Transcripts For CSPAN3 Politics And Public Policy Today 20240622

Thank you, senator. From my perspective, having joined as a correctional officer in 1988 and around that time the bureaus population was a little more than 60,000. I think historically when you book at the bureau of prisons and go back from 1940 to 1980, the bureaus population pretty much remained flat for many, many years in excess of 20,000. So in 1980, which is the primary target for this discussion, we, as an agency, we had approximately 24,000 inmates in the federal system. We had less than 9,000 employees, 41 institutions and able to operate the entour bur en tour bureau of prisons for 330 million. So when you look at the increase from 1980 to 2013, we were at more than 800 as far as the growth of the population. And our staffing didnt keep pace with that growth. And with our mission, where we are tasked with anyone and everyone who is convicted and turned over to the department of justice and placed in the care of the bureau of prisons, we have a job to do, a significant job. And it takes staff to do the work that is required. Let me ask you, from your perspective, again, youve been there, what drove the dramatic increase in the prison population. Well the war on drugs in the early 80s had a significant drive on the growth of the population. And as a result, we were having moro fenders come into the system. And we have a longstanding practice within the bureau of prisons and this goes back into the 1930s that the reentry efforts are always in play and that is to ensure that for our role were providing prehab ilttation. But the challenges as we try to protect the inmates and staff in our facilities but the driver has been the war on drugs. Has there been any legitimate increase due to a crackdown on Violent Crime that we just really again, appropriately crack down on that, or is that really like re didnt we didnt become a more criminal society. We are always arresting and convicting people and putting them in jail and are we putting them in jail longer. I want you to address that aspect as well. In regards to violent offenses, the department, through prosecutorial efforts, there is a mixture of individuals, as you are aware, nonviolent and those with violence. And within our population, i think it is safe to say we have very violent offenders in our population to include a significant amount of gang members in the federal system, we have more than 21,000 Security Threat Group Members that pose significant threat to the public and staff. And gang violence, that generally driven by drugs . It can be driven by drugs. If the gangs and those who are associated with that activity and part of the structure within the money to be gained. And let me stick with the director in terms of in spector general horowitzs testimony. Why havent we been proactive in terms of the Early Release programs that have been authorized. Is there a risk aversion . Because who wants to be responsible for releasing somebody into the public that will commit another Violent Crime. Can you speak to why we havent taken advantage of those programs a little bit more robustly . The bureau of prisons as director of the agencies my authority is very limited when you look at taking advantage of the various programs that are being referenced. With compassionate release, which i will start there, we, as an agency, did a thorough review and we determined a couple of years ago when we were looking at the number of individuals who would meet the criteria just for the release based on terminal illness. We dofred there were discovered there were a little more than 200 in the bureau of prisons and once they are identified you have to go further that those that are considered that they have the resources if they are given an opportunity through a motion and released under that program. To 200 inmates agencywide with the population at that time that was at 220,000 is a very, very small number. So again were talking about compassionate release, and Early Release and release to foreign nationals and under all three programs you are saying the law is written too restrictively and doesnt give you the latitude to utilize those programs more and mr. Secretary, ill be asking you the same question. And we moved from medical to nonmedical. And even when we look at those cases and many are being referred, when you are looking at the criteria, as well as being responsible for Public Safety for any individuals having the propensity to continue more criminal activity, we have to take that into account. With the transfer program, and i do share the concerns that the Inspector General has raised, we identified through the audit a problem there and we have since that time provided a number of training opportunities for our staff and educating the inmate population on their rights under consideration for the program and we have seen an increase. However, when we submit the application for consideration there is another process that takes place with the Department Working with the various countries who have agreements under the treaty transfer program to make determines on when those individuals are removed. And of course, they would probably rather have the u. S. Bear the cost of keeping those people in prison themselves. Inspector general horowitz, can you speak to from your perspective why the programs havent been utilized more fully. I think there are a couple of reasons. And i agree with director samuels. In many it is not the b. O. B. Decision making or elsewhere in the department or the way the programs have been instructions have been placed. For example, elderly release, 65 and eldery and that was announced with many fanfare, but there is only two. We find two released under the program a year plus later. And why is that . Well, in part because of the over age 65 they have to meet strict criteria and both with regard to meeting the criteria and as we found in that program and treaty transfer, the discretionary calls that have to be made. And perhaps it is risk aversion, perhaps it is a feeling that someone got a jail sentence that let me ask. Appropriately strict criteria . We found we had concerned with elderly provisions. For example, requiring people to serve a long period of time and to demonstrate a lengthy period of service for a sentence. What that meant was for inmates that were the least dangerous, presumably had low sentences, they couldnt get released because they hadnt served a long period of time. That seemed odd to us. So that is something we should take a look at. Right. Thank you. I dont want to go too much over time. Senator ayotte. Thank you. Director samuels, i want to ask you about a particular prison in my state that is important, especially inco osk county, and it is fci bur land and i wanted to ask what the status is of staffing at that facility, warden tatum has indicated the facility was staffed at about 290 and there were about 1200 incarcerated individuals there. Can you give me an update on levels and also what the ultimate goal is for capacity there and staffing . Yes. Thank you, senator. Right now with the planned for continued activation of the facility we are working very, very closely with the warden staff to make sure our recruitment efforts remain on target and also ensuring that as we build the population that were making sure that the inmate to staff ratio is where it needs to be so we dont have more inmates in a facility until we are comfortable with the number of staff at the facility. And this is continuing to progress. I know there was a concern at one period in time where the applicant pool was not where we like it but with the recruitment efforts we have a very good pool for hiring individuals to work at the facility. So one followup i wanted on the applicant pool. This is an area of our state where people are always looking for more jobs. And so to get people from the area that have strong backgrounds, one of the issues that has been a challenge is the 37yearold age restriction. And has the bureau of prison actually reexamined this. I know i have previously written on this issue. But it is important that my constituents have an opportunity that live in the area to work there. Yes, thank you again, senator. Our focus is to make sure we are aggressively hiring from the local community and looking at veterans and we do have the ability for individuals who are applying who have served to make waiver to to grant waivers and we are in the process of doing that. Well that is very good to know and i appreciate your prioritizing hiring people from the community. I know they are anxious and would like opportunities to work there as well as our veterans. So i really appreciate your doing that. And i think youll find that they are a really dedicated group of people in the area. So thank you for that. I wanted to follow up on the prior panel, there was quite a bit of discussion and criticism, actually, on the Reentry Program, peace, from the bureau of prison and the commitment toward where we are when someone has finished their time and putting forward successful programs an path to success, which im interested because with our recidivism rate it costs us a lot financially and also to the individual, to the quality of life, that the person has an opportunity to set a new start if there is not a good system in place for suck ceaces. So i wanted to get your comments on what you heard in the prior panel on this issue. Thank you, again, senator. I will say to everyone that reentry is one of the most important parts of our mission. Along with safety and security of our facilities. And the expectation bureauwide is for all staff, all of the men and women who work to the bureau of prisons to have an active role in reentry efforts. In any day in the bureau of principles for education, we have more than 52,000 inmates participating in education. We have more than 12,000 individuals actively participating in our federal principle Industry Program which is the largest Recidivism Program in the bureau of prisons. Those who harp are 24 less likely to be involved in coming back to prison. And for Vocational Training, more