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tv   HHS Secretary Sylvia Burwell Testimony on the Fiscal Year 2017 Budget  CSPAN  February 12, 2016 11:14pm-1:28am EST

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>> that is u.s. digital service administrator mikey dickerson. watch the entire program tomorrow at 8 p.m. eastern on c-span. on news maker, george senator johnny isaacson, chair of the veteran's affair committee discussed obama's $177 billion va budget and instituting change at the veterans affair. watch news makers at 10 a.m. and 6 p.m. eastern on c-span. earlier this week president obama released his budget request for 2017. the secretary of health and human services was on the hill talking about her chunk of the request that calls for $82 mi million in congressional
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support. she reminded us of the dangers of fighting ebola and the dangers of the zika virus. >> it is going to be my privilege to introduce the secretary. it would appear that senator wyden, grassley, and senator schumer are not here. they have conflicts. none intended. i am going to ask unanimous consent that the statements by the distinguished senator from oregon and the ranking member and the distinguished member hatch be inserted in the record. with us today is the health and human service secretary who has been leading the department of health and human services since june of 2014. she has a long history of public
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service sector including her previous position as director of the office and management of budget under president obama. in the clinton administration she was the deputy director of omb, the deputy chief of staff the president, chief of staff to the treasury secretary and staff director at the economic council. she has not served as the secretary of agriculture, however. she has extensive private sector experience including serving as president of the wal-mart foundation and before that the president of the global development program at the bill and melinda gates foundation. thank you, madam secretary for being here today. we would invite you to please proceed with your five minutes
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opening statement. we have inserted the statements by the ranking member and the chairman for the record and we will proceed with questions following the secretary's statement. please proceed. >> thank you senator roberts and thank you members of the committ committee. i want to thank you for the opportunity to present the president's budget are the department of health and human services. i believe we have common interest and share common grounds. the last legislative session this committee embraced that view of bipartisanship and leadership when it took historic steps to pass the medicare access and chip reauthorization act of 2015 and i want to thank the committee for that leadership. a very important piece of legislation for a number of reasons. the budget before you today is the final budget for this administration and my final budget. the budget makes critical investments to protect the health and wellbeing of the american people. it helps insure that we can do
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our job to keep people safe and healthy, accelerating our research and expands and strengthens our health care system and helps us continue to be responsible stewards of the taxpayer's dollars. 82.8 in discretionry budget authority is requested. our budget includes targeted reforms to medicare, medicaid, as well as other programs. thes reforms to medicare would result in savings of $419 billion over four years. it invest in the safety of health for all americans. let me start with an issue we are working on at home and abroad as we work to stop the spread of the zika virus. the administration is requesting 1.8 million with 1.4 for the
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health and human service. we appreciate congress' timely request as we implement the strategies to fight this virus. i know the rise of opioid misuse and abuse has affected many americans. 78 people die every day from opioid-related deaths in america. that is why the budget poses over $1 billion to combat the opioid epidemic. too many of our nation's children and adults with diagnose mental health disorders don't receive the diagnose they need. research shows early intervention can set the course for a child's success and that is why we propose expanding the home visiting program to help more families in need. while we invest in the safety and health of americans today we must relentlessly push forward
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the frontier of diseases. each one percent drop in cancer deaths saves the economy $500 billion not to mention the comfort and security it brings to families across the country. today we are entering a new era in medical science with proposed increases of 107 million for precision medicine and 45 million for a brain initiative we can continue the process. for americans to benefit from the breakthroughs we need to make sure all americans have access to quality, affordable care. today more than 90% of americans have health coverage for the first time in the nation's history that this has been true. the budget seeks to build on that progress by improving the quality of care that patients
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receive spending our health care dollars more wisely and putting an engaged and empowered consumer. by improving the way we pay doctors, coordinate care, and use data and health care information we are building a stronger system. i want to thank the employees of hss who in the past year helped end the ebola outbreak in west africa and advanced the frontiers of medical science and helped millions of americans enroll in health care coverage. they do the quite work that makes our nation stronger. i am honored to be part of the team. i am personally committed to working closely with you and your staff to find common ground and deliver impact for the american people. with that i would be happy to take your questions. thank you. >> thank you very much for your
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statement. madam secretary, you recently stated that you believe we have more work to do with the affordable care act but the marketplace is stable. i am going to take the opportunity to remind you one of the five insurers offer offering insurance in my home state left the exchange and they provided half of coverage for all kansans last year. when we say we have insured stability it becomes a problem. i think the data showed the premiums for the bench mark plan increase 16% this year in kansas
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and that is causing a great concern. with insurers pulling out of the marketplace already i am troubled to see you are taking steps to increase government control over the plans available on the exchanges and ultimately reduce consumer choice through the notice of payment parameters. the notice claims consume are less likely to be left with a plan they are satisfied with if there are too many. do you think there are too many choices on the plan? >> with regard to the stability and the marketplace. in the marketplace this year, 9-10, had an ability to be in a market with through or more issuers. that is where the competition
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is. i believe we need to continue to take steps to further stabilize and make sure the market stays stable. with regard to the payment notice, i think you know we are in the middle of that and will be completing that. our objectives are not about limiting choices for the consumer but instead making it easier for the consumer to make choices. a number of steps we took in open enrollment were about that. we created tools in the marketplace where you could search plans and understand if the providers you were looking for were part of that. the other part was create a tool called the total cost tool. it is a tool that will allow you to figure out your deductible and premium for the year. our objective is to continue to promote stability in the market and make sure there is consumer choice not to limit it. >> i apprec at th -- appreciate
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that. there is a job to review all of the agency's rules with world providers. i mind appreciate any more information you could provide to the committee after this hearing. i am interested in how you see this new effort functioning. the distinguished senator franken is the co-chairman of the royal health care caucus. i need to know or we would like to know how this council coordinates with the work done by the hss world health task force and hss national advisory committee on human health and services. there might be duplication and i hope we can pull that together.
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>> the council that has been pulled together i think is in response to topics we have discu discussed in this committee. i think you know my personal interest in rural america. there were serious questions i asked every time about rural america. we are formalizing a process by which those analytics that i think are important to understand because i think rural markets and urban markets are different sometimes and as we consider rulemaking we need to consider both. it is formalizing a process we have been doing informally over the past year in terms of rulemaking. we will be happy to make. this is an issue of interest and we would like to work with the congress in making sure we are considering the right things as we ask questions about the impact on rural america. >> senator caldwell. >> thank you for your work on the budget. always good to see you. i want to go over the
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implementation of the basic health care plan which some states have taken up and want to get your commitment to implement those plans. my understanding is new york is targeting lower premiums and plans that are better drivers of driving down cost in the marketplace. so definitely want to get your commitment on that. >> yes, i think you know in the time i have been here, we have engaged in a number of these. now with new york and minnesota in terms of the two places but we look forward to other states coming forward with proposals that do a number of things. it has to meet the basics of making sure the number of people that need access have access. it needs to meet the requirements of the health benefits required and in terms of deficit neutrality for the federal government. we know these plans are about access but also about states coming to approaches that are doing delivery system reform and thinking of more efficient ways
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to provide quality care. we look forward to working with states as they come forward with their plans. >> i think it is telling when you look at this model because we are talking about the lower income population that was always hard to serve in general and that is to get them on on affordable plan maybe because an employee didn't offer it or have leverage. so new york with low monthly premiums of only $20 it is astounding we can provide coverage for a huge population and focus on manage care which drives down the cost as well. look forward to your commitment to working on other states with that. as the administration looks at payment models to properly incentvise care providers how are we moving ahead particularly for low medicare rate states
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like washington that want to see the improvement but not be penaliz penalized? how are we making sure we are transferring from the fee per service and to the model? >> last year in january we committed as an administration and at hss that we would transfer 30% by the end of 2016 of payments in medicare to payments based on value not volume and by 2018 it would be 50% of the payments. we are on track to meet that goal for this year which is important because we are a largepiration large portion of dollars but also in terms of the market and whether that is private or like in new york with medicare. to the point of rewarding those who are making advances in quality and affordability with our accountable care organizations we took the
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feedback we have received and in the next round of those we have put forward changes that hopefully will protect and reward those who are already leading in the space. ...and reward those who are already leading in the space. >> on graduate medical education, there's something that you guys have entailed on setting the standards for emerging needs in health care as it relates to medical education. what are those standards going to entail. >> what we're trying to do? we want to make sure the monies that are for graduate medicare re >> we want to make sure were focus on primary care where we need more services. as well as the issue of specialties where we do not have enough people. what we are trying to do is create standards where it serves
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the pipe elation it's supposed to and it is targeted to the places where we have shortages. >> right. i think the problem we have that we need to focus on is that given a state criteria, you can be in seattle and be well served and be in spokane and have a shortage. we need to focus on the fact that even within a state you can have great geographic differences and what your different to serve graduate medical education. so it's important to us to have that in spokane. thank you. my colleague i'm sure is going to ask about puerto rico. the bottom line is our calyx need to understand that while there is a cap on medicaid rate expenses in puerto rico, it is tens of thousands of people come to the united states there's no cap on that.
