medicaid insure the poor across the country. but when it comes to drugs like harvoni, most states don't provide the care until the.disease has advanced. how is that the case? >> this drug is being priced out of reach by the manufacturers. it is not insignificant othink of a price tag that is $94,000 or $200,000. now, i want to be very clear that medicaid is the nation's hearlnation'shealth care safety. we provide care for oldest sickest most medically complicated patients in the country. are this is not unusual but what's different here is we've had kind of a social contract in the pharmaceutical world for many, many years where you ask charge orphan drug prices, for orphan drugs. so medicaid doesn't bat an eye when we're paying $400,000 a year for treatment of kids with cystic fibrosis because it is a relatively small number of people. but when we look at hepatitis c, three and a half million americans, more than a million of those are on medicaid. >> right. >> and when you do the math of more than a million people on medicaid

medicaid payments in 2015 according to gao. on the flip side the department of defense still has 79 major weapons systems programs for a total acquisition cost of over $14 trillion dollars. dod spends $100 billion each year on the systems but has failed to strategically manage the investments resulting in inefficiency and waste. taxpayers and the troops deserve better than that. i want to thank our witnesses today. providing critical service to the american people with this annual report. as well as with the work you do every day to help ensure our tax dollars are spent wisely. i hope that you will share with all of your employees how grateful we are for their pursuit of excellence and for them helping to provide us with road maps to make a difference. with that, mr. chairman, i yield back. >> i'll hold the record open for five legislative days for those who would like to submit a written statement. we'll now recognize our panel of witnesses. we have quite a few people to swear in. we are pleased to welcome the honorable gene d

through improvements to medicaid integrity program there would be $350 million of improper medicaid payments in 2015 according to gao. on the flip side the department of defense still has 79 major weapons systems programs for a cost of over 14 trillion dollars. dod spends $100 billion each year on the systems but has failed to strategically manage the investments resulting in inefficiency and waste. taxpayers and the troops deserve better than that. i want to thank our witnesses today. with this annual report. as well as with the work you do every day to help ensure our tax dollars are spent wisely. i hope that you will share with all of oh your employees how grateful we are for their pursuit of excellent and for them helping to provide us with road maps to make a difference. with that, mr. chairman, i yield back. >> i'll hold the record open for five legislative days for those who would like to submit a written statement. we have quite a few people to swear in. we are pleased to welcome the honorable gene dadaro, comp general of the united states accountability office. sir, we are pleased t

of the medicare and medicaid programs. we share this committee's -- stewards of medicare and medicaid marketplace and the children's health insurance program, cms is serving almost 140 million americans and we want these programs to be as effective and efficient as possible. we review the gao- we view the gao as an important partner in these efforts and appreciate and take seriously gao's work and their recommendations and are working to address and implement them. we are making important progress in our efforts to reduce duplication, improve efficiency and protect taxpayer dollars all while providing our beneficiaries with high-quality care. we implemented 38 gao recommendations and implemented 100 further recommendations to gao. one of our driving forces at cms is the way health care is delivered in this country, based on quantility rather than quant. now an estimated 30% of medicare payments are tied to alternative payment models and millions of american patients are benefits from better coordinated, improved quality of

more states are using manage care to serve medicaid recipients.nizing the change in the work, we proposed changes to the care aligning with private coverage, promoting care, and strengthening integrity and enhance the beneficiary experience. the commitment to integrity underlies all of our work. we are utilizing analyting technology, fraud preventions to identify leads to further protect the program from inappropriate billing. in the first three years, 820 million was identified and stopped in inappropriate payments and a 10-1 return in 2015 alone. using risk-base screening enhances ability to screen providers on enrollment and identify those at heightened risk for creating fraud. this saved the program 2.4 million. we have deactivated 540,000 providers and suppliers that don't meet requirements. perhaps most importantly, increased screening efforts have allowed 7,000 applications to be denied preventing claims from ever being submitted. cms is dedicating to better care, protecting patient safety, reducing health care cost, and providing people ac

the neck, the medicaid side with access of care issues with proper network. man working with the state. >> given that three years has gone by and i apologize for interrupting but i was a cabinet secretary for health. can you provide something in writing that talks about the ways in which god forbid it ever occurs in any other state ever again what cms ought to be doing with those acute care dollars? people lost their lives end continue to do so. >> i agree with the principle of access care and we will provide a response. >> said chair. >> we will do a follow-up on his question but as i understand it is technology that allows law-enforcement to capture sulfone information. >> day is the key should be getting a warrant? >> i am not certain that we didn't. >> day you thank you should have? will you say that is an oversight or we don't need one? >> i am not certain to be honest of the requirements for use of this technology fit is required or not. >> you said you used it 37 times. >>. >> why did you use this? >> in the course of the investigation. what sort of cr