than 10,000 inmates are participating. And for those who participate and compared to those who are not, the recidivism reduction is 33 . And you all are very familiar with the Residential Drug Abuse Program and we have our nonresidential programs as well. And we are very, very adam about in ensuring the programs are provided to all inmates within our population to have them involved for a number of reasons. It is safer to manage prisons when inmates are actively involved and we are definitely trying to do our part to ensure that for recidivism reduction in this nation that we are taking the leap. For the number of individuals that come into the bureau of prisons, despite all of the challenges an the figures you are hearing, the men and women in the bureau of prisons do an amazing job. When you look at the specific fubs relative to numbers relative to recidivism, with the feder federal, we have 80 who do not return. And we have 20 who end up in state and local and we have always known that the overall recidivism for the federal system is 40 . The 20 that return to the bureau and the 20 that go into the state systems. And i would just also add that when you look at the bureau of prisons, and there is a study that has been done that for the state correctional systems, and it is 30plus. When you look at the over all average of recidivism it is 67 . So i would still say that we have a lot of work to do. I mean the goal is to have 100 individuals never returning but as ive already stated for the record the amount of growth that has occurred over that time period, we are very limited with our staffing. But it does not repov us from the commitment to our mission. If our staffing had kept pace with the growth over the years, i do believe that i would be sitting here reporting that the 80 would have been much higher. So i want to give the Inspector General an opportunity to think on how you think were doing on reentry and any work youve done on that. Were actually, senator, in a middle of a review of the Reentry Programs and in the middle of the field work to go to the institutions and look at the education because of the concerns we heard. So i cant give you a report yet out on it. I think well have something later in the year for you to look at. But it is a significant concern. One of the issues, ill just pick up on what director samuels said about staffing, that is a significant issue. It is a significant safety and security issue, reentry, because what you see is first of all by most accounts the federal Staffing Ratio of in mate to staff is worse than many of the state systems, what they have. And that has been exacerbated ore time as over time as the prison population has grown. There is a cascading effect of that. The director and the staff have to pull people out of other programs to do correctional work that they cant be doing some of the other programs were all talking about. And so that i think has lost is lost sometimes and something were looking at right now, is the cascading effect. If you understaff the prisons the director has to first and foremost make sure the systems are safe. And i hope when you give us this report, i hope you give us advice on the best models phoenix youre going to invest resources to create a better path so reduce the recidivism rate and your recommendation on the piece of what is working best and invest resources would be helpful. Thank you. And senator. And i was handed a note that 2,000 out of the population are participating in the program. Can you quickly describe why, both of you. It sounds like a successful program, why arent more people engaged in it . Because i think in total we release 45,000 from the briefing, about 45,000 every year. Yes. If the 10,000 is in reference to the Vocational Training programs, we only have a limited number of opportunities that we can provide based on the number of in mates in our system. And that goes back to the crowding with increased crowding, you have waiting lists in the federal prison system, no different than any other system and the goal is to try to push as many of the inmates through and as we complete classes we bring more individuals in for participation. What i expect is an answer. I want to get that on the record. Inspector general. Yes. I think that is generally what we are finding, there are limited resources and with limited resources mean limited number of classes. Okay. Senator booker. Thank you very much. Director samuels, i appreciate you being here but more importantly or excuse me also i appreciate the fact that you visited me in my office and take a look of the issues and concerns, you represent the administration as a whole, as the president has, have done some extraordinary steps around over all criminal Justice Reform and im grateful you are here today. It means a lot. I also want to echo, you are a part of the Law Enforcement community. And your officers put themselves at risk every single day to protect this nation and im grateful for the sacrifices that your officers have made and im glad that you mentioned on the federal and state level, we have officers not just losing their lines but officers injured severely, often in the line of duty as well and we as americans should recognize that and that sacrifice that can be made. And i want to focus on solitary confinement and begin with solitary confinement of juveniles. There is a bipartisan dialogue going on right now about putting real limitations on the use of solitary confinement. We know this is an issue that faces thousands and thousands of children across america but when it comes to the federal system this is a very small amount. It was probably surprise a lot of people to know that we are talking about kids that are in dozens. This is two populations. Children tried as adults that are housed in adult facilities and then the contracts, if im correct, that you do with state facilities for juveniles as well. Do you think it is feasible that, as is being discussed in congress right now and ive been in the discussions in the senate, that we just eliminate solitary confinement or severely limit it for children, being very specific for instance, by placing a three hour time limit on juvenile solitary confinement and banning it really for punitive or administrative purposes. Is that something you would see as feasible and something would you be supportive of . Thank you, senator. And i believe that for this issue, and in the federal system, as youve already mentioned, we contract out this service. We do not have any juveniles in an adult correctional facility. And the expectation that we have with the Service Providers for us is that at any time they are considering placing a juvenile in restrictive housing they are required to notify us immediately. And even if that placement were to take place, there is a requirement also that they have to monitor those individuals every 15 minutes. So in regards to your question with looking at the restrictions that could be considered, i would say that for our purposes, regarding this, that it would be something that is definitely something that should be considered and looked at as a practice. And if congress were to act on legislation putting those severe limitations on the practice, with limitations of just a matter of hours, that is something that you would agree to something that is feasible . Yes. I really appreciate that. And that is actually encouraging to the discussions going on right now. And frankly, it is a small population but doing it on a federal level would send a signal to really resonate throughout our country and frankly is already being done in some jurisdictions. Pivoting to adult solitary confinement, if i may, this practice, as you know, is harshly criticized. If you listened to the other panel, there is a lot of data from the medical community, specifically, and also Civil Rights Community and human rights communities. In may 2013 report which i know you are familiar with from the gao found that the federal bureau of prisons didnt know whether the use of solitary confinement had any impact on prison safety, and didnt know necessarily how it effected the individuals would endure the practice or how much frankly it is costing taxpayers in general. Just this year, a recent internal audit notedin aud kwasys in Mental Health care and reentrance for people in solitary confinement. As was head in the previous panel, many people max out in solitary confinement and find themselves going right into the gem well not into the general, but back into the public. In many ways i think the reports are a wakeup call of the seriousness of the issue. I first want to say, do you know, right now, how many people are in solitary confinement beyond 12 months or say 24 months or 36 months, do you have that data . Senator, i can provide that data for you. Okay. So we do track those folks who are staying in often for years in solitary . Yes. And senator booker, i can first i would just like to state for the the bureau of prisons, we do not practice solitary confinement. If my oral and written testimony, our practice has always been to ensure when individuals are replaced in restrictive housing, we place them in a cell with another individual. To also include that our staff make periodic rounds to check on the individuals. And i also believe that it is important and im sorry, i need to be clear on that. Your testimony to me right now is that the b. O. P. Does not practice solitary confinement of individuals singularly in a confined area . You are correct. O only place an individual in a cell alone if we have good evidence to believe that the individual could cause harm to another individual and or we have our medical or health staff it is a benefit for the individual to be placed in a cell alone. We do not, under any circumstances, nor ever had a practice of placing individuals in a cell alone. That is astonishing to me. And ive id love to explore that further. Because all of the evidence that i have said it is a practice at the federal level. So you are telling me there are not people that are being held for many, many months alone in solitary confinement, is that