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we are digging a deeper hole in our budget by not fixing the problem in puerto rico. thank thank you. i will let my colleagues speak on that. [inaudible] in your understanding of urinalysis. we thank you for that. as you know, as you know, cbo recently came out with a and said that by in ten years without addressing mandatory spending and other issues of the mandatory interest will consume 99% of all federal revenues. that's unsustainable. we been together and rinse talking about budget issues so when your omb director we were not able to reach an
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accommodation so i decided i was going to stall. every week i would go to the senate floor and talk about waste, fraud, abuse and how we can save taxpayers money. one taxpayers money. one of the issues i'll be talking about today is the report regarding improper payments through cms. my understanding the inspector general listed 25 in on implemented recommendations for proving taxpayers dollars. cms wants to do this but they said there's short on resources. cms could save 1.76 a billion dollars if it have followed the installation of improving automated claims.
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and a number of other things. my question is here where asking for more resources and i would like to bring it to your attention, there are ways to free up money for absolute necessary functions for cms. some of these recommendations and all of these recommendations if they are implemented can help with that process. i want to bring that your attention. i would like to get your response to that in terms of the ability to go forward and get these recommendations implemented. >> with regard to and we agree and i think you know the seven-- one statistic for every 1 dollar we believe we can save seven. that that the average over the most recent. of time. last year with the justice department we had the largest takedown we have had in the fraud area. it it was over $700 million in one takedown. it's a combination of things that we can do, the technology portion of it. we do believe we
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need finances to change and do some of that automation. we have asked for those resources. in terms of acting administrator who is taking on these issues i think he's had an opportunity to speak with him about it, it's an an issue on our regular desk of things we are talking about. i think we believe as you articulated, fraud is an important part but i think we can go at it aggressively. with data, getting ahead of it instead of chasing it. i think we need to consider with improper payments there is fraud and then the category where people are providing the right data and information. we have tightened the requirement in order to do things like requiring paperwork before payment so that we get in front of it. we find that we are seeing greater numbers of people not getting the right paper.
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were focused on that technical assistance to providers to get the information to us. that's also place where resources are important. >> given your experiences with the director i think this is in your wheelhouse. the secretary of hhs i think you're the right person at the right place to get the stone. we wish you success in getting these implemented here. it can free up necessary funds. >> that particular part results in greater savings. that seven-- one numbers focusing average over the last three years. >> thank you. i have 40 seconds left which i.e. yielded back in interest of the vote coming up. >> thank you. who is next? >> thank you mr. chairman. i will only ask one question on this round giving colleagues being here. we are very pleased with the secretary here in my view gives public service a good name. we are glad that she is here. the issue is opiate abuse is
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widespread across the country and particularly in oregon. i have opened an investigation and the potential of interest between opiate manufacturers in the paint industry. the concern here is the manufacturers may be trying to influence opiate prescribing practices and will have more to say on that in the days ahead. oregon has been among the states with the highest nonmedical use of prescription pain relievers. the cdc estimates that one of 15 people who take prescription painkillers for nonmedical purposes are going to try heroin within ten years. nationally, healthcare providers providers read enough prescription for opiate pointing reliever for every adult american to have a bottle of pills.
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many studies and experts found physicians are inadequately trained on pain management. this past past week i sent a letter to the cdc to offer my support for the cdc draft guideline for prescribing opiates for chronic pains which will help prescribers have consistent, evidence-based guidance for appropriate opiate prescribing. so set aside for purposes of this morning, this question of the investigation into potential conflict of interest we'll talk about that more in the future. for purposes of this morning what is hhs plan to do to ensure that opiates are prescribed more appropriately, and what is the plan to re- deuce the number of people using prescription pain relievers for nonmedical purposes. >> when i came in june of 2014 this is a priority i chose.
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because i'm from the state of west virginia where their problem is acute. i visited in colorado, and pennsylvania to it and across the country. we we put together a three-part strategy based on evidence. it was three parts with number one being the issue you just touched on, that is prescribing. prescribing is how the starts, it's how it starts in terms of prescription medication. as he also reflected 70 people who do hair when it is after they have done prescription drugs. in colorado colorado i met a woman who said after three men's, heroin was cheaper, easier to get at a better high. she started with with her wisdom teeth being pulled in taking the drugs. first prescribing practices is what cdc is doing. second is medication -assisted treatment. this is this is the approach
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that is a broad bipartisan support. it support at the state level with the governors, sheriffs, everyone to make sure we are getting the treatment for the people. right now in our state and across the country we have so many people who are already addicted. that's what the vast majority of the money in this proposal do. it's important to note that that is the money that will go to states and communities. it will go through herself and another entity so that we can build our capacity and states and community to do medicare assistant. the third part is melodic sewn. we we have a situation where many people overdose. seventy-eight people a day are dying of an opiate related death. back in be prevented from being a death by applying narcan.
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part of the monies are about making sure we can help and support communities to get access to that drug, to their first responders as well as we recently saw the organizations like cvs and walgreens working to make this drug and over-the-counter drugs. >> with so many other colleagues waiting to ask questions, i will ask others on purchaser round. >> thank you. senator sanders sanders is next. >> thank you. welcome and nice to have you here. i appreciate being able to discuss the issues with you previously. i want to raise some concerns about the great plains area, the reports coming out have been unacceptable. unfortunately there has been a
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failure to deliver other promises to fix healthcare services in this area. reports of failings were issued in 2010, 2011, 2013, in 2014i was informed a contractor was in place in 2014 i was informed a contractor was in place to strengthen the length between external oversight of the development of patient care processes. reports cover the same issue when it comes to fixing these issues the administration seems to continuously fail. i would like to know from you what the administration has done the past three years to engage with tribes in the great plains area to make meaningful reforms to the system and to ensure patients receive the quality care they deserve. if you could talk about that. >> thank you senator. i share your concerns. it there been a number of changes that we are taking right now in terms of trying to get a different result from where we are. i think it is important when cms said we do not have safety and quality issues that we acted upon that to protect the health and well-being of the folks. that still means they need access to quality care and how do we get there. first, the region itself we have change the leadership in the region. in addition we are supporting
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that by sending our public health commission officers who are part of quality control to supplement the hhs control officials on the ground. we are making sure that we're doing quality management changes. it's about meeting the qualities dander that management and cultures that we need to make changes in and we have hired a deputy, dorothy dupree who has come from the field to work on quality issues and brought in mary smith as another deputy to her, management issues. in addition you saw in the hearing that your income i specifically asked the acting deputy and think this committee for her hearing, doctor mary to put together an interagency group within the department that met yesterday to set specific goals of what we can achieve during our time. >> thank you. we will will look forward to continue to follow up on those issues. want to change gears for just a
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moment and ask about a mrs. more forward-looking i hope, on how we can make reforms on the ihs. i like to follow up on the officials with ihs. i requested an update of when of they would finalize a regulation that was published in december 2014 which would expend medicare rates for physicians and not hospital services. i understand from the budget proposal this regulation is awaiting for approval at omb. i am encouraged by what we are hurting by the congress. i'm interested in when you believe this regulation will be posted. in addition i would like to know how the administration plans to conduct its consultation with the tribes in south dakota. >> with regard to the specific regulation that you are speaking though it is in omb under review
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process. that's generally a 90 day process. the comments come back to us and the question is how extensive those are in terms of the timing. it is at a late stage in a regulatory process. process. it's one that is a priority for us in terms of what we've got to omb. we're hopeful that we will get it out soon. it's also related to the issue and i think you know because you're saying governor have been an important part has has been alaska of changing how we do other payment issues that are not a part of that regulation but are important to the payment system of how we provide healthcare. were working on the regulatory front and also one that doesn't one that requires the same process in terms of the payment. i think you know where changing the matching rights. >> i appreciate the efforts there and would encourage you to continue to push the omb to move forward with finalization of that recreation. i'm with you with the past which is via electronic mechanisms used to exchange the claims and
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payment process. in the purchase referred program claims are still being bailed back and forth, my understanding is the ministration is considering a move to electronic claim payments. it would be understood in the update if the of ministration thinks that is feasible. >> with regard to the specifics of where that is i would like to get back to. the overall concept with the emphasis in our delivery system and one of the anchors of the strategy there is an electronic health benefits and data information and the ability to move quickly so we can improve quality. and we approve affordability. if it's within the overall what were trying to do. where's that at this moment i will need to get back. >> thank you. my times up. >> under the aca, 17.6 million people now have healthcare. louisiana is expected to expand
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medicaid and their legislative session, that's another 400,000 people. that is 18 million. the republican governor states that have refused to expand medicaid and will eventually is another 4 million. so 18 million plus 4 million is 22 million. 22,000,000 people will have healthcare out of an eligible population that did not have healthcare of 34 million. that is two thirds, that is a huge success. i don't think that story is really understood, how successful the aca is.