medicaid payments in fiscal year 2015, according to gao. on the flipside gao found the department of defense still has 79 major weapons systems programs, total acquisition cost of over $14 trillion. and dod spends $100 billion each year on these systems, but it has failed to strategically manage those investments, resulted in inefficiency and waste. taxpayers and our troops deserve better than that. i want to thank all of our witnesses today, to mr. dodaro, you and your talented staff provide critical service to congress and the american people. as well as the work you do every day to help ensure our tax dollars are spent wisely. i hope that you will share with all of your employees how grateful we are for their pursuit of excellence, and for them helping to provide us with the roadmaps to make a difference. with that, mr. chairman, i yield back. >> thank you. uphold the record open for five legislative days. we when i recognized our panel of witnesses. we have quite a few people to swear in that we are first place to welcome the honorable

cost to medicare and medicaid. to your taxpayer dollars. and from 2025 to 2030, that is 10 years of the new treatments being in place, we would see a half a trillion dollar reduction in the cost of medicare and medicaid. now this isn't pie in the sky. this isn't just wishful, hopeful thinking and a prayer and a song. this is a real possibility. those of you that have been reeding the -- reading the press or listening to television news programs over the last year, you'll note a significant change from hopelessness to hope. yes, hope. there is real hope that we'll be able to attack this debilitating dementia, alzheimer's. that we'll be able to delay the onset and quite possibly stop it. to cure it. now that may be off into the future. but we're now gaining an understanding, because of the research being done on alzheimer's and much of the research discuss discussed earlier with discussion of mental health programs and research going on by the united states military as they attack the problem of post-traumatic stress

we haven't done the medicaid cost analysis. there's actually a number of both at penn and i know within cms some interest in doing that. our experience is if you have social workers on the team as we do and you have the true inter-disciplinary approach and get the care for the care givers and the patient in place, the kind of amount of nursing home placement and then therefore medicaid costs significantly less. >> i'm afraid this one might be for dr. conway, too. maybe anybody else want to join in, that would be terrific. everyone including presidential candidates is talking lately about the problem of rising drug costs. how will these demos address the problem and are there any particular demos that directly address this issue? i think i know from where you were speaking this morning that you have a specific demonstration to talk about. >> yes. so a number of the models before i talk about the specific one do include drug costs, typically b costs, but next generation even includes the possibility of organizations bringing in d

on the medicaid side -- >> given for three years has gone by, and i apologize for interrupting you, but this, as a physician, i was a cabinet secretary for health, this is untenable. can you provide something to this committee in writing that we talk about ways in which, god forbid, this ever occurs in any other state anywhere ever again, what cms ought to be doing to assure that you didn't spend that kind of acute care dollars? and, in fact, mr. chairman, people lost their lives in my state, continue to do so. so i would appreciate that response inviting to this committee if i may, mr. chairman. >> i agree with the principle of quality and save and exit the care being paramount, and we will provide a response. >> thank you. i yield back my time. >> the chair recognizes the gentleman from wisconsin for five minutes. >> we would do a follow-up on mr. jordan's questions. first of all can you explain what that stingray technology is a little bit for our listening audience? >> as i understand it, it is technology that allows law enforcement to capture cell phone information basically. >> yo

the state highways and the medicaid. saying well, you know, state highways are for everybody and the other program is really just for a few, so we have seen states opt out. but i wonder if the politics are different for a program that affects poor people versus a program that affects everyone, middle class, upper middle class families who are very powerful and stimts. i was wondering if you could address that. >> it sounds like you're talking to a state that puts 95% of its student aid money in merit-based programs. we had this conversation yesterday with the presidents of the land grant. when states have reduced their budgets like they have, college tuition has gone up. at some point the middle class population starts screaming and yelling they can't afford it because they're left out of the student aid equation. that's resulted in zell miller getting elected in georgia and 14 other states adopting merit-based programs. it's a middle class backlash because states have increasingly made their institutions less affordable

center for medicare and medicaid invasion, cmmi. you will hear that acronym a lot today. cmmi is approaches that we are going to be talking about today. eric young, next to me is trisha newman and her left is jerry young, director and cofounder of medstar medical center. eric will give us a glimpse and medstar expanding to other facilities. to my far right james, he leads rochester payment program and has a hand in aco like and risk base models. so we are going to start off at the far end with cristina bakuti and talk about evidence that we have on hand. >> thank you, let's see. okay, good. so i'm going to start with just a little connect for delivery system reform and medicare. i am going to go a brief summary of three of the models and conclude with a few thoughts on ongoing challenges and opportunities. so to get right to context, i will mention a few items. although cms had been running a few models on reform. the affordable care act really brought in a large multiprong effort to reform, created some permanent changes to the way