corre correct . When you look at the bureau of prisons agencywide, that is not a practice which we have three forms. We have our shu, special housing unit, which is the majority placed in restrictive housing. We have so in the shu, so they are not individually held . No, sir. And on average, agencywide, the average amount of time that individuals are spending on average, again total, is a little more than 65 days. And show the shu is not solitary confinement, they are not an individual in a cell alone. That is not the practice of the bureau of prisons. Never has been the practice. I hope there will be another round. Senator. How many individuals have been convicted of a Violent Crime in the federal courts . Convicted of a criminal of a Violent Crime. Of a Violent Crime. Give me a second. Approximately 5 . Okay. So we have 5 violent, 95 nonviolent. I think the thing that people need to understand, which im not sure people do, is that 5 that committed Violent Crimes, you dont even have primary jurisdiction probably on most of those crimes in the federal system. I dont think people realize that the federal Law Enforcement system was not designed or ever intended to address what most people think of as crime in this country. It was originally intended to be just for those kinds of crimes that because of the interstate nature of them that they needed to be handled by the federal government. That would be Crimes Involving the drugs going from country to country, and then we started nibbling away at that and started doing bank robbers and then we started doing interstate kidnapping or interstate and i know this because we handled a lot of murder cases when i was the prosecutor in kansas city, and we had the best homicide detectives in the midwest and the Kansas Police department we have experienced prosecutors and handled murders every day and when there was a high profile murder case and the fbi would sniff around and try to grab that case and find some kind of interstate part of the crime so that they could take the case as opposed to us, who handled murder cases all of the time, and frankly, in my opinion, biased as it may be, had much more expertise. I say this because you are spending 7. 95 is being spe on nonviolent offenders. And that is astounding. And you guys dont get 911 calls. Nobody calls the fbi with a 911 call. I used to make the point to my friends who were fbi agents, hey, they didnt call you, they called us. So the federal system gets to pick what they this is not required. They get to decide what they want to prosecute. Unlike state prosecutors who have to make a decision on every single case. So are you ever called in to the policy discussions about the growth of federal Law Enforcement and this massive amount of prosecution that is going on and growth in the prison system because these decisions are being dictated by the department of justice and how many cases they are actually filing. Are you ever consulted on any of those decisions . Senator mccaskill, i would offer that the bureau of prisons, when the discussions are taking place, we are brought into the discussion when needed by the department. But i also would share, which im sure youre aware, that for any policy decisions relative to who is being prosecuted, that remained with my colleagues in the department, who would be more than anyone else regarding this issue, capable of responding to that. So lets get at the stuff you can do. Lets talk about the elderly offender program. The way you entered into some of the contracts, you didnt specify out what the costs of home detention was versus your detention, correct . In other words, what you did, you werent able, in the pilot, isnt this correct, mr. Horowitz, they werent able to discern what a leigh lease and home detention was costing versus incarceration in one of the facilities. That is correct. The gao found that in their report. And so you are not in the position to cost a to estimate a cost of what the cost would be. Were working to isolate those costs. And how are you doing that. Weve put together procedures within the administration division. The staff responsible for the contracting over site to monitor okay. There were 784 of 855 applicants for the elderly release program that were denied. 784 out of 855 were denied. Can you explain why they were denned, that massive amount, and these are all elderly. These are not young people. I can take your concern back, but from the knowledge that i have regarding this, many of those individuals, it was dealing with the issue of being eligible based on criteria that was put in place. Who sets the criteria. The criteria for the pilot . Yeah. Who set it. That was established by congress. So were the ones that said if it is a low level offender that got an 18month sentence they couldnt go to a home program unless they served 18 months . Well the department was involved with the final determination on what the criteria would be but that was something done through conversation between department and members of congress. Well i would love to know who was in on that conversation, if you would provide that to the committee. And would you like to see the criteria. Because if you have 95 of your population is nonviolent, and youve got we know that the recidivism rate for people over the age of 55 is between 2 and 3 . And by the way that is a recidivism rate that any Reentry Program or Drug Court Program or any state court system would die for. That is an amazingly low recidivism rate. I do not understand how we cannot even were turning down 784 of 855 applicants for a reason. And it seems that we are stubbornly stuck in the status quo. Stubbornly stuck in the status quo. And im excited that we have Critical Mass around here that somebody against a lot of political head winds started as an elected prosecutor and i convinced the people in my community and the Police Department that a drug court was a taxpayer factory because the people who went into drug court were on welfare or stealing and they werent paying taxes and all of the nonViolent Crimes they were committed is because they were drug addicted and the drug court movement, our begans in 1993 and it spread all over the country and the world because it worked so well. You know what, i begged the federal government to participate in the Drug Court Program. Didnt want to hear a word about it. I couldnt even get them to send the mules, the girlfriend mules. I said let me take your cases. Your lowlevel drug offender cases, wouldnt hear of it in the 90s. Im not sure if weve move that much in the department of justice and i hope we can Work Together. I know my time is up. I have some questions. I would i have some questions about reefs county and the contract and why are we using as a county as a gobetween on a prison contract and the criminal alien prisons that half are immigration offenses and im curious about the 1 billion price tag on that. So ill get you those questions for the report. Thank you mr. Chairman. Thank you, mrs. Mccaskill. I think were finding an area of agreement. The federal government getting involved in Something Better left to the states and local governments because they are better at it and closer to it and the common sense approach and i frequently said washington, d. C. Is the law of in intended consequences and were seeing a lot of that here today. Not because of good intentions or because people arent working hard and sacrificing but i think that is true. I want to be respectful of the witnesss times, but lets not abuse the time. Im grateful. And i think were having semantic problems, mr. Director. So the d. O. J. Defined solitary confinement as the terms isolation or solitary confinement meaning the state of being confined to ones cell or for approximately 22 hours per day or more, alone or with other prisoners. The Health Consequences for solitary confinement, period, are well alerted. And this is a common practice in the federal system. But it is not just with other prisoners, in the shu, and often prisoners in the special management units, it is common as well and the average stay in that is 277 days and in the adx or the administrative maximum prisons an the average solitary confinement is 1376 days. So this is a real problem and it does exist and forgive me if my semantics are wrong and i think i have more precision now. Nos. , and i didnt want to clarify. At the adx, when i testified in 2012, at that time we had a little more than 400 inmates at florence, colorado, which makes up onethird of the population and for that population those individuals are placed in single cell and the majority of the population also, when you look at their offenses, 46 have been involved in some homicide at some point in their lives. Again, but the reality is, is that the actual result i dont care if it is a homicide, nonviolent drug crime, what are we getting for taxpayers for putting them in a environment in which human rights folks consider that torture. And we have a medical community that has a consensus about torture. And so or the harmful excuse me, the traumatizing effect of that. And so what im just saying is, and again, the crime and violent, nonviolent, im saying this is a nation that doesnt endorse torture or believes we should traumatize folks and if there is no data supporting us having something positive coming out of this, it has to be a practice that weve we should end. Or severely limit. And that is what im saying. Im trying to do a data driven approach relying on experts and science. And just because i want to stay on the good side of the chairman, im going to shift off of this issue because i have enough questions to last another ten minutes and i dont think im going to get that. I will tread upon his his indulgences as long as possible. No you are not. So a real quick point. Federal bureau of prison houses 14,500 women. As we talked about in the last panel, overwhelmingly, the women have children. Children of of a minor age. The trauma visited upon children and those often the primary caregivers, there is a lot of issues and i want to get to one reality in danbury, connecticut, which is 70 miles away from the