really not that clear. there's to concepts here. one is confidentiality, one is materiality. there's a term known as a mosaic theory. if s

we work with hhs, cms, the department of labor. we work with as as a.e would -- work with a lot of other agencies. >> have other -- >> some underwear. i will check, but i am aware of any details or details that all. >> okay. if you could check on that i would appreciated. thank you. the last thing, i want to kind of get on the health insurance reform implementation fund. some money has been spent by the ira so far. >> through 2012 that number sounds right to me. >> about in the ballpark. >> yes. >> how much money do you anticipate using or kneading in regard to implementation of that billion dollars is out there? >> i don't know how much of that is left. we -- i can answer it this like an answer what i need generally. my needs this year -- >> implementation. and just talking about implementation. >> implementation, we ask for something in the room with 360 million. who will spend less than that this year because we did not get it. next year, you know, in the budget is 439 is something like that. >> because my understanding is that the irs has been -- >>

the chief actuary of cms was here a year ago saying you can't spend the same dollar twice. on the one hand, you can't count savings from medicare to pay for obamacare and count it as a savings to medicare. so far putting the bendixen the report to that effect the other point is in our budget we put a reserve fund, which is a budgetary mechanism to address any inadequacies in the provider community that may arise if the case occurs where we feel like providers are restricting access to beneficiaries because of these cuts. so that is just to answer the difference with a paradox. i have three questions, and i just -- you just released your budget this week, madam, good to see you by the way, madam secretary. first, on the means testing before we get mutually agree on policies which $30 billion of savings. where is the delta. where do you make the difference in the 20 billion? >> the difference, congressman ryan, is there is a new formula rather than having i think what was in the past four different categories. it's now nine. the lower limit -- >> was it still 80 or does it go

we have an e-mail address omhill@cm. >> we talked about why this is so important and how it worked outh the young ladies when he had the sisterhood summit but this is crucial to the development of men? this is crucial.cial we ask any business under the sound of my voice in the county who can employ a young person for the summer call s now. we do not have the same number of job opportunities as we have interest. these young men. we need them on a positive pathv the way to doe it is occupy the, show them a better way. this is really going to contribute a lot not only to thl lives of young people but will also assist our community to continue to drive down crime numbers. we want to prevent them from coming to me in the first place. >> keep them from coming into your office and lives in this good way. >> we want to support our young men. we know they can succeed with our support. that's what we're here to do, d support and help our young people succeed. >> when they succeed they cany c give back. >> our whole community rises. >> thank you for tawnling with us this morning. m >> brotherhood

i take a lot pride in the stats at cms, and this is not something we want to happen ever. we will do a thorough investigation and we will give you feedback. >> margaret thatcher died monday after suffering a stroke. wednesday, members of the british parliament will pay tribute to mrs. thatcher. we will bring it to live from ons onitish house of comment cspan3. >> senator john mccain of arizona was at the naval academy for a discussion on the impact of automatic spending cuts on evaporations. this is 30 minutes. >> it is nice to take a trip down memory lane. it is a wonderful institution. my grandfather and my father and my son all have been graduates of the naval academy and none of them did nearly as badly as i did. about life atore the academy. you are at the bottom of the list. one of those whos thought they could be the system. no one has ever be the system at the naval academy. i enjoyed my time there were that i can tell you and the friends that i made there are my friends today. all these years later. that iest friends survived with and worked with and played with a

ever now serving not just a cms command, so it's not just the ambassador for his final tour, but we are having more mid-level officers serving with two three-star commands and getting that experience and to withdraw from afghanistan, were not going to have as much as an opportunity for foreign service is to serve side-by-side in the military. it will be a key element of preserving the experience of working side-by-side. our goal is to have political counselors and about others who have experience working side-by-side with military commanders. one of the things we found when i came into this job was that it wasn't considered necessarily a desirable job and we put a lot of effort into making sure those who do good work get promoted. if you get promoted, it becomes more desirable. we had more dates are foreign-policy adviser jobs last year, exponentially more than ever before and may see more advisers provided that we've ever had before. so that is a testament that they have value thank them for their careers. i don't think you have it quite right. it is an extraordinary fund that we hope