if they expand medicaid, it will be greater. so i think there's -- i think there's a lot of good things that have happened and good things to come. >> thank you for -- to you and your team for everything that you have done to help make health insurance more affordable for so many of our neighbors across america. thank you. >> thank you. >> now dr. burgess is recognized for five minutes. >> thank you, mr. chairman. thank you administrator slavitt for joining us at our committee again. i think it's important that we continue to have these types of discussions. certainly in the very early days of president obama's administration, the statement was made repeatedly that transparency would abound in this healthcare law. in many ways it was meant as a criticism to republicans that if you are a -- if your member is not on board with this, everybody will know it. if your member is with the insurance companies and not with the administration, everybody will know it because it's transparent. it's going to be on c-span. then we found it was

today, medicare and medicaid are now 5.6% of gdp. social security is 4.9% and discretionary expenditures have shrunk to 6.5% of gdp. why is that important? because transfer payments are really consumption and you do not get that much return on your investment and they want to highlight the blue line. back in the 1960's, investments as a percentage of the federal budget actually used to be higher than transfer payments. they were 32%. they have gone down to 15%. for the republicans in the audience, if there are any in berkeley, california. [laughter] mr. druckenmiller: i want to remind you that government spending can be a lot more effective than what some of you have been putting out there in the press. what did you get for this blueline? you got the internet, gps, the interstate highway system, and we got nih grants that have moved the needle dramatically on cancer and other diseases. what has been going on for the better part of 50 years is the amount of money we are spending on transfer payments, primarily to seniors, has been cro

for the elderly, we also have medicaid for children. but as you can see it doesn't move the needle much. and social security has been at the expense of money we might be spending on our younger generation. for some reason -- well, this is kind of sad but i'll work around it. the chart you're supposed to be seeing is the united states poverty rate by age group. and what you see in red back then president johnson declared a war on poverty. since then, the poverty rate for seniors has dropped to 30% to 9%. i think we can all agree that's a wonderful accomplishment. there's nothing worgs than thinking of an elderly person who is poor and can't make it in society and all that encompasses. but the interesting thing is during that same time period, the poverty rate for children -- maybe we have it on -- how clever. this is what happens when you're over 60. you don't know how to use technology. the poverty rate for children has actually been an uptrend. thst it is actually pretty much flat to up but believe it or not we have made no progress in

majority of state medicaid programs are shifting their medicaid population to the extent that i think excluding some of your most vulnerable into your medicaid managed care, who is getting benefit of rebates on those lives as well. on top of that, we had medicaid expansion. our companies took a significant hit on different things that they were required to do following the passage of the affordable care act. another thing, i think, from a state perspective, that's important for you to understand, i think the level of understanding on the value that medicaid rebates brings to your state varies based on how much you work with your medicaid department, how much you work with your health and human services and health committees. the rebate process is incredibly complex. we have minimum mandatory rebate of 23.1 for all drugs. in addition, we have consumer price index penalty. every tomb a drug in the commercial market goes up the rate -- the price goes up faster than the rate of inflation, there's a penalty paid to the state and that penalty is compounded over the time that the drug is on

why do they invest in medicaid before they invest in higher education? why did land grant universities get created? federal government gave lands under partnership states would have to do following things which would create the greatest public university system in the world which resulted from that. so legislatures, state legislatures, they, one of their top motivations, incentives is whether or not they're going to leave federal money on the table. and i'll point out one other thing about the '72 act. in 1972 when pell grants, beog was passed there was also consensus that following the pell grant student, the cost of education allowances were passed by congress. what was supposed to happen was $2500 would follow those student to those institutions, to the institutions, to provide the programing for the low-income student. cost of education allowances were passed at same time pell grants were. they have never ever been funded a penny. so institutional aid was recognized. institutional programing was needed but it was never funded by the federal governmen

and on top of that we had medicaid expansion. so our company took a significant hit on different things they were required to do following the passage of the fo affordable care act. and another thing from a state perspective that's important for you to understand, and i think under the level of understanding on the value that medicaid rebates bring to your states varies based on how much you work with your medicaid department, how much you work with your health and human services and your health committees. but the rebate process is incredibly complex. so we have the minimum mandatory rebate of 23.1 for all the drugs. in addition to that a consumer price index penalty. every time a drug in the commercial market goes up, the rate of the -- the price goes up faster than the rate of inflation, there's a penalty that's paid to the state. and that penalty is compounded over the time the drug is on the market. in addition to that, we pay supplemental rebates for product placement on your preferred drug list. so we've got the minimum ma