greater newark area, and which is an easy reach for visitors from the investigate. That will be changed and those women will be moved slated to move to alabama to a facility there which is about 1,000 miles away from the greater newark area, a drive that takes more than 16 hours. So why was the 500 mile policy enacted, which is a good thing, which is something i endorse, due to the cost of travel, would you commit to revising the rule to have a presumption of 75 miles if possible. Do you understand . Is there a chance to revise that rule . Senator, when we looked at the Mission Change for dan berry, we made every effort for fairness through those offenders that were not only living in the New England States or as far as the residence but we have many offenders from california, from texas. And we tried to make sure that with the realignment that we move those individuals who were not from that part of the country, so they could be closer to their family. And so were taking care of the californians but there are a lot of people from the investigate from the northeast, women having those relationships severed and im going to shift for now if i can. And i apologize. Just quickly looking at the private prison issue real quick and shift to mr. Horowitz if i can, i dont want you to think i was ignoring you in this hearing. Are you concerned about the growth of private prisons that contract with the b. O. P. And what part are accountable to the public because we have real issues with the contacts with a total costing us about 5. 1 billion for taxpayers, and these are for Profit Companies and 330 prisoners were held in private facilities and that number has grown significantly to over 38,000 and im concerned about oversight. And then there is a lack of reporting information that is just i can get information easily from the prisons that are being run by the director. But there is this unbelievable really offensive to me lack of information and data about our private prisons and what is going on there. And so i want the last part of the question and then im done, just to wait for the answer, is the abuse reports of immigrant detainees. Now i understand those folks are not american citis but they are human beings. And the report of abuse at our private prisons are troubling. Thousands of men live in 200 foot kevlar tents that each house about 200 men. The facilities are described as filthy, insect infested, horrible smells, constantly overflowing toilets. This is an affront for this nation and what we stand for, for me it is an affront and im wondering what steps are you taking to hold these prisons accountability and to live the veil that protects the American Public from knowing what is being done with billions of their taxpayer dollars. We are taking several steps, senator, we issued the report on the Reeves County facility this year and focused on that particular private prison and the concerns we found just like you mentioned, taffing levels for example, as you know, Reeves County had a riot several years ago and one of the issues was supposedly staffing levels. We looked and saw there were concerns about the staffing and billing and contracting purposes and we made a variety of recommends for that and recommendations for that and we are looking at leavenworth and kansas and a broader review of the bop monitoring of the contract because that is an issue of concern as the spending has increased and the number of prisoners has gone from 2 to 20 of the over all federal prison population. That is an issue of concern. So were doing those reviews. Several of the contract places like reeves. Like adams, the northeast Correctional Center in ohio, have all had riots in the last several years. Those are contract prisons being used by the bop and it has raised the concerns that were looking at closely. And why not better reporting . Why cant i or the public get the same kind of transparency in reporting that we would get with the prisons that are directly under the purview of director samuels . And that is something were looking at as well. Were looking at what kind of reportering the bop is getting from the institutions and in addition what kind of information is flowing and accessible and why arent we doing why isnt more being done to be transparent about that. Thank you, senator booker. And you can have my personal assurances that ill continue with you personally and continue with this committee to highlight the issue. I want to thank again both of you gentlemen for the service to this nation and your thoughtfulness. I want to thank all of the witness witness. I think we did accomplish the goal to lay out the reality and admit we have a problem here. Im not sure we have readiy solutions but weve taken that first step. With that, the hearing will remain open for 15 days until may 14th at 5 00 p. M. For the submission of statements and questions for the record. This hearing is adjourned. [ hearing adjourned ] coming up today at 6 00, a look at austin, texas, this is part of the cspan cities tour which visits across the nation to learn from local historians, authors and Civic Leaders every other weekend on c stashs book tv and cspan American History tv and with congress on the break we are featuring the cities tour every day on our companion network cspan. And today well show you president obamas remarks from the iran nuclear agreement. He spoke at american university, telling the audience that congressional rejection would leave future administrations with the only option of war. Watch his remarks tonight at 8 00 p. M. Eastern on cspan. This month cspan radio takes you to the movies. Hear the Supreme Court oral argument in four cases that took part in fop lar movies from the woman in gold, from the people versus larry flynt, the watergate case from all of the americans men and the 2011 drama the loving story, about the landmark civil rights laws prohibiting interracial marriage. Here the four cases that played a part in popular movies. Saturday in august on cspan radio. Listen to cspan radio at 90. 1 fm or online at cspan or download our cspan radio app. Up next, a look at the medias a role in 2016 Campaign Coverage from this mornings washington journal. Mr. Warren, good morning. Good to be with you on an interesting morning, what you just noted about rome rider, is just a perfect example of kind of media confusion about the debate or debates on thursday and just sort of underscores i think there is just no perfect criteria. So yes, Lindsey Graham is a smart guy but if he is sort of not registering in polls, i mean, i feel a little bit of sympathy for fox, they are sort of damned if they do and damned if they dont and you certainly couldnt have 16 or 17 guys on a stage at one time. What do you think it will stay over all of the coverage of campaign 2016 starting with this fox this process and your thoughts and what you are seeing when it comes to coverage . Oh, i think as opposed to what would have seemed 30, 40, 50 years ago when there were just sort of a handful of real gate media gatekeepers deciding basically what the story line was on a given day and you might hurriedly pick up the New York Times or the Washington Post and that drove particularly a not of network coverage. I think this is by enlarge terrific. It is the internet age. There is more of everything. There is more stuff. There is more total unadulterated junk. It was like yesterday it was tweeting on stories by the political reporters, there may have been three or four who didnt tweet the fox announcement of which ten were picked. It even prompted, if you look closely, scott simon, the npr host, to wonder in a tweet, whether he was the only person who had not tweeted about who the ten were. So i think there is a lot more good stuff. There is a lot more unadulterated junk. There is a nice little piece this morning short and sweet on vox by ezra klein but i think he called it the medias five stanley cups of depression over donald trump and i think he nails it as we go from pure astonishment now to a grudging acceptance there may be a slight people that people are raising their hands on his behalf. The Washington Times highlights a chart that shows the number of minutes and appearances by donald trump and fox news. 31 appearances and five minutes of screen time. And if you Media Research center, theres a chart there that provides some of the coverage of gop candidates on abc, cbs and nbc. Donald trump leading that pack as well. So theres fascination there with donald trump, jim warren. Tell us a little bit about the time hes getting on air on these networks. Oh, its all over the place. The Pointer Institute about a week or so ago, if you remember, there was kind of a story that was dominating the Media Echo Chamber particularly in d. C. And new york about the Huffington Post deciding to basically characterize trump coverage as entertainment. I wrote about that, and debated one of the others in the times on some shows, and thought, and think its a little silly. But then we went and checked about the amount of huffington coverage. And though they were sort of, i think, somewhat condescendingly deriding trump, they were giving him far more coverage, no matter what you call it, politics, entertainment, than any of the other candidates, especially when one looks at all the bloggers whose stuff on trump, that they were using. What it was was coverage of him disproportionate. Yes, absolutely, totally disproportionate. Is there some justification how hes been resonating in the early going . Yeah, i think theres some justification. Are there reasons for the likes of Lindsey Graham and other serious folks to be frustrated . Yeah, there is. But its also, you know, august of 2015. Weve got a long way to go. Its a bit of a silly season. There will probably be a pretty decent audience on thursday night. But its august. And sitting in the heartland, i can tell you, most people arent thinking about any of this. Before we let you go, james warren, theres also joe biden in the news recently, a story just a headline saying biden 2016 is a media fantasy. Why hes almost certainly going to sit the race out. Do you agree with