the applications that cms and hhs have put out so far may take 45 minutes to fill out. it is a big deal. you have to fill out all your information and people are likely going to need help to do that. once they get through that initial stage of filling up the application that tells them they qualify for medicaid and the exchange and what subsidies you can get, they will need help picking a plan like a broker or agent. you got people working for the exchange called navigators. they will helpeoplguut if they want the plan, the silver, the gold and platinum which are the different levels. the offer different sets of benefits that they have different costs. host: let's go to baldwin, mich., independent line. myler: good morning, question is -- we have a large veteran community in northern michigan. there is a lot of us that our sole health care is provided by the va. there is a lot of confusion amongst us how this affects us about finding health care or do we still fall under the va care? you will still fall under the va care. probably your insurance will pretty much not be

as you can see cms has been hard work over the past year in improving health insurance market for all americans. this work and these achievements make us excited for the future health insurance market. soon consumers want better access to health coverage that best fits their needs. i thank you for all under holding this hearing and i would be happy to answer questions. >> i thank you very much, mr. corn. -- mr. cohen. regarding the navigators, i believe the la law says if they have received a session from an insurance company they are not eligible to be employed as a navigator, is that correct? >> that's what we've said in the regulations. so let's say mary smith is an insurance agent in pennsylvania, 20 years and if you. she received a license to sell insurance instant pennsylvania. she had to have 24 credit hours of training. then she takes a test, she passes the test. must continue to take 24 credit hours occurring every two years to maintain our license. let's say she has sold a wide range of insurance for companies, nonprofit and profit to perhaps thousands of individuals. she wo

but the cms and the federal government managing the transition to of an effective delivery system and chose approach relies more on the system with a government cannot mess it up. the consumers will select the highest i.q. delivery system is properly consented to do so. >> you got my juices flowing. i am sorry. you can of it -- overemphasize of the health care sector because there is nothing like medicare. as you say 1965 did resemble to insurance but it doesn't now. there is nobody with the employer sponsored health insurance world in the individual purchased who was on the unmanaged fever -- peter service system. everybody is networking and intervening to steer or manage and to administer prices is the 800-pound gorilla this is the price. ticket for the visit he don't get any of our business. within a provider except the t. providers to face up to. medicare has tremendous political advantage that it gives consumers the most choice anyone could have when you have the most choice anyone could have you cannot be unhappy are criticized for but the decisions to make that resulted for qua

. >> to your recommendations for cms as well? >> yes, definitely encourage participation in medicare to make sure they are responsible for training the hospitals and nursing homes to train staff in a balanced way. one more thing i didn't get a chance to say. >> quickly running out of time. when we encounter the context of providers patients who object to having a family member. it has nothing to do with privacy. i don't want to worry to have any responsibilities. >> you the served the clear culture how does this impact decision-making by health care workers and facilities tasked with taking care of your son? >> it's more than one hospital, sir, but essentially we are not able to defend terrific things from happening. we've had discussions with their knowledge due to the privacy rules we try to emphasize to make a decision and it doesn't phase them. what happens is the patient get mistreated, so is pervasive. >> ideal that. >> thank you, mr. chairman. affect payouts to know i've read all of your testimony even though i listen to y

. >> do you have recommendations for cms as well? >> would definitely encourage as part of the conditions of the participation in medicare and medicaid to make sure the training they are responsible and accountable for training the hospitals and nursing homes to train the staff and a balanced way. >> quickly, i'm running out of time. >> we have our contact with providers to patients object to having a family member involved. it has nothing to do with privacy. it has to do with i don't want to worry my daughter. i don't want her to have any responsibility it's not to privacy. >> you observed a culture of fear in one of the facilities your son was admitted to how does this impact the decision making by those health care workers and facilities taking care of your son? and it's more than one hospital, sir but we are not in the position to prevent things from happening. and we have had some candid discussions with the staff and doctors and local hospitals with the we acknowledge they use the word our hands are tied so we try to go further