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if you wonder where i got the 34 million, taken 45 million was the population that did not have healthcare and i am subtracting those that are here illegally, 11 million to get 34. twenty-two out of 34 million will have healthcare. that's a success. i want you all to chronicle that story. >> i think when we think about the issue of the success it's around affordability, access and quality. as you reflect on the access point we are now at a place where over 90% of americans have insurance in the country. that is a very big big change from where we were. for medicaid, 14 million additional facts people are in
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medicaid from 2013 until now. in the marketplace that 17.6 as well as other numbers in terms of that reduction, the other thing that's important is when we have low unemployment people have health insurance to that as well. all of those things are coming together to put the downward pressure. i don't think we can forget the other things like pre-existing conditions which so many americans, people who have answer and asthma, is very beneficial as well as preventative care and conditions. that gives to some of the issues we've all discussed. >> okay. puerto rico, the mosquito that is in puerto rico that has spread a lot of fever is the same mosquito that carries the zika virus. fortunately the zika virus produces a flulike symptom that
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is relatively moderate but where's having tragic results is on pregnant women with children that are deformed. puerto rico needs help and low and behold, if puerto rican pregnant women are being exposed and they have this tragic results of the these defective births, that's going to be an additional expense upon the healthcare system to take care of these babies. i note you put 250 million in your budget to curb what is expected to be in puerto rico,
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this outbreak of zika. would you comment about the. >> with regard to the zika virus, the concern we have right now and the plant we have put in place is about preventing further damage and focusing specifically on pregnant women. what we know is that on the island of puerto rico, this mosquito is a very dominant presence. at the mosquito that will sometimes bite for humans and one feeding. therefore it spreads the disease quickly. because 80% of the people are not symptomatic you don't hope you've had it. so for us to do mosquito control it's not just for puerto rico, puerto rico is the place we expect to see the most and have had mosquito transmission already. in the continental in states like florida, texas, were concerned because this mosquito is prevalent as well. we want to make sure were putting the resources against the preventing as much against the zika virus as we can. >> yankee minister chairman.
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i want to continue on the lines and the zika virus. the cdc in fort collins colorado has been on the frontline of studying and monitoring this issue of this disease for years. as you mentions in your opening presentation it was at 1,800,000,000 dollars to respond to the zika virus. as can. can you give us more detail about how you propose to spend that money and to what role the division of the department would play. >> were appreciative of the work they have done today because the testing that is occurring mainly with the cdc in terms of fort
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collins, that's where a lot of the testing is occurring. were trying to move it out to the states so it will be more proximate to those in need. that's a part of what that money is about to make sure it states will have the capacity to test because for any woman who has gone to mexico and the estimates are about 450,000 pregnant women travel to these areas. they don't know if they had that disease. so if you're pregnant and come back you will most likely be tested and we recommend it. therefore, a lot of the money is about making sure the states are going to have that testing capabilities. >> i want to switch gears. senator grassley and i along with others introduce the ace kids act and now has 30 cosponsors to improve care for children with things like cancer, congenital congenital heart disease and down syndrome. approximately two thirds of the
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children with complex conditions are covered with medicaid. they account for an estimated 6% of medicaid enrollees and nearly 40% of medicaid costs for kids. our bill would create a national framework of world-class providers and hospitals in the medicaid program that would coordinate care across state lines on behalf of these children. i know hhs is working within certain states to test these models. we hope to work across state lines. were working with our finance cosponsors. we will need assistance from your team, is this something you would be willing to prior trays? >> we want to work with the authorities we have and we want to work with you on ensuring we can do all the work we can to
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ensure these children are serve. >> i appreciate that. i think we can do a better job at providing care at a lower cost if we can coordinate it. i yield back. >> we are going to senator portman. i apologize i will be back but the bill on the floor is my bill. i will have to go vote on it. senator portman will take over and my staff will stay who is next. if any republican senator here can tell you who is next. >> thank you senator. thank you madame secretary for reaching out for this hearing and seeking my counsel of course i have not for you except to say we have differences on this budget. i agree what he just said about the importance of her kids health act which is called the
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ace act which will help improve care and reduce costs. we have differences on the big picture. i've talked about some issues we face it but i want to talk about something i like in the budget. that is the work on opiate addiction. so it is at epidemic levels in my state and across the country. we are losing lives every day. we lost over 2300 in ohio last year alone. we have over the last three years been working on legislation that is bipartisan, comprehensive. we've had a meetings with experts from the country we've tried to bring in the best people to figure out how you get at the problem. we've talked about it and i appreciate appreciate your reaching out to me. that legislation called cara just passed while you are testifying.
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it passed and it was unanimous. that does not happen here. i'm going to thank you for what's in the budget because what you put in the budget is consistent with cara and provides more funding specifically for treatment. one of the things i like about the budget is it provides some funding to look at and i'm reading through the budget evaluating the effectiveness of -- sites research at the federal level on best practices. not all treatment programs are equal. some work better than others. some that i have visited have incredible results. i think it's important to and i encourage you to do that. i know you have a personal interest in it. senator whitehouse is the other co-author of this. we have a bipartisan group and around the country supporters,
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the attorney general's i think 38 endorsed the bill. the groups represent the people who work in the trenches every day in the state. this is one we can get done. i know the white house has to said good things about the bill but not been willing to say they support it. i hope you you will support it and get behind it. we understand there has to be funding that goes along with it. that's why i think the budget is a step in the right direction. the funding we got at year-end will help but we will need additional to make sure that it can actually be implemented in the proper way. do you have any thoughts on care that you could share with us today? >> first thank you for the leadership i think it's important to the progress we can make and in terms of the number of folks, i think as you said it aligns with the strategy that i articulated earlier that the bill does, i think we want to continue to work i just have 11
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months, so the idea that we can put into place the things, i hope we hope we will start to see the results of our efforts. it will take longer but the idea that we can put in as many as possible as well as these prescriber issues that we face, we look forward to working with you on it. i'm glad to hear about the vote. >> we are encouraged by the vote and by the amount of support were getting from around the country. and with the administration weighing in precisely on this legislation what often happens around here is political games. people offer amendments amendments to try to kill it and say it's about politics, it's never about politics. we've kept it nonpartisan but we'd like your help to get this to the president's desk for government to play a partnership
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role with nonprofits to address what is a crisis in our community. there's other legislation that has been introduced and it's called the stop medication abuse and protects seniors act. this help us to save lives to make sure that patients are not dr. shopping and getting medication from different doctors. the cms demonstrated testified that medicare is prohibited from using this. your budget touches on this. can you comment on this legislation in your view on this and if we can meet this legislation further? >> as was commented by cms i think you know it would come statutorily. medicaid programs and states are doing it as well as the private sector. the one concern is to make sure we do not make access to hard.
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pain is an important issue and so i think we agreed that we can do a better job which i think is the objective of the bill in terms of controlling access to the drugs in terms of providers and pharmacies. to do it in a way that don't have an access for those who need it. >> thank you i look forward to working with you. >> we have rotating chairmanships today so i'm getting confused. thank you for your service to our country. i think you're doing an outstanding job. as you know congress passed the autism care act in august 2014 which i wrote to continue the research and intervention, support program that existed under the old named combating autism act.