that headline . No, at this point, i dont know what hes going to do. I mean, hes obviously, you know, sitting back and knows that theres some large percentage of folks that maybe just sort of are sick and tired of the clintons. The email controversy sort of reminds people why they are sick of the clintons. In their minds, Hillary Clinton hasnt really offered a rationale for her candidacy. The problem with him are all obvious. Theres the caricature thats maybe unfair to him, but its sort of hard to unravel about being goofy and gaffeprone, and his best chance at it was 1988 arguably when he blew it by stealing those lines from a british politician. He thought about in 2008 and got zero traction. And hes 72 years old. So i think theres a possibility. But it is really unlikely. The National Political columnist, new york daily news, jam warren, thank you very much for your time this morning. My pleasure, as always. When the senate takes the august break, well feature book tv programming on cspan2 beginning at 8 00 eastern. At the end of the summer, look for two special programs. Saturday september 5th, live from the Nations Capital for the 15th annual National Book festival, and live indepth program with lynn cheney. Book tv on cspan2, television for serious readers. Next, health and Human Services secretary Sylvia Burwell testifying before the house education and work force committee. Representative john kline, the minnesota republican, chairs the committee. We will come to order. Good morning, secretary burwell. Good morning. Thank you for joining us to review the policies of the department of health and Human Services. As is often the case when a cabinet secretary appears before the committee, we have a lot of ground to cover in a short period of time. That is especially true for a department this big. At the end of the current fiscal year, hhs is expected to spend approximately 1 trillion administering millions of programs, including child care, welfare, health care, Early Childhood development. At a time when families are being squeezed by a weak economy and record debt, we have an urgent responsibility to make sure the federal government is operating efficiently and effectively. It is a responsibility we take seriously, which is why this hearing is important and why we intend to raise a number of key issues. For example, we are interested to learn about the departments progress in the child care and Development Block care program. Last year the committee helped with the reforms to strengthen health and safety protections, empower parents and improve the quality 6 care. This program has helped countless moms and dads provide for the families and we hope the department is on track to implement these changes quickly and in line with congressional intent. Another Vital Program for lowincome families is headstart. Earlier this year the committee outlined a number of key principles for strengthen the program, such as regulatory burdens, and encouraging better engagement with the parents. And feedback would help turn these principles into a legislative proposal. It was in the midst of this effort that the department decided to restructure the program. Some of the changes will help improve the program. However, the shear scope and cost of the rulemaking raises concerns and has led to some uncertainty among providers who serve these vulnerable children. Strengthening the laws is a better approach than transforming the program, and we urge the administration to join us in that effort. These two areas alone could fill up most of our time this morning. I havent even mentioned Services Provided under the 1996 welfare reform law and the Older Americans act. Of course, as you might expect, secretary burwell on the minds of most members of the challenges the country continues to face because of the health care law. Families and workers and lawyers are learning more about the harmful consequences of this law. For example, patients have access to fewer doctors. Controlled costs, estimated that insurance plans on the Health Care Expansion have 34 , fewer providers than 32 fewer primary care doctors and 42 fewer oncologists and cardiologists. The law is plagued by waste and abuse. In 2014, investigators with the Nonpartisan Government Accountability Office used Fake Identities to enroll 12 individuals on a health care exchange. Just this month, they announced 11 of the 12 fake individuals are still enrolled and receiving taxpayer subsidies. More than 7 million individuals paid a penalty for purchasing Health Insurance. Roughly 25 more than the administration expected and the worst case scenario. According to the associated press, at least 4. 7 million individuals were notified their insurance plans were canceled because they did not abide by the rigid mandates established under the health care law. The Nonpartisan Congressional Budget Office estimates the law will result in 2. 5 million fewer fulltime jobs. This reflects what weve heard over and over again from employers who have no choice but to cut hours or delay hiring because of the laws burdensome mandates. Health care costs continue to skyrocket. According to the New York Times, Health Insurance companies are seeking rate increases of, quote, 20 to 40 or more. Suggesting markets are still adjusting to the shock waves set off by the Affordable Care act. Finally, after all the mandates, fraud, loss of coverage, fewer jobs, higher costs and nearly 2 trillion in new government spending, its estimated more than 25 million individuals will still p lack basic Health Care Coverage. Yet, just last month, president obama said the law, quote, worked out better than some of us anticipated, close quote. Of course, for those who oppose this government takeover of health care, this is precisely what we anticipated and precisely why the American People deserve a better approach. In closing, madam secretary, i want to thank you again for joining us this morning. It is our responsibility to hold you and the Administration Accountable when we believe the country is moving in the wrong direction. However, there are areas i believe we can find Common Ground, and advance positive solutions on behalf of the American People. Todays hearing is an important part of those efforts, and i look forward to our discussion. With that, i will yield to Ranking Member bobby jindal. Thank you. Thank you for being with us today and look forward to your testimony. Today well hear about the fiscal year 2016 budget proposals, and the departments budget priorities. The budget was released months ago and im pleased to see the word priority is included in todays the title of todays hearing. Budgeting requires making tough choices and a budget is in fact a reflection of priorities. As legislators, we decide what our priorities are and how best to invest in our country. It was reflective of many important priorities, such as protecting access to health care and insurance for all americans, giving all children a chance to succeed, and reducing inequality around the country. In many areas, i believe weve made great progress on these priorities. The afford care act gave the opportunity to some who have Health Care Coverage for the first time in their lives. It closed the doughnut hole for seniors and improved access to Mental Health services and preventive care. Just weeks ago the Supreme Court decided in another case pertaining to the Affordable Care act in king v. Burwell, the legality of subsidies for those obtaining Health Insurance through the federal marketplace, instead of a statewide marketplace was upheld. The affordsable care act was structured and designed to improve Health Care Insurance coverage in excess across the entire country, and it has, now those living in virginia have enjoyed access to insurance subsidies just like someone in minnesota, and because of the outcome of the case, they will continue to do so. I want to thank secretary burwell for her efforts and her departments hard work in implementing the aca. I recognize the challenge that your agency faces, and implementing the law with limited resources and unlimited attacks. But despite these challenges, the aca is working. I was also pleased to see that the president s budget request placed priority on giving all children a chance to succeed by showing robust funding through increase to child chair programs. The republican budget adopted by the house earlier this year is not reflective of these shared national priorities, despite Research Showing for every dollar spent on early education, there is a return of 7 in reduced costs in other parts of the budget. We must invest in quality Early Learning programs because all children deserve to enter kindergarten with the Building Blocks of success. Properly nurturing children in the first five years of life is instrumental in supporting enhanced brain development, cognitive functioning and physical health. But also too often lowincome working families lack access to Early Childhood education, and these children tend to fall behind. In addition to this it achievement gap, children who dont participate in Early Learning programs are more likely to have weaker educational outcomes, lower earnings, increased involvement in the criminal justice system, and increased teen pregnancy. Affordable highquality child care is not just critical for children, its also critical for working parents. Because child care is a twogenerational program. Parents of Young Children need child care to go to work or go to school. A lack of stable child care is associated with job interruptions and job loss for working parents. Child care ought to be a National Priority for americas chirns and help grow our economy. Just two programs outside of the bulk of federal role in early education, the Headstart Program and Child Care Development block grant. Unfortunately because of limiting funding, too few children have access. This unmet need continues to grow. Only four out of ten eligible children have access to headstart, and only one out of six federally eligible families receive child care subsidies. Investing in programs like headstart and Child Care Development block