we haven't done the medicaid cost analysis. there's actually a number of both at penn and i know within cms some interest in doing that. our experience is if you have social workers on the team as we do and you have the true inter-disciplinary approach and get the care for the care givers and the patient in place, the kind of amount of nursing home placement and then therefore medicaid costs significantly less. >> i'm afraid this one might be for dr. conway, too. maybe anybody else want to join in, that would be terrific. everyone including presidential candidates is talking lately about the problem of rising drug costs. how will these demos address the problem and are there any particular demos that directly address this issue? i think i know from where you were speaking this morning that you have a specific demonstration to talk about. >> yes. so a number of the models before i talk about the specific one do include drug costs, typically b costs, but next generation even includes the possibility of organizations bringing in d

chief administrator for innovation equality and chief medical officer at centers for medicare and medicaid services at the united states department of health and human services. so, i thank you, again, for all of your good work and being here. pursuant to committee rules, all witnesses are to be sworn before they testify. those on the panel as well as those that accompanied mr mr. dodaro, if you would all rise and raise your right hand.

to medicaid.ou can go to their website and find the numbers and find a map of the different state. let's go to karen in leesburg, virginia. she gets her insurance through her employer. good morning. caller: caller: i have one son that was in college and one that it was about to go and being able to have them on my plan through age 26 has been a blessing. i have united health care. i think consumers are misdirecting where the blame is. i had surgery two years ago. it was surgery that cost upwards of $52,000. the problem is we don't need to look at who the company is, we need to look at the cost between insurance and the hospital system. that is where we are losing ground. if you want to complain about why our premiums are going up, we need to talk to united health care and why they are not negotiating better rates. it's astronomical, what they spend through patient care. so paying $900ms for an actress is ridiculous because i can pay $49 and urgent care. guest: she certainly nailed it. the cost of

, medicare, military spending and to do that you would devolve medicaid and medicare to the states.n my heart of hearts as governor of new mexico is the federal government would have given me a medicaid and medicare with 20% less money i could have delivered health care. i could have administered or seen the administration 20% less money to deliver those services. when it comes to the military a 20% reduction in the military only goes back a handful of years. [applause] john: mr. mcafee would you cut the welfare programs for the poor? >> this is a complex issue. let's look at the social security. they have the largest drain on the federal budget at over $700 billion and get everyone on social security paid money that they worked hard to earn into a system that the government promised would pay them back when they were older. [applause] that is a commitment that we made as a government and as libertarians do we not meet our commitments? it's an obligation. if the allegations that we are not meeting which are the problem. the veterans. we send young men and women off to war saying ris

when we look at improper payments, whether it is medicaid, medicare or any of those, certainly it is hhs and cms having a role in that. there is a headline today, or in the last few hours, the irs admits that it encourages illegals to steal social security numbers for taxes. you can't control what is in the press. it is all about the earned income tax credit. and if there is something not allowing the irs to go after those improper payments, because this is not the first hearing, i've been in four or five where we continue to have this problem, enough is enough. it is time that we address that problem. and if there is something from a statute standpoint that doesn't allow you to share the social security numbers so that you could do the proper vetting that you need to do, let us know. we'll work about that in a bipartisan way to address it. but i hope that this is the last hearing where we're not addressing that particular problem. from a dod standpoint, there is too many stories out there in terms of what we're spending and the fact that you can't pass an independent audit where you

the second thing is understanding what medicaid pays. 5% of the population who use medicaid consume 55% of medicaid almost all of them are mentally ill. it is a huge cost. why is that? illness,with mental 75% of them have at least one of their -- have at least one other chronic illness. costs spending there. they're not getting care, they don't follow through on care, they don't believe they have problems. their lives are deteriorating. jail,o have the cost of you are 10 times more likely to be in jail than a half though. if you are a minority, it is worse. these things all multiply. other federal barriers exist. are low income, they don't let you see to doctors in the same day for the same problem. if you see a family physician and he says your son is showing bad symptoms here, he is depressed, with drawing his grades are going down, he is blocking the windows in his if youe is irritable, are on medicaid, the door is closed. we create this prejudice against impoverished mentally ill. you will not get help. if you are mentally ill, you're more likely to be in poverty. you are working th