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while the cares that contains requirements that hhs conduct research in key areas, among them is a report focused on young adults and youth with autism who are transitioning out of school-based support services into the community. according to the cdc data, one and 68 children nationally, and unfortunately one and 45 in my home state of new jersey identified with an autism spectrum disorder. early diagnosis has come a long way to support these children. unfortunately youth and adults don't have the same access to supported services after they leave the school. after the last passage i convened a roundtable discussion with key autism community leaders in new jersey. this issue of aging out and transitioning to community-based
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services was something that was consistently mentioned as an area in dire need of attention which is why i mandated this report, which would provide the agencies with a comprehensive understanding of not only what services are available but what we need to do to ensure every individual with an autism spectrum disorder can exit succeed into adulthood. can you provide us with an update on the progress of the report and confirmed that it will be completed by the statutory deadline? >> thank you you for your leadership in the space it's important in helping us with the work that would do. were working in terms of this report and i will get back regarding the question. >> i'm concerned because i understand that this is not even
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been started. if that's the case at a how we make the august deadline. i hope i'm hope i'm wrong and you give me better news. if not i'd like to get a sense of urgency. mike i have talked about the opiate epidemic and it deserves that attention. last year in new jersey heroine deaths were up 160% since 2010. we ten. we suffered more than 1200 overdose related deaths. this is really an epidemic. i recently held a listening session to address the crisis. to a person the issue that came up the most frequently as the most substantial barrier to addiction treatment was the limitation on a provider's' ability to conduct medication assisted treatment.
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as you know these limitations a provider's ability's ability to treat, at most 100 patients. with the number of people seeking treatment for outpacing the number of providers who can help, it seems to me this is it out dated limitation. it ties providers hands. i would like to see a brighter provider universe. when something is an epidemic you need to figure out that maybe an artificial cap at one time is now not the reality of the moment. i appreciate the administration's request for funds in this area and i will be supportive of it as i can, what can we do to increase the access to treatment and what can the department do under its current authority? >> i think it's in the specific
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case of narcan. right now were at changing our regulations and proposals and using our administrative authority as we can to change that. that's something i would expect happy this year. as indicated it is the place where the question where the diversion of its we want to make sure. we want to expand those numbers without creating that problem. that's what were working on right now to use our administrative authority. the the budget there's. the in the budget there's a proposal to expand the ability for train people incorrect settings. so making making sure the positions might be able to use it. there are two friends we are working on one is the budget one is administrative back chin. >> i would appreciate if you're's that would keep us informed. i would just like to mentions in
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my colleagues have brought it up, i hope that your department will do everything you can to take the administrative steps that are possible in the healthcare crisis in puerto rico. i listen to the stories from people on the island and i listen to their families in new jersey, it is getting out of hand. there are other issues they have in terms of their finances but this is an issue of increasing concern. i hope you'll see what ever administrative powers you have. three and have american citizens who happen to live there. >> were very focused in terms of administrative actions we can take. think as you know the medicaid spaces where large dollars in large amounts of care are very important. it's on on equal footing.
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we spent time yesterday on important legislation that needs to occur. i would be remiss if i did emphasize emphasize the importance of what were trying to do. we want to make sure americans in puerto rico has equitable care in terms of rates and that's what the proposal in the budget. at the same time will do everything we can from an administrative perspective. the issue that's raised about zika is particularly important. when you think about the cost senator nelson was mentioning, cdc estimates children who are worn with some of these severe birth the facts the cost is one-$10 million per child. making sure were doing everything we can to help in assistance of puerto rico in preventing cases of zika and pregnant women that could lead to these additional issues are priority focus.
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in terms of the urgency of the need. >> i appreciate your answers. we are ready and willing to do what we can on the side of the capital to be helpful in your efforts there. >> thank you. >> thank you senator mendez. >> let me just say in public what i told jim private two days ago, i appreciate your accessibility and willingness to work to solve problems. i appreciate what you've done for us in georgia. thank you very much. you're on the task force for cancer cures. >> i am. >> i have a homework assignment for you. the surgeon general in 2014 said skin cancer is the fastest-growing killer of all cancers. melanoma the fastest-growing of the skin cancers.
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i survived two melanomas in my life i took that on as a call to action and started investigating. i found out there's a 13 year backlog of ingredients that have been submitted for approval and sunscreen that have been delayed in terms of processing of their approval. we pass the sunscreen innovation act and a pass on the floor and buy the house and signed by the president. 14 months later none of those ingredients have been approved yet, nothings move forward. and to quote the president, he's asked you to identify and address any unnecessary regulatory barriers and figure out how to expedite this. would you please make your first item on your agenda the sunscreen act. >> with regard to the issue and we've had time since last year i spent time. one of the things in terms of the ingredients as we need the data and information from the actual manufacturing companies. we are working with them being
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very clear about here's what we need to meet the standard of approval. that is part of what the actors is making sure we meet the standard. the sunscreen that everyone knows now we put them on every day because we know every day in the summer though sunscreens are going on. the the question of what that sunscreen doesn't terms of absorption in the skin and if it causes other issue that's what we want to make sure. we want to get to a base level of safety, we've been very clear, we heard you when you talk to us last year about the issue. were trying to work with companies to be clear about what data we need. press to say that it was approved in another place can we just see the analytics to make sure what were putting on children to say. we're trying to work with industry to make sure were being clear and to make it as simple as possible to get the information we need.
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>> alter favor for you if you get me the information that i need to call them and tell them to expedite it submitted to you, i'll do that if, and i've just been handed this, i take no responsibility for this but i have great staff, the fda has moved the goalpost is now requiring a new a new test that no one has ever heard of. i will check on what that is if you'll check on that too and we'll see if we can get the barrier removed. i think it's important to get these done as fast as possible. on the zika virus, we talked last week the estimated request is 1,800,000,000. >> yes billion. >> yes 1.48 for hhs. >> and another hearing i was saying there is some money in the a bowl of funds and someone was suggesting that goes to zika. that be fine but please do one thing, their private hospitals that assist the ministration and responding to the bola.
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they were told their be reimbursed for their costs as they responded and make sure that they have all and reimburse before but not on something else. >> yes or. i think we want to make sure that we finish the job on e bola. that's an important thing for us to do. we know just this last week new cases have occurred. even when we declared a claim there is a new case in the good news is we found it. we makes need to make sure we finish the job on ebola including making sure that repayment hospitals that helped with this issue. >> the cdc did a marvelous job in responding to them. the administration is great what they did. i just want to make sure everyone who is supposed to get reimbursed us. one of the companies in my state's equity equity facts which is a provider of cms to verify medicare eligibility.
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make sure you are utilizing those people and they're not the only provider. i know we have a lot of things fall through the cracked and things of pay that should be paid i understand there is an underutilization of those verifications. please follow up on that to make sure were using the resources which are cost free to make sure those eligible for medicaid are in fact eligible. thank you very much. >> i have not asked questions are graded. if i could just greet her and i'll ask my questions after you. welcome. i've been running back and forth, i had a bill on the floor i just want to welcome you to the committee and sorry to be late but i am very pleased with
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the hard work that you are doing. it is a tough job job and i think you are doing a straightforward and good way that i could expect. i just want you to know that i'm proud of you and i want to keep working with you. so listen to our side too, we might be able to get a lot done if we do. were happy to have you here. >> mr. chairman, thank you very much. thank you for being here and think you for your stellar public service at a difficult time. of two questions. i hate to pass up the opportunity to report good news, we need that. just some numbers, you don't have to respond but i was struck by some of these. between 20202014, 87000 fewer patients died due to infections.
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150,000 fewer readmissions which is good for the individual and good for saving money. in the budget presentation is happy to see a lot of things but i will just do some highlights this won't be fair to every priority. requiring coverage of eps program for children inpatient psychiatric treatment facilities, extending the children's health insurance funding through 2019 and the new initiative for the new dollars for an existing maternal and infant childhood visiting, 15,000,000,000 dollar dollars investment over ten years. it is voluntary and it is evidence-based home visiting which is good for the baby and the mom and family. all of that for good news in addition to the 17.6 million
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covered by aca since the enactment. that's all good news. on the bad news side you've been asked several times about the opiate problem, terribly significant problem in our state. we have the ranking on pennsylvania being third-highest in heroine death. the corners association, every one of our 67 counties have a corner reporting on how people die. that number has gone up from about 47 a few few years ago to hundreds of deaths every year. thousands if you look at it over several years. a huge issue in a huge problem. i know you have been working on it. one subset is we have heard anecdotally that child welfare agencies are having increased
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foster care placements due to the opiate epidemic. how is hhs taken into account the needs of child welfare population as a court meets its response to this epidemic? >> in a number ways. one is to make sure the mother gets into coverage and health before she has the baby. this is also about the health of the baby and making sure we do everything we can to for an addicted mother. and in colorado i visited with a successful program. making sure we have the coverage. the coverage that has a current through the aca and people coming in through the marketplace we believe we will reach more women. step one is to make sure we have
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the coverage. step two is to make sure they're willing to come inches i hope the conversations were having publicly destigmatize women, and in. that the other problem that the barrier. you don't have health insurance, then you're stigmatized if you come in. these are some issues were working to do to make sure we start at the beginning of the child's life. >> i appreciate your work on this. my last question is on the complex rehab assessor is issue that came up, now and a situation that for the first six months of the year providers will face the same payment difficulties they would have faced if we cannot pass legislation. cms performs these quarterly updates. we had some discussion about doctor wakefield when she was
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here. did you work with cms to ensure the mandated payment change is included in the april update? >> we will implement as quickly as possible. this is the end of the year and i think the administrators plan on having a conversation directly with you. will follow up. >> will take time now to ask my questions because i might have to leave again. i have some things i'm doing today it's hard to keep up with it all. welcome again and i appreciate the work that you're doing down there. it's very meaningful very difficult. you're doing good. i have great concern of the topic on medicare part d program. there's been rumblings that there might be another order that would allow the federal government to negotiate
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prescription drug prices in the medicare part d program. such an order would be in violation of the law. as the statute splits it leapers habits interference in private negotiations. despite this fact the possibility of an executive order i take very seriously. the part d program gets these needed drugs to medicare beneficiaries. we need to keep the program as it was originally structured because it works. everybody knows the party is one of the most important things that really work. beneficiaries have choice of prescription drug plans, private entities negotiate keep costs down. overall spending is significantly less. beneficiary satisfaction is high. it's been a tremendous success.