grant works. The time is to invest in these programs and ensure that were giving all children the chance to succeed. Lastly, its past time for congress to raise the sequester level of the Discretionary Spending caps that we can make as a nation. These caps threaten nearly every program under the jurisdiction of this committee from lowincome Home Energy Assistance programs to Older Americans act and others. The sequester has led to woefully inadequate investment in Critical National needs and puts us on a path to another government shutdown. Coming back to the idea of priorities, investing in our nations future should be Congress Number one priority, not Corporate Tax breaks or lowering the estate tax. Our focus should remain on restoring investments that strengthen our nations middle class and help hardworking American Families get ahead. So thank you, mr. Chairman, and thank you, secretary burwell, for being here today. Pursuant to committee rules, all Committee Members are permitted to submit records. The record will remain open for 14 days for submission of the official hearing record. It is now my pleasure to introduce our distinguished witness, the honorable Sylvia Mathews burwell. Prior to joining hhs in june of 2014, secretary burwell served as the director of office and management and budget where she oversaw president obamas second term p. Deputy chief of staff to the president , chief of staff to the secretary of the treasury, and staff director of the National Economic council. Welcome, madam secretary. I will now ask the secretary to stand and raise your right hand. Thank you. Do you solemnly swear or affirm the testimony youre about to give will be the truth, the whole truth and nothing but the truth . Let the record reflect the witness answered in the affirmative. Before i recognize you to provide your testimony, let me briefly remind you, or more importantly my colleagues of our lighting system. We typically allow five minutes for each witness to present. Although, i will be flexible on this timeline, given you are the only witness, and you are a cabinet secretary. I would ask you, though, to try to limit your remarks, because we have a lot of members who want to get to questions. And i will be strictly enforcing the fiveminute rule, and perhaps the fourminute rule, the secretary has a hard stop time at 12 00, we would honor that and i would ask my colleagues to be patient. Well put the timer on, but you can effectively ignore it if youd like. It will be green and turn yellow when you have a minute to go. And red when the remark time is over. That applies only to the secretary, to my colleagues when five minutes is up, five minutes is up. Now youre recognized, madam secretary. Thank you, mr. Chairman. And Ranking Member scott. As well as members of the committee. Thank you for this opportunity to discuss the president s budget for the department of health and Human Services. I believe firmly that we all share common interests, and therefore, we have a number of opportunities to find Common Ground. We saw the power of Common Ground in the reauthorization of the Child Development and block grant and Development Block grant that happened last fall, as well as the partisan sgr repeal earlier this year. I appreciate all of your work to get that passed. The president s budget proposes to end sequestration fully, reversing it for domestic priorities in 2016, matched by equal dollar increases for the department of defense. Without further congressional action, sequestration will return in full in 2016. Bringing discretionary funding to its lowest level in a decade adjusted for inflation. We need a whole of government solution, and i hope that both parties can Work Together to achieve a balanced and commonsense approach. The budget before you makes critical investments in health care, science, innovation, public health, and Human Services. It maintains our responsibility stewardship of the taxpayers dollar. It strengthens our Work Together with congress to prepare our nation for chief challenges at home as well as abroad. For hhs, the budget proposes 83. 8 billion in discretionary budget authority, this 4. 8 billion increase will allow our department to lay a Stronger Foundation for the nation for tomorrow. It is a fiscally responsible budget which in tandem with accompanying legislative proposals could save taxpayers a net estimated 250 billion. The budget is projected to continue slowing the growth in medicare, by securing 423 million in savings, as we build a better, smarter, healthier delivery system. In terms of providing all americans with access to Affordable Quality Health care, the budget builds on our historic progress in reducing the number of uninsured and improving coverage for families who already have insurance. The budget supports our efforts to move towards a Health Delivery system that delivers better care, spends dollars in a smarter way, and puts the patient at the center of the care to keep them healthy. The budget also improves access for native americans. To support communities throughout the country, the budget makes critical investments in Health Centers, and our Nations Health care work force. Particularly in rural and other highneed areas. To advance our shared vision for leading the world in science and innovation, the budget increases nih funding by 1 billion, to advance biomedical and behavioral research, among other priorities. It also invests in precision medicine. A new department effort focused on developing treatments, diagnostics and Prevention Strategies tailor to the individual interests. In providing americans with the Building Blocks of healthy and Productive Lives, this budget outlines an ambitious plan to make affordable quality child care available to working and middleclass families. Specifically, the budget builds on important legislation passed by this Congress Last fall, to create a continuum of Early Learning, opportunities from birth through age 5. This change would provide highquality preschool for every child, guaranteed quality child care for working families, grow the supply of Early Learning opportunities for Young Children, and expand investments in voluntary evidencebased Home Visiting programs. To keep americans safe and healthy, the budget strengthens health and Public Infrastructure with 975 million for domestic and international preparedness. It also invests in behavior Health Services including more than 99 million in new funding to combat prescription opioid and heroin abuse. Finally, as we look to leave the department stronger, the budget invests in our shared priorities of addressing waste, fraud and abuse. Initiatives that are projected to yield 22 billion in gross savings. The budget addresses the departments medicare backlog with a coordinated approach. The budget also makes a significant investment in the security of the departments information technology, and cybersecurity. I want to conclude by taking a moment to say how proud i am of the hhs team, and the employees that work on ebola. Their work every day and their commitment every day. I am personally committed to a responsive and open dialogue with members of this committee, as well as with your colleagues. I look forward to working closely with you, and i welcome your questions. Thank you. Thank you, madam secretary. The light didnt even turn red. Im unprepared now. Im at a loss. Seriously, i want to thank you, madam secretary, for your ongoing efforts to keep us informed about the departments progress in implementing the child care and Development Block grant act of 2014, as well as the opportunity for the staff to communicate directly with your staff. Can you update us briefly on the timeline for the release of guidance in the proposed rules in accordance with the act . With regard to, i think our staff has had an opportunity to go back and forth. I think thats helpful as were producing the guidelines. Im hopeful, i think that im not sure which particular piece youre referring to, so i want to make sure. We can follow up on that. But overall were making progress and ho to get them out. One piece i would like to recognize with the implementation of the authorities you gave us, there is an important piece of the budget that is related to the implementation. One of the things that we were told with regard to the authorities improves the quality, improves the safety, and improves our ability to serve the communities that sometimes arent being served, such as parents working different hours. Theres funding in the budget that were talking about today on the discretionary side, that i think is important to do that. I do want to raise that as a part of this conversation. That there is some funding to do that. Okay. Im not sure thats exactly what i was getting at, but thats good. Ill get back on the specifics of the time line. Just trying to get a better feel for the time line. Exactly. I very much appreciate the exchange between staffs. Its very, very helpful. I wanted to take the remainder of my time, no doubt, and ill try to be brief, but there is an issue having to do with the Affordable Care act thats just sitting out there, that really, really needs to be addressed. And thats the maximum amount of pocket limits for cost sharing that im sure youve heard about. Ive heard from several employers recently about this unilateral change, the cost sharing, maximum outofpocket limits under papaca. We cant seem to determine where this is coming from. The statute is pretty clear, there are two separate and distinct types of coverage. Selfonly, and other than selfonly coverage, each with respective outofpocket limits. Before this new rule, any combination of family members outofpocket costs count towards the maximum of these outofpocket family coverage limits. Now, the department has started in 2016 the individual outofpocket limit applies first before the family limit applies. That means the cost of the employer coverage will increase because insurance will pay 100 of the outofpocket costs sooner. I understand that youre aware, ive been led to believe youre aware of these concerns. Im sure employers have raised this issue directly with