, medicare, military spending and to do that you would devolve medicaid and medicare to the states.my heart of hearts as governor of new mexico is the federal government would have given me a medicaid and medicare with 20% less money i could have delivered health care. i could have administered or seen the administration 20% less money to deliver those services. when it comes to the military a 20% reduction in the military only goes back a handful of years. [applause] john: mr. mcafee would you cut the welfare programs for the poor? >> this is a complex issue. let's look at the social security. they have the largest drain on the federal budget at over $700 billion and get everyone on social security paid money that they worked hard to earn into a system that the government promised would pay them back when they were older. [applause] that is a commitment that we made as a government and as libertarians do we not meet our commitments? it's an obligation. if the allegations that we are not meeting which are the problem. the veterans. we send young men and women off to war saying risk

who use medicaid consume 55% of the medicaid spending and almost all of them are mentally ill. it is a huge, huge cost. why is that? because a person with serious mental illness, 75% of them have at least one other chronic illness, half have at least two, a third have three. cronic illness, heart disease, lung disease, cancer, diabetes, huge costs in spending. they are don't follow through on care. they do not believe they have problems. their lives are deteriorating. not taking care of themselves. they're homeless. also cost of jail, that you're 10 times more likely to be in jail than a hospital if you're severely mentally ill. if you're a minority it is even worse. these things multiply. there are federal barriers currently exist, if you are low income like medicaid, they don't let you see two doctors in the same day for the same sort of problems. so if you see a physician, family physician, and that doctor says, ma'am, your son is really showing some bad symptoms here. he is depressed, he is withdrawing from activities, his grades are going down. he is blacking windows in hi

so despite, you know, our advances with the affordable care act and medicaid, we know that there's a big gap between how many people need treatment and how many people get it. in my job i can't ask you to advocate for things, but i would thoroughly encourage you to communicate your state needs to your congressional delegation in terms of, you know, quite honestly we need funding for this issue now. you know, last year congress appropriated over a billion dollars for ebola. and we had one person in the united states die of ebola. and we have 78 people dying every single day of drug overdoses. and we know despite, you know, support from congress of additional funding over the past few years that we have too many people who still need treatment in the united states who are not able to get it. these are people who end up in, you know, our criminal justice system. these are people who end up in our child welfare systems. these are people who end up in our emergency departments. and these are people who end up dying. and we need to make sure that we're doing that. but clearly, you know, it

she was upset at -- that scott cut medicaid and signed a bill that cuts funding for clinics such as >get election alerts when you want it. get the latest breaking news, polls and results as this historic election continues to unfold. >>> the p -- the manufactured in china. the scarves do not need -- customers should return them to the store for a full refund. >>> let's talk about the cost of being a woman. a report cites a huge gender pay gap. we know about soum of that. it says that a woman starting her career though will earn $430,000 less than her male counter part over her career if this persist minorities. native american women will earn $883,000 less. and la teen no women will earn $1 million less. >>> a group of virginia state ledge lators is trying to stop george mason university from naming its law school in honor of scalia. lawmakers have sent a letter asking it to reject the name change. the university needs the council's approval. george mason is slightly tweaking the new name because of the unfortunate acronym that provides. instead the name of the new school would --. >>

but you should be struck down it reminds me of people who talk about medicaid expansion.eventually they will come around. and with those who don't have helped or any health care. they will come around and i.m. willing to do that. aided the meantime what is going on. >> and let's talk about the voting rights act and then it sucks all the air so let's spend more time of that bright shiny object. >> i have done the work on voting rights into in terms of protesting the civil-rights commission there isn't any part to this issue i have not touched but the reason why it is important any time i find people taking advantage to get away with it big time like those who didn't hold those local council elections and they would have controlled the patronage. allegis to have the election and even when they are forced to. and then to pretend those who paid money to this person or that person if the federal government had not been invoked unvocal da was a part of it. and held that seat from the time of anybody could remember even after they did all of that and i have just it the person fo

and representatives from the pentagon, irs, and centers for medicaid and medicare. c-span, "washington l."rna coming up in about 45 minutes, tom rice on tax reform proposals and the republican budget. then pennsylvania congressman brendan boyle looks at some of the issues before the house foreign affairs and oversight and government reform committees. later, mark warren, talks about his "esquire" magazine willing at the blurring lines between politics and entertainment. [captions copyright national cable satellite corp. 2016]] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. isit ncicap.org] host: good morning. it's wednesday, april 13, 2016, and in the headlines for today's "washington journal," house speaker paul ryan ruled out a presidential bid amid growing speculation that he might enter the race for the republican nomination at the party's convention should the delegates fail to choose a nominee on the first ballot. meanwhile, newly confirmed educational secretary john king was on the hill o