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allowing the government to negotiate prices is not a new idea. the president's budget budget proposal states it has no budgetary impact, the congressional budget office doesn't see it as a big saver. having said that my question is does anyone at hhs working or has worked with the white house on an executive order that would allow the government to negotiate prices or any other exchanges related to drug prices. >> with relation to drug prices were focused on both sides of the issue. not just prices is about innovation which is why we brought people in for a conversation about both of those issues at the end of last year so we can hear from industry and consumers in terms of the issue. as we think about it and the steps we have taken were focused on both innovation and affordability.
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i think you know the issue of deficits and mandatory spending, we take it very seriously and are looking for the opportunity because it's becoming an increasing percentage of our health costs. we saw great increases, the most rosita many years. that's why we're focused on the issue. the session that we did include closing the donut hole which is part of the aca and the third step is on the issue of trying to provide transparency because we do believe that puts pressure and have created -- >> let me interrupt you. i'm concerned about this. i think they followed it up.
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frankly if you don't have the data time of 12 years which we negotiated, kennedy and i negotiated that, because we know we have to have it enough data for the companies to recoup their costs. where we can actually get cures it takes about 15 years and $2 billion. so you need some time to recoup that money or if you have the five years that they have in that provision the costs are going to be so high that people will be screaming in the industry will go down the drain. that's where we'll fight some cures that might really save healthcare costs over the long run. the case of pharmaceuticals i'm sure they get that figure
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they'll be started to do that with pharmaceuticals which are a billion dollars in 15 years. and they will need to recoup those funds in order to create new drugs in the case of bio therapies. i'm concerned about it and i hope you'll weigh in because we have to have some economic sense and these things or we will lose the whole pharmaceutical and certainly the whole bio industry because of what i consider to be stupid provision in the tpp. my time is up. >> thank you mr. chairman. thank you for your service, we appreciate appreciate your career service to the public. we have talked earlier but let me point out that the extension of access to emergency psychiatric care which was included in the omnibus i offered along with senator
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stanley and collins is a logical extension of the program through september but allows you to extend it through 2019 it is revenue neutral, but we need the guidance and i know you're working on it. it's very important particular for those -- i encourage you to stay focused on that. i i think it's critically important for psychiatric care. i also thank you for being willing to look at the pediatric oral health care issue that we provided coverage under the affordable care act but the report indicates that far too many americans are not getting access to dental care. we we need to figure out a strategy to get beyond coverage and make sure there is access qualify for those dental services. i want to follow up on the psychiatric care act and the
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community mental health needs. this past week i had a discussion in baltimore with experts on mental health and addiction services. we talked about this several times in the committee, the need for greater community access to mental health and addiction services. what came out at this meeting was a few interesting facts. the number number one priority still is the reimbursement structure. that does not take into consideration care managers. so if your hospital trying to be able to deal with psychiatric care, someone comes into your emergency room do you really know how to triage that person into the most effective, least expensive care setting. do you have the capability #if your qualified health center can
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you deal with walk-ins and referrals and do you have 247 capacity to do this. the reimbursement structure is not to terribly friendly towards those who understand that they must have those types of capacity in their facilities. i know you invited comments this july on how we can make the reimbursement structure more effective and congress has taken some actions in regard to a program in several states. can you just update assessed to how we are moving forward to encourage community-based models for integrative collaborative care for mental health services. >> section 223 in terms of implementation of an approach where were trying to experiment with different payment models builds on the back of behavioral health centers that are in communities as well as our federally qualified health centers. that the steps we took and
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senators on the house side have been very engaged in this issue. we are ahead of the schedule regard to implementation. in the budget that came up on tuesday we would like to extend those demonstrations so more of those that applied can start doing the types of things you're talking about. we are hopeful that our budget proposal and i think mr. stabenow and mr. blunt are both supportive of going beyond what we have in our budget. >> i strongly support that and thank you for doing that. it's very important. i would just suggest that we need systemwide changes in the reimbursement structure so that we can deal with mental health. i know you're looking at that as part of your july inquiry. we should take what we've learned. we know for every dollar we spend in the settings we are going to save $6.
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yet the reimbursement structure does not allow creative ways of using care managers and communities that may not be part of this program. i urge us to think broader as to how we can make the system work for mental health, historically it has not and today it still is not. >> i think what we are hopeful is that we can get the examples and models to scale in terms of the changes that will do the other way is through our accountable care organizations and having visited some of those in new york and seeing the progress they make with integrated behavioral healthcare , were funding those are our accountable care. so we are creating the models we need to have the analytics on. >> i know were gonna have real champions on this issue. thank you.
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thank you sir. good morning is good to see you again. a couple questions for you this morning i happened to be the cochair of the prescription drug caucus, i know there's a lot of funding throughout the budget for opiate abuse, there's one account that's zeroed out that the access to recovery count i was zeroed out by the administration, my assumption is other resources and reports of the budget more people are dying for the overdose than from auto accidents or gun violence. we talked to that so you can help some of the folks with their concerns. >> i think this gets to the topics so that were getting the money that we've asked for and specifically around narcan we have moved those monies out. were trying to work on this on two fronts in terms of helping
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people with the overdose portion of this and that is through our funding helping communities but were also looking for the private sector to make sure it is taking steps to be able to access. i think you know that in a number of states we see pharmacies like cvs and walgreens working with the state to do regular regulations to make it over-the-counter so access can occur for first responders and families. the other thing were doing is fda has approved the first nasal making it easier for regular people to be able to give it to their loved one if they need to say don't need to do a jab. thank you. my next question is i know you've spent some time in the south, and 2013, each thousand 13, each state was provided with a cms liaison to contact with
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questions and issues. these were removed recently and replaced with a generic e-mail account and it was caught with some challenges seems to be nearly impossible for things like south carolina to get quality answers, specially answers that are necessary for the time and perspective. what i've been told is that the responded many times they don't list their names so just via e-mail contact and it signed with regards to ffm response team. when they do identify themselves as almost never includes that individuals e-mail or contact information so long story short it's very difficult to have an actual conversation via e-mail with a specific person that leads to immediate response. >> i will follow up on that the response from a customer service is something our relationship with the doi. i need to doesn't have to with
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the federal market? a follow-up in terms of that. it does get to the issues of resources with cms. i thinking of the question of funding for these things in this particular type of service we can't do the fees. our budget this budget this year, fees that are coming in for the ffm will far exceed what were asking for an appropriations which is a good thing. but there's certain services fees cannot pay for. as you're reviewing the budget if you look at that may follow it specifically if we change something and if we need to figure out people need to know who to contact. i hear very clearly that we need to be a follow-up with someone. >> exactly, i assume in your budget there some flexibility to shuffle some of the resources around?
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>> we have done i think you know funding for cms over the past few years has been an issue that has been a challenge for us were hopeful that were at a different place this year. >> i know you've answered a few questions about the challenges, about 2,400,000,000 dollars in loans across the country however recently, including in my home state of south carolina we have seen closures which will likely result in loss coverage, higher premiums and maybe even higher deductibles. i be about 67000 people in my state can lose insurance. sadly as we've heard this morning often between 22 and 23 states where they operate or suffer large losses there very few signs that these co-ops will be successful in the future.