you and your staff, probably many times. They certainly have with us. Wed like to understand under what Statutory Authority you did that . And then, id like to enter into the record letters from the arisa industry committee, the American Benefits council, conveying their grave concern for the departments new embedded maximum outofpocket limit rule. The letters also convey compliance will not be possible by 2016, given that employers plans are already set for next year. It wasnt until may when Additional Guidance was issued that most large employers knew this change applied to them. Its real confusion out there, madam secretary. And again, im fairly confident that youre hearing some of this directly, but i want to make sure you heard from me. Can you commit to at least tla the impact of this really significant rule change for at least a year . And if not, why not . With regard to the question of delay, we are now hearing and receiving feedback, and i want to incorporate that and determine what we should do to move forward. I think its important to note why the change was put in place. And the change was actually put in place about the consumer. And the fact that when one consumer in a family hits that individual limit, and the question of should they hit that family limit, and whether you should aggregate, or the individual. I think actually when consumers purchase, and how the consumer thinks about this issue, i hear and understand, and we are hearing from the companies in terms of how they think about the question of the maximum outofpocket limit, but if you are an individual, and a family, do you think that limit is your individual limit . And then theres a broader family limit for all. Once youve hit your individual limit, what would happen is you would keep going. And so you would not have those things paid for. And you signed up in a place where you thought your individual limit was your individual limit, and your family limit was for all members of the family. And so thats how the consumer has tended to think about it. At least from what weve heard from the consumer side of it. Thats why we have gone forward. We are hearing comments and want to incorporate those comments and understand if it is implementable. Im not making light of it, but we think the statute is pretty clear. So because there is so much confusion out there, and there is the uncertainty and arguably the inability to comply, we are hopeful that you will commit sooner rather than later to a delay of this rule change. Im going to try to its already too late. The light has turned red for me. But mr. Scott, youre recognized. Secretary burwell, thank you for being with us today. I wanted to ask you a few questions about the Affordable Care act. But first, i want to thank you for your departments outreach efforts, particularly joann grosse, the regional director in my area. Shes just been outstanding in the outreach into the community, making sure that people know about it, and during the signup period was all over my district. So im sure she was all over the region. Can you say a word about what the Affordable Care act does for people with insurance in terms of preexisting conditions, and job block . Two Different Things that i think it does. With regard to preexisting conditions, it creates a situation where anyone with a preexisting condition is able to get insurance. And so whether its the people that ive met as ive traveled across the country that are concerned for their children, as their children get older, if its a child that has asthma or other conditions, or someone who has gotten cancer and theyre now well, to know they wont be locked out, so preexisting conditions are no longer something that creates both health and financial worry for people in the system. With regard to the question of lockout, and job lock, there wouldnt be people who make changes for fear of losing coverage. That is a part of the numbers that the chairman stated in terms of the changes that occur. Because with regard to the employerbased market, we have not in the two years that the Affordable Care act has been up, seen that shift from employerbased coverage in terms of the reduction in percentage of employees. We havent seen that shift. Some of the estimates are about people, though, who will choose to make a decision to go do something entrepreneurial, if they want to start a business, or make other changes in their lives. And so the lot that was created because they were fearful of losing coverage doesnt exist because they have an option, and that option is through the marketplace. What has happened to the growth and Health Care Costs due to the passage of the aca . Thinking about it in terms of, weve had some of the lowest price growth per capita that we have seen in 50 years, in terms of slowing of that growth. I think when discussing the question of growth and cost growth, while its a hard thing to recognize, one needs to look at historical growth and then what growth is. In the Medicare Trustees report, which is lets reflect on the public costs of this growth, what we saw is growth of 1. 2 over the period of the last four years. What we saw in that period before then was 3. 6 . What weve seen is a flowing in a lot of different places, both the public and the private of that growth. The programs under your jurisdiction, can you say a word about the effect of the sequestration if we dont do something about this sequestration . As we look at this issue of being funded at the lowest level in a decade, when one accounts for inflation, it is across the entire department. And whether thats an issue of headstart or child care, that will focus on in this committee, it also is in places like the nih in our research, or the cdc who has been so active this year in so many ways, whether thats ebola, or measles, and also in places like the fda, who are doing things like making sure our food is safe, and that we are watching and taking care, and that our drugs and diagnostics are safe. Its across the entire department. Another place that this particular committee is interested in, i know, is the Older Americans. And the programs that we have there to support those Older Americans around food, and transportation, as well as elder justice. Thank you. Headstart is not in the department of education, its in the department of health and Human Services. Can you explain why its important why the services of lowincome children get by remaining in health and Human Services, not just be an Educational Program and why heads start is so important . We have it as part of our continuum of hhs. Thank you to all of you who supported the Sustainable Growth rate bill that had the extension of the Home Visiting. That starts with the care in the home, visiting the home and helping start children on the right track. And we believe that continuum as well as the changes in the authorizations in headstart that you all have done to push to improve quality. It is all part of a continuum. The continuum is related to the issues that we work on broadly at hhs, and whether thats starting the mother on the right trajectory with her Maternal Health so the child is born with certain in a certain environment that has been taken care of for the nine months, and then continuing that early care, starting that learning early, and that brain development. The science that we know in having a 5 and 7yearold of how quickly that nural development is occurring, sometimes it surprises me. It is what we believe is a continuum of both health and the Building Blocks of healthy, Productive Lives that we use at hhs. Thank you, mr. Chairman. Thank the gentleman. Dr. Foxx . Thank you, mr. Chairman. And madam secretary, welcome to our hearing. Madam secretary, i appreciate your bringing up the Older Americans act. Were looking at the committees looking at ways to promote best practices to combat elder abuse. And i wonder if you could talk a little bit about how the department is working with other agencies to protect Vulnerable Elders . Working across the department, obviously the department of justice is a partner with some of the work we do, but most recently, whether its with our departments and states as well as other stakeholders, the white house conference on aging, we took an approach this year where we actually went out to communities across the country, and this was one of the pillars and issues that we focused on. And used that as an opportunity to bring in the engagement and involvement of both ideas, as well as how we can implement better as a department in terms of the issue of elder abuse. Were seeking that input to improve what were doing both within the u. S. Government, but also with a number of the players that implement. And those are stakeholders on the ground in states. Many of the programs are actually delivered and implemented at that level. And would you discuss a little bit those delivery models of the elder americans act and what makes them work well . Youre working with other agencies, im sure. Its the right thing to be doing. But are there ways to implement these similar delivery models across other programs, across the country . And how is the department providing leadership to do that . So, i think there are many things, but ill focus in a short time on two things that i think are important in this space. One is actually the awareness of the issue. Elder abuse is something that is not an issue that many focus on, and whether these providers, and the organizations in the community are a part of recognizing the issue. It is a little like our issue that is also the victims in trafficking. Creating a greater awareness of it is an important thing to do. I think the other thing we think is an important thing to do is when these acts occur, that justice is served. And so that people know that when they are taking advantage of the elderly, thats a place we need to continue to work with state and local officials on that as well as federal. And i think one very specific example of that is the recent takedown that was done on medicare. You all probably know that our most recent takedown, which was a joint effort with us, doj, the fbi, hhs, oig