the sequester cut 8% of the program for cms, a direct hit to aca implementation efforts. it was obvious they didn't. -- it was obvious they did it. it is medicare as we know it for people kneeling -- nearing eligibility by turning it into a touching program. -- by turning it into a vouching program. ironically, the cbo says the voucher proposals would lead to higher national health care spending. we have dealt with access with the aca. we now have to deal with the cost. the is what is the implementation that we are going to be into presently breed their policy is not a clever one. it is not lead to better care. it is not ethically responsible. in contrast, our medicare reforms were based on reality, not rhetoric. through our efforts, the growth rates are historically low, and projected to remain so for the perceivable -- foreseeable future. solvency was significantly extended. new payment and delivery system reforms, which will create a program that favors value over volume, and helps drive the right cost, the right care to the right patient at the right time. it has not

. >> it's a partnership by cms and the administration to keep managed care in the market. if they're happy, to keep that option. if they prefer a government plan, to have that option as well. throughout health care reform several cuts hit the managed care plans. it is taking down rates by 2.3%. there's an mlr minimum that assures if they don't hit 85% of premium revenues spent on medical expenses it's getting rebated back. so there are still those items intact. but what really changed last night is what with he refer to as the dock fix or sustainable growth rate. since 2010, physicians were supposed to have their fees cut. and that was supposed to bring down overall health care spending. but if you put these in, some of us are going out of business. they have been playing it. the current delay was scheduled to expire at the end of this year. they had been paying the managed care, as if these cuts were going into place. what happened last night is they're on apples to apples basis. we saw 500 basis points improvement from that change. >> i still don't understand, though. or

. >> do you have recommendations for cms as a? >> yes.ms could definitely encourage as part of the conditions of participation, and medicare and medicaid, to make sure that the training that they are responsible, accountable for training the hospitals and other, and nursing homes, to train their staff in a balanced way. one more thing which i didn't get a chance to say speak quickly, i'm running out of time. >> just quickly. we ask, when we encounter through our contact with providers, patients who object to having a family member involved the it has nothing to do with privacy. it has to do with, i don't want, i don't want to worry my daughter, i don't want her deado have in response of those. >> okay. mr. kelly, you've observed that a clear culture of fear pervaded one of the facilities your son was admitted to. how does this culture of fear impact decision-making by those health care workers in facilities tasked with taking care of your son? >> and it's more than one hospital, sir. but essentially we are not in a position to prevent hor

cms -- have found was we found flaws in the design so it makes measuring the effectiveness of that program overall difficult. the bonuses that are being paid to encourage that performance are going to plans that just have an average performance. therefore we recommend cancelling the remaining year of that program, which was six two billion dollars. host: one other recommendation was modifying tobacco tax rates. why? guest: the tobacco tax rates have increased in recent years but have done so in -- they created a disparity across the different tobacco products and different types. as a result we have seen a marked shift on both the consumer examples and producers to lower the price of tobacco products. there is potential for revenues gained here if the taxes were equalized. we're talking in the neighborhood of between $600 million and a little over a billion dollars per year. host: let us hear from manchester, new jersey. marlene is a republican. good morning. caller: off of the last caller's back, there was a gentleman who is concerned about the contract situation that appear to be duplica

with the bipartisan policy center, their interest and recommend nation to rely quite heavily on the cmsnd federal government managing the transition to an effective delivery system. joe's approach and the one i support relies much more on a system by the government can't mess it up again and the consumers will select with the proper incentives the highest value delivery system if they wanted to do so. >> you got my juices flowing. i'm sorry. >> you can overemphasize how much medicare can influence the rest of the health care sort or because there isn't anything like medicare. medicare as you say in five did resemble hope insurance, but it sure doesn't now. in one of the world for the individual purchase everybody is intervening in some way to steer or manage patients. there isn't another system withers at mr. prices and this is because the student said the 800-pound gorilla. nationally we adjusted for price differences across the country. take it or leave it. if you need to come you don't get any business and that's too big a chunk for any provider except boutique providers could face u