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what is your next step? >> with regard to the co-ops in terms of our next step, the consumers are the center of our strategy to make sure that we take care those consumers. that's why number came out before open enrollment. we will continue monitor with the states where the lead regulator. one of the steps are taken as making clarity in our guidance so that the co-ops can actually seek a broader range of capital for them to have as they try to work through issues they have. consumers at the center we support the stated continue to monitor closely so we understand there are changes in the facts they have given us. >> thank you my time is up. >> thank you and let me thank you, i think you're a superlative secretary. i've seen a lot in the many years i've been around here. nobody has more has a greater
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grip on what's going on, understands the policy, the practicalities, and is able to get things done. so kudos and accolades. >> what i want to talk to about his two things. one is the zika virus. i don't don't know if that is come up so far but i apologize if it has. your administration, our administration has sent us 1.8 billion in emergency supplemental request for funding to address the zika virus. we have a window here, we have time because the mosquitoes that carry it in a related one in new york, the tiger virus is not going to come for several months yet. so we have time and were pretty good if we get a handle on intercepting mosquito borne mosquito viruses. i'm glad you've asked for these monies. again, our republican
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colleagues, i'm going to plead with them not to just talk the talk but walk the walk. you cannot combat these crises, whether it's it's zika, opiates, mental health, security in our country without an effective government. the private sector is not going to fight zika it makes no sense. but what they're trying to do right now is say that we should not have any new monies, will will use the monies that were set aside free bola which have not been all spent yet to fight the zika virus. it seems to me were robbing peter to pay paul. would you please explain to me why we should not do that and rather have a new allocation of money for zika? what the money for a bowl is being used for why they're still
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needed even though the a bola crisis for the moment has subsided both here and in africa. >> with regard to our evil the money there's three main parts of the reports that we sent to the congress are fully obligated but as you know much of the money were using. the biggest pot that is left is about 500,000,000. that has to. that has to do with the global health security agenda. congress gave us that money and we have committed to 17 countries to help invest over a five-year period so we spend it wisely, our monies go down as there goes up. were negotiating were negotiating plans so we have implementation is what were working on together. those monies are set over five years to do this. the recent that's so important in terms of why would you take that money, one of the conversations we didn't have was in middle east respiratory syndrome. last year we had more cases outside saudi arabia than we've ever had in history but we did talk about it because korea was able to handle it.
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each year we have something. we have to get these countries ready, actually zika started in africa but we don't know because -- so some of the money goes to stop people of from spreading it. we all know it will come here if it's there. >> that's another portion of the money. we know just recently in sierra leone a case came back, were able to do tech the case because were still swapping, so dead bodies they swab and test. that's that's how it was found so didn't spread more. we need to get the job done in the countries and continue our prevention of notches zika or a bola,. >> and isn't some of the money to develop a vaccine or some preventative measure? that is another piece of it.
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>> so we'd be robbing peter to pay paul? we we be make us less safe against a bola but more safe about and you think that would be a serious health mistake. >> it would be a mistake. speemac's because because i'm running out of time, puerto rico we've been talking about puerto rico in a dire situation. i've sponsored along with many of my colleagues some of whom are here, to deal with the problems the a puerto rico. and bankruptcy is number one but senator hatch is trying to be very helpful on this and we appreciate it. in addition to bankruptcy and no money should be a substitute for allowing to declare bankruptcy, we need other monies to help and also be additional.
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my question is, how long do you estimate puerto rico's current medicaid allotment to last. what would happen if congress fails to provide additional money to their medicaid program, or as we both propose to grant them with state treatment. >> we continue to analyze. we we worry about things in terms of that allotment could happen as soon as this year. that's part of why we have the proposal we currently have in the budget, to make sure we treat puerto rico equitably in terms of how other americans are treated in terms of medicaid. it's an important issue i thank you for that extra minute and appreciate you holiness hearing and always. >> center, process could you wait just a second. but the time back up. i have to leave, so let me just think the secretary for being here as well as all of our
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colleagues who participated in this hearing my hope that what we discussed here today can be used to improve the health care system is for the taxpayer dollars are used efficiently and effectively. i would also ask that any written questions for the record be submitted by thursday, february 25, 2016 if we can do that and you can answer them as quickly as you can we would appreciate. sorry to interrupt you but i need to leave. >> madam secretary, thank you. it's great to talk with you this week. your dad, my mom spent some time in nursing home care, my mom from dimension i think your dad as well. i shared shared with you the other day i visited a presbyterian nursing home outside of dover, delaware.
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they did something that was very encouraging, they have stopped prescribing antipsychotic medication. dementia patients seem drugged out they don't know who they are where they are. a lot of people are in their 90s and even in their 100's. they have a fitness center there, they're doing yoga, but they don't take the medicines. they report back the number of falls now compared to what used to be is dramatically reduced. >> .. i think they have currently over the long term residents, zero percent of them are on antipsychotic drugs. on a personal level but really on your professional level, i just want to know if the
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department of health and human services, everything else you're doing, this is in your -- is this something you are thinking about. we have worked on this issue with respect to trying to stop, reduce or at least reduce the prescribing of these mind-altering drugs for like foster kids. that's been an important issue. this is something like your grandparents or great grandparents. i think they're on to something at westminster village. any thoughts? >> i think it aligns very much with what we are trying to do to get an heed indicated empowered engaged consumer at the center of their care. when we pay people for actually the outcome instead of paying for fee for service in the transaction, that's i think when we get to that. that's when in a place like that on a regular basis, there is a meeting of the care givers with the family to have the conversations about these things, to talk about them so you can reduce those.
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i think it's all part of the delivery system reform we are doing and shifting the payment system so in medicare, i think the other place that we will be pushing on this kind of specific issue is as we try through our innovation center to do our experiments in home-based care which mr. wyden certainly has spent a lot of time promoting, those are the ways that i think it is a lot about payment incentives as well as certainly opioids are a separate category but the type of drugs you're talking about i think have a lot to do with how we pay physicians to care for people and we pay providers to care for people. it's about the quality of their care, defining that and defining that the outcome is value, not volume. not how many pills you prescribe, not how much they're taking, but what the situation is for the individual. >> good. thank you. for us, this one's personal. i very much appreciate what you just said. during the last session of congress, actually the last congress, i worked with dr. coburn and you and some of your
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colleagues at the administration on issues including improper payments and something called the prime act, the prime act, which dealt with preventing reducing improper medicare and medicaid expenditures. over the last two congresses we passed bits and pieces weechlt have now enacted i think the entire prime act which is a wonderful thing. i'm going to ask you for the record to talk about the implementation of the new law which has been implemented in pieces and how we are doing to curb waste and fraud but not here at this forum. we just don't have time. i would ask, though, that on reducing opioid and painkiller addictions, as i understand it, folks that are in some cases physician assistants, nurse practitioners, are able to prescribe medication for opioid addiction to help increase the number of health care providers who can help us address this epidemic.
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could you just talk about -- i think there's a pilot, i may be confused on this but i think there's a pilot program that would folkocus on this area allowing them throughout the country to prescribe medicines for opioid addiction but to do it on a pilot and the question is, is that something we ought to do on a pilot or is this something that we should allow them to do nationwide? do we need the pilot? i goods that's my question. >> with regard to the question of medication assisted treatment and broadening the number of prescribers that can do it we have a proposal in our budget that would do broadening. i think there are two separate issues. there is the issue of broader medication assisted treatment and there are different categories of it. one particular issue which is a drug that has limited caps, right now we are in the middle of reviewing that and using our administrative authorities to raise those caps. that drug distinct from some others, there are concerns that
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it may have greater diversion and so we want to make sure that as we are creating access to it weesh , we do it in ways that we don't have diversion. i think there are two different categories as we think about when we scale things, when we have the evidence that we aren't going to create an unintended consequence move more quickly and broadly. in cases where we need some more evidence to make sure that there are reasonable questions being asked, that we do that in smaller settings. >> thanks. thanks. great to see you. >> senator stabenow. >> thank you very much. secretary burwell, we thank you for all your wonderful leadership. i do want to follow up on behavioral health and substance abuse. before doing that, i want to thank you for all of the efforts of your department and the administration in helping us with the incredible public health emergency in flint and the person that you have put on the ground is really tremendous.
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and the work that's going on there, i know you will be going next week to flint and so we appreciate your personal attention. as you know, we have a community of 100,000 people who through no fault of their own have seen their water system poisoned and basically in many parts of it, destroyed because of lack of corrosion treatment before switching to the poor quality flint water and up to 9,000 of those are children under the age of 6 who are now exposed and some of the houses have lead levels as high as a toxic waste dump. this is extremely serious. we are still hopeful, we have had difficulty coming together and getting bipartisan support here to help rebuild the pipes and so on, but we are still working and still hopeful we will be able to come together and do something. but thank you for that. your help. i do want to talk about as you know, another passion of mine we
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spend a lot of time on, that is implementing what senator blunt and i were able to get passed in the new law to create the structure so that we are not just funding mental health and substance abuse services from grants that ebb and flow up and down, but a structural change on payments that recognizes when a behavioral health specialist, psychologist, psychiatrist, social group, does work that meets quality standards, that they would be reimbursed like we reimburse other health professionals under a federally qualified health center and we have known actually since president kennedy passed the community mental health act over 50 years ago that we needed a structure in place so that we were providing comprehensive health care in the community. that's really the final gap, mental health parity. as you know, under the direction of legislation passed by the
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congress, we now have qualified community behavioral health clinics, definitions of what quality is, like we do for fqhcs, federally qualified health centers, and the question is how do we get that available in every community in every state. so the congress was willing to provide enough funding for eight states with planning grants for states interested to see how they could meet those qualifications in order to apply to be one of the eight states. under your direction and all of the wonderful folks that have been involved in your whole team, hhs, cms, everyone, you have built a program ready to go and 24 states have gotten planning grants, 24 states, 24 governors,csts÷ 24 states have we want to do this, we are planning how we meet those quality standards and we
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currently only can accommodate eight states even though to do anything else we want to do, opioids, mental health and so on, it all comes back in the end to having community services so people aren't going to jail or the emergency room at the hospital, they are getting the service in the community. i wanted first, i noticed that in the president's budget you expand the number of states from the eight we are talking about to 14. there are 24 states that are getting ready to go. i wonder if you might speak to what is our joint efforts, senator blunt and i, bipartisan effort, to actually allow every state that's working to be ready to go to have the opportunity to provide the resources so that we really have mental health and substance abuse services in the community. >> thank you for your leadership in this pace, senator. you and i have spent time together, senator blunt and i have spent time. through your leadership, moving forward on that establishment of the quality standards and then that imp machination because it is about the infrastructure to
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implement. that's why it's so important in these communities across the country that lack access. so many communities across our nation actually lack basic access to psychologists, psychiatrists or other behavioral health professionals and we do have an infrastructure in place and so now what we need to do is take those quality standards and make sure we pay and that's what i think we believe that the eight demonstrations that we're doing, or going to do, we believe is taking that step and our budget i proposal we do more because we think that's the right thing to do to build on this more to get that transition to where we finally treat behavioral health issues on par. it's not just about saying we're going to do it. it's about having providers to do it and quality measures to pay for. this is a direction we are pushing hard. i think you know we are beating our statutory deadlines in terms of some of this work because we believe in it strongly. >> yes. i want to thank you, just take another minute to thank you for
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doing that. because you are working hard to meet those standards. hopefully you proposed expanding that, we want to take it to every state that's interested and frankly, listen to the sheriffs across the country who are tired of having people in jail who ought to be receiving mental health or substance abuse services or hospital administrators who are treating people. i will never forget talking to the cook county sheriff whose director of his jail is a psychiatrist and we say why, it's because over a third of the people in his jail need psychiatric help. under the quality standards that we have now put in place, 24 emergency psychiatric help would be required as part of this quality certification and hopefully, congress this year will stied to gidecide to give states that stepped forward the opportunity to put services in place. >> we look forward to working with you on this.
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>> senator warner? >> thank you, mr. chairman. thank you, secretary, for your responsiveness and if i can get my questions out quickly, you may be done for the day. i have got three piece, want to thank you, secondly, a concern and third, a question. on the thank you, an issue we talked about a number of times is the gabriela miller kids first act which deals with pediatric cancer and celebrates the life story of an extraordinary young woman from leesburg, virginia who passed but advocated for researching pediatric cancer. i was very glad to see that it was fully funded in the president's budget proproposal. we had to work to get that done and i'm grateful for that. i'm also glad the president's cancer moon shot included elements targeted at pediatric cancer, since pediatric cancer is so different than adult cancer. thank you on the front end of that. on the concern issue, this is just to put on it your radar
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screen, we are working with cms, we know that due to budgetary constraints, a number of the community based care transition programs that initially folks thought might last for five years have been cut to four years. we have a successful program in virginia that does this coordinator transition care. unfortunately, they were cut back without being able to make the full transition to sustainability. we are working with cms and let me just, this is a concern but not asking you to kind of one-off here, we are working with cms, they have been cooperative but when we see successful programs that can and should make the transition to economic viability, i think we have got one here and i again would just appreciate the collaboration and cooperation of cms to try to make this successful program make this transition. finally, a subject again that we have talked about at times. and it's one that i think
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candidly that the american public is ahead of most of our elected officials and that's around care planning and end of life issues. i think that we still remain the only industrial nation in the world that hasn't had this kind of adult conversation about care planning, about trying to make sure that issues around end of life are dealt with respectfully but also recognize that this is not about limiting choices but about expanding choices. and i was pleased to see that cms introduced a payment form for physicians to have those kind of conversations. about advanced directives and the other legal entities that come out of those conversations. and these conversations should include family members, loved ones, religious advisors. senator isakson and i have been
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working on this and we're gaining broader based bipartisan support and there's not a member of the senate that i haven't talked to that doesn't have a personal story. mine was my mom had alzheimer's for 11 years, nine years of which she didn't speak and i was relatively well-informed citizen yet we didn't have all of those conversations before it was too late. we're working -- i guess i would like to assure that a commitment that we'll continue to work with your staff on the care planning codes, how we look at more wrap around services. we're trying to work to make sure that these type of advanced directives can actually travel across state lines because so many loved ones, even if you move forward with this documentation, i know this is something that senator wyden has been engaged in as well. mom and dad and aunts and uncles move. trying to make sure that those documents travel with you built into your emr.
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i would like your comments in this space and again acknowledging that we have, i think for the most part, elected officials have to move beyond some of the horrific language that may have been used six or seven years ago. this is a part of everyone's life and it needs to be dealt with and dealt with appropriately. my hope is that the care planning act we actually may get this done. if you would like to make a few comments on that. >> thank you for your leadership. because your leadership and senator isakson and others, it helped create the space where we could go forward and make the changes that we've made. in terms of paying. we think that's an incredibly important first step but we know it is a first step. now the question is how do you implement this so it's useful to the people and meets the goals and objectives that i know we share. we're going to continue to work in that space. we welcome the comments and welcome continuing to work with you on the issue. we did this because we believe
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it's an important change and a change about quality of care for people across this country and their families. we take seriously the next step that we need to do and we look forward to working with you on that. i think being able to pay makes a very big difference. >> and not only being able to pay to have that conversation but also to recognize that people's wishes ought to be respected. i know it's an issue we have talked about and you have been a lookeder on this for many years. my sense is that is a place with the american people are candidly ahead of their elected officials. there's not a single member in this body that hasn't had some experience either with a family member or friend. and it just breaks your heart sometimes when you see, i recall one virginian had to go twice as
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a daughter to make sure that her mother's wishes at 102 in terms of being resuscitated when she had chosen not to have those wishes honored. and i again appreciate the secretary's sensitivity in this issue. it is a hard issue to talk about but it is one that i think in america we need to address and it is not about limiting choices. it's about expanding choices. thank you. >> thank you, senator warner. it's striking. i was going to talk to secretary burwell for a few minutes about the future and how appropriate that senator warner, who along with senator isakson, have really been in the vanguard of laying out some new policies to expand choices for end of life care. one of the areas that i'm very proud of took years is now as a result of the secretary's good work we have finally put in place what's called medicare care choices. so for the first time older
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people would not have to give up the prospect of curative care in order to get the hospice benefit. and i have been hearing about that since the days when i had a full head of hair and rugged good looks and was director of the gray panthers. >> mr. chairman, is that back in the early part of the 20th century? >> it's impossible to calculate. but the point, the point is, what senator warner has been talking about is creating more choices. this is not about washington, it's not about producing another federal cookie cutter program. empowering patients and their family. it is high time. and senator warner, you and i and senator isaacson have been prosecuting this case and i'm very appreciative of it. medicare starts us down the
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path. but senator warren is absolutely right about several of the next steps and i'm with you. >> secretary burwell, your last hearing. and one of the assessments i would make as we wrap up is that because of the good work that you've been doing, you and your colleagues, america is not going to turn back the clock. america is not going to turn back the clock on the affordable care act. you talked about the increased enrollments. i'm particularly pleased that you're making this point that the heart of the aca, right at the center of it is making sure that it was against pre-existing conditions. if you add a pre-existing condition, you're wealthy.
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you all have now made it clear. one of the first areas i would like to mention is newt gingrich and dom daschle wrote an op-ed piece a few days ago. i don't think you see that happen every single day. the republican speaker, past democratic leader writing an op-ed piece. they said let's have a bigger role for the states. let's have a bigger role for the states in the affordable care act. they had a variety of ideas. pulling the ghofr nors together.
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to look at approaches. making sure the funding sources were more integrated. i guess in the lingo of the agency, those are funding streams. but to me, it's taken the various funds and trying to find a way to coordinate them. i want to be clear, this is not talking about anybody trying to duck the coverage requirements of the consumer protections and the law. the political spectrum can figure out how to test various approaches at the state level. what are the possibilities. the authorities lie the authority with states to do things we want. we spoke with ms. cantwell about the basic program and the steps that new york took in terms of how they wanted to approach.
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the access has been gained but not lost and we're also watching the finances in terms of in terms of the federal government. there are different alternative approaches to that. he's working towards the kind of care that we were just talking about at the end of life, educated, empowered, engaged consumer at the center of their care throughout their entire life. those are the kinds of things we want to work with. the constraints in ters of where the boundaries are, affordability and access. we look forward in regard to
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1332. we want to hear innovation and ideas. >> second question i would like to touch on is a committee project. i'm very appreciative of chairman hatch's interest in this. he knows i have been interested in this for years. medicare of 1965, people stayed in hospitals a lot longer. if you hurt your ankle and it wasn't really serious injury, it was part b of medicare. if it was really serious, you were in the hospital for a few days. that is not medicare today. medicare today is cancer, diabetes, heart disease, strokes. that's most of the spending. and we now have a task force, which fortunately is led by senator isaacson and senator
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warner with their interests in these issues and it's really stunning what you come up with when you look at this. after seniors, particularly in areas where you don't have medicare advantage, after seniors get that free physical, thank you affordable care act, so often their care, or kind of the nonsystem that sbis exists just sort of leads them off the rails and they end up in a hospital emergency room. and when they're about to be discharged, nobody even knows who to send a record to. what do you think is ahead there? >> i think as you're reflecting, chronic care, both in terms of quality and in terms of cost. we know about 80% of total care comes in diabetes, heart disease, other things.
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from a quality of life perspective and cost perspective, taking these issues on is important purpose atn't center of that, it's more integrated care. we need to change the way we deliver care in the country. and we're on a pathway to do that. and whether that's in prevention, as you highlighted, the importance of preventive care services that are required without additional cost through the affordable care act, where a person is responsible for making sure the pieces are together in a way that serves you. i think that connects to a point we discussed earlier, which is making sure we are paying for value, not volume. we're paying for the outcome of your health. and whether that's that prevention up front, or when you do have something, making sure we get the outcome you want. the payment system is a very
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important part of the tools we have that drives care that is more integrated with them engaged as part of that care in terms of the choices we were discussing at the end of life, but well before then in terms of your everyday care. >> i can tell you that, of course, the popular wisdom is that this is an election year and nothing is going to get done. he's set what i think are reasonable kind of principles we ought to work around. buckle up for that one. we're going to push very hard to advance that this year. i want to make sure we formally
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acknowledge the improvements to the tanif program. the improvements you all made. tanif, of course, outside of washington is public assistance. i think we made some real progress. we have more to do to help struggling parents find work. and i think you all have some promising proposals. i just heard about the staff, senator casey made a very good point with respect the spike in foster care. certainly a factor in that is the opioid epidemic. chairman hatch and i have spent the better part of the last year working on a proposal.
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family first would allow states to use their foster care dollars on programs that know how to be effective. drug treatment and mental health that help prevent the need for foster care by keeping families together. and i think the premise is these types of programs, not only save money for the overall system but they also approve the health and well being of vulnerable. you all have a similar proposal as i understand it. there's certainly a roll here for medicaid. and that is important. foster care dollars can also be used more efficiently in this space. and i would be interested in whether you share that view.
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>> we're trying to make sure that children stay in their home setting as much as possible as long as that is safe ten appropriate, but there are ways to encourage that. and many proposals are around that. we welcome the opportunity, wlar the key ways to support patients who are able to care for that child appropriately. >> whey always sensed about your agency and handling the
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responsibilities there is doing your job well is a contact sport. i admit i went to school in a basketball scholarship. that's kind of my world. but i see you constantly reaching out to legislators, to state officials. these are advocates, people who often don't have the power and clout. and i just want you to know i really appreciate that. i wish there was more time to get in to some additional issues. i know we talked briefly about the 18-month investigation into the hepatitis c drugs. there's a piece out.
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the states are aingsing hepatitis c drive. they can't afford to take care of people. by the way, when you ration hepatitis c drug, people get sicker and sicker and people have these very serious illnesses encost even more money. handling just a small percentage of those who have hepatitis c. and likely to end up with bigger expenses as a result of care being rationed. and i think it's a question, we're going to start examining here is, we are on the cusp in the united states of having a policy that says, we are going to have spectacular cures for illnesses. and the hepatitis c drugs are cures.
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that certainly is a debate that won't be for the feint hearted. i will be glad to have you for close to an additional year. i so appreciate the particularly the way you constantly come back to pulling people together. policies pick up by osmosis. you're constantly reaching out to people. it's not about accepting each other's bad ideas. bipartisanship is about taking good ideas. chairman hatch indicated, we have colleagues who may ask additional questions. with that, the finance committee is adjourned.
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>> during campaign 2016 c-span takes you on the road to the white house as we follow the candidates on c-span, c-span radio and >> and thein the latest edition of time magazine and also available online, the kids are all left, millennial's areleft memorials are financially stressed, socially liberal and politically pivotal. joining us on the phone, paul taylor, author of a new
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book on paperback called the next america. >> great to be with you. >> basically older americans are getting wealthier and younger americans are getting poorer. >> it plays out politically in ways that we began to see earlier this month in iowa and new hampshire. something in the democratic primary that to my knowledge is never happened before. one candidate winning the older vote while bernie sanders was winning the youth vote. in one instance he got 83 and 84 percent. i've never before seen an age this magnitude, and i think some of it flows to the economic anxieties that all americans are feeling. we are at a tough new normal. less familiar is the degree to which the story has increased the inequalities needed cycle.
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whereas older adults have been largely shielded. >> not a surprise. my question is why. >> well, i think you know. let's just look at the political campaign that is unfolding before us. a tremendous roar of protest politics as usual. whether it is gridlock for the sense that politicians are not responding to the major economic challenges. the share of americans who describe themselves as independent has been going up steadily.
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this is very much driven by the young. today's young are now the largest. about 48 percent of today's john kamas them a party they are so they are leading this move away from affiliation. >> a couple of demographic issues. four out of ten are living with a parent or older relative and they have only become half as likely to be married at the same age as their parents. >> well, these are all related to each other. the refrigerator is usually stocked and you don't have to put coins in the washing machine. this number spiked during a recession. unemployment rates are down.
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that pattern has not changed yet which reflects economic and cultural factors. listen, as you say, they are not getting married.married. how does this play economically and politically. one of the things it tends to do, young adults would like to get married. when he asked single malaria -- millennial's why haven't you the most common responses i can't be a good provider. this tends to be self-perpetuating because marriage has promoted prosperity and economies of scale and division of labor and all the rest. a growing share of young adults and frankly that is
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the share that is likeliest to be politically led. we talked earlier about the huge divide, but there is as important a divide in terms of democrats and republicans. if you look back were not for the millennial vote the leading candidate would be mitt romney the incumbent president. led by the activism. a terrific job doing the elbow. youth turnout was actually lower this year than it had been seven years ago or eight years ago. >> we are. >> we are talking with paul taylor. his essay is available online. a new paperback version of his book.
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as you.out in your book millennial's are better educated, far more tech savvy, but they tend to be more distrustful. >> well, there are two things about this trust. trust another human beings. actually optimistic and aspirational generation, less trusting of other human beings think some of that may be related to their tech savviness, so much of their social lives unfold online. takes them about a nanosecond. they are distrustful of all major institutions and in
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that regard they share this with the american public. how does this play out? again, i think in terms of -- that will play out in terms of the sense that the system is not working, the system is failing them and they are very much up for new approaches and innovations. one of the things that is so striking is even in this year of distrust is the millennial generation that has come forward with disruptive technologies and colors. these are new technologies that rearrange the way we do conventional things and are enormously reliant on trust. millennial's have been
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driving this change. they don't trust people or institutions. the trust algorithms because they live in a world where every buyer and seller gets a rating online and you can trust the wisdom of the crowd. i think that may explain one reason why bernie sanders is able to do so extraordinarily well. ego on a college campus and it is bernie, bernie, bernie, bernie. >> an eye on the millennial vote and the impact of this generation will have. thank you very much for being with us. >> thank you for having me.


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