and cms, it was over 700 million in false billing. Many of those examples were around elder justice issues, where patients were being told they were being treated for dementia and were simply being moved from one location to another, being charged for that, and medicare was their charge. I think it is the combination of those kinds of things that we try and bring together. Thank you very much for that. We know that you are congressman scott brought up headstart performance standards. We know that headstart is the Largest Program we have at working with Young Children, but were concerned about the impact of the new regulations that youre putting out there. We wanted you to not the reauthorization of 2007 required you to have regulatory revisions not result in the elimination of or reduction in quality and scope of services. But you are talking about a reduction of 126,000 children slots, elimination of 10,000 teachers jobs. How can you ensure that the revisions that youre proposing are in compliance with the 2007 law . We have done three issuances of regulations with regard to implement the law. And this is the third of those. The first in terms of one of the things we did is make sure theyre serving lowincome communities. The other was making sure there were reviews and people had to reapply. This is the third part. In this part, were using evidencebased studies to improve the quality and safety, which we believe the authorization is what it told us to do. One of the things that the chairman mentioned that i think is important to mention is we got rid of onethird of the guidelines in terms of simplifying, and making it easier. With regard to some of the things youre referring to, i think youre referring to the extension of the day. And the year. And the evidence that we have seen all the Scientific Evidence shows that moving from 3 1 2 hours to 6 hours is an important effort to provide the quality that we need to provide. And the summers, having two children right now going through their summer, what they lose if they do not have that kind of continued education. We proposed the amount of money it would take in our budget. Were hopeful we can move forward on that. If grantees cant meet that, theres waiverability. The gentle ladys time has expired. Mr. Hinojosa . Thank you, chairman kline, and Ranking Member scott. I strongly support the health and Human Service budget request. And ask that we Work Together to forge a consensus to ensure that our families continue access to quality Health Care Coverage and funding for headstart. We can invest in our preschool programs today, or in juvenile detention tomorrow. We have heard pope francis deliver a very strong message all over the world, urging leaders like us. The pope says we must make the right amount of investments to address poverty found in older senior persons, and children in lowincome families. Madam secretary, thank you for your testimony on the departments enormous progress weve made since the enact of aca. Its a pleasure to have you testify before this committee. Today in my congressional district, because of the Affordable Care act, there are over 100,000 individuals who now have Health Insurance, and 88,000 seniors who are now eligible for medicare preventive services, without paying any copays, coinsurance, or deductible. We know that another program, headstart, is a crucial Developmental Program in my congressional district, known as the lower rio grande valley. This program serves between 15,000 to 20,000 children and families. Headstart has made a Significant Impact on improving the opportunities for eligible children, especially our nations latino and africanamerican youth. Thank you for your strong budget support for this program. My first question, what is at stake for our nation if we ignore the evergrowing body of research, and we fail to sufficiently invest in quality Early Learning for our nations minority children . I think this is why this area in our budget, and we discussed the headstart portion of it, but theres also the child care proposal, and part of the child care proposal on the discreti discretionary side comes to implementing the authorization. Thats on the discretionary side. The broader proposal that we have, which is a larger mandatory proposal is about making sure theres access on this continuum. So that what we do is we take care of that child from the moment of the Home Visiting, and the pregnancy, through those early years of education, and that we do that both for those at the lowest level of income, and headstart is focused on that. But child care, and thats a part of what were proposing is child care for working families, that there is supplement so they can afford that. Up through that school age. So what were trying to do is create a continuum which we think is a part of the concepts of the authorization. This budget funds it fully. We think its one of the most important priorities. As we reviewed the budget and put it together, it is a place where we made choices that we would prioritize and put a lot of our dollars, because we think it is so important to the longterm health of those children, and the wellbeing of our society. I agree with you and i recommend that you consider adding more emphasis on early reading and writing for children from cradle through the fourth year, so that they can love books and improve their vocabulary and be able to stay at grade level and do well. In my district, the majority of the uninsured population falls under the medicare excuse me, fall under the medicaid coverage gap. And does not qualify for assistance in health care marketplace. According to the Kaiser Family foundation, up to 950,000 uninsured people would gain Health Care Coverage if the state of texas decided to expand medicaid. What justifications, if any, have you heard, or received, and how has hhs responded to discussions that youve had with the governors like abbott in texas . With regard to the conversations with governors, i just spent the weekend at the National Governors association. The year before i did that as well. The thing in terms of any concerns that governors have, what i want them to know is, we want to expand the program. We want to expand the program in a way that implements the statute, which is about expanding access, and doing it for lowincome populations so its affordable. But we want to do that in ways that work for states. I think in terms of answering concerns and questions, whether its the negotiations that we did with governor pence, and i personally participated with a number of other governors, so we make sure we do this in a way that serves the citizens of the states that may have different needs. So thats in terms of one of the issues that comes up. I want to work with governors and their states. Thank you. I yield back. The gentleman yields back. Im going to yield to dr. Roe. But i want to give members a headsup here. Ill be recognizing dr. Roe for five minutes, and probably ms. Davis, maybe mr. Wahlberg, and after that grij val va. Well go to four minutes, and im trying not to go to three or two. But i want to give everybody a chance to be involved in this conversation. Dr. Roe . Thank you, mr. Chairman. Thank you, madam secretary, for being here. Just some questions i want to bring up to begin with. Then well get to the questions. These are things i want your shop to answer. One are the medicare wage index, or area wage indexes. If you look at those around the country, it was never intended to be like that. But 20 of the highest are in california and massachusetts. And 14 of the lowest are in alabama and tennessee. For instance, what you get paid in santa cruz, california, is 1. 7, with a medicare area wage index, and. 73 where i live. Its putting us out of business. That needs to desperately be looked at. The second thing i want to bring up, and i want to know what your solution for that is, are the rack audits. The rack audits, were all certainly against fraud and abuse. But in my state, medicare comes in, does the audit and we win 72 of them. We now, the backlog is so long, you cant get in front of anybody to get your money back that youve earned. Thats unfair. I think you absolutely need to redo the rack audits. Thirdly, this is a much deeper one. It may take some time. But medicare is on an unsustainable course, as you well know, last year, in 2014, medicare spent 316 billion, and we took in 304 billion in premiums. Thats unsustainable. Since its inception, 3. 6 trillion negative of premiums over what weve spent on the program. Id like to know what your recommendations are to put this on a more sustainable course. Id like to know what the issues are. And re yetably, ive got to ask some questions now that i dont like asking but i think are extremely important to ask. I also one last thing, qfr on ipad. Do you think one person, you sitting in that seat, should have the power to determine how medicare dollars are spent, if it goes over this formula . Id like to know that. Theres nobody on that 15panel board right now. Recently, weve seen two videos that showed planned parenthood physicians basically having wine and eating a salad, bargaining over the harvesting sale of dismembered baby parts. I find this incredibly offensive to me as a physician and obstetrician. Have you seen those videos . I have not seen the videos. Ive read the articles about them. Last week in the wall street journal, it reported that you couldnt comment because you hadnt seen it. But you need to see those, secretary burwell, as quickly as you can. And its only eight or ten minutes. You need to look at those videos and see what the rest of us have looked at. Given planned parenthood, which i think is a horrific conduct, americans may be troubled to realize that planned parenthood gets over 500 million a year through much of it through your shop, through medicaid and title 10 funding. Having said that, with a significant financial relationship, could you tell us what youve done to investigate these activities . So, first, just because its so related to the budget issues were discussing today, the rack issues and backlogs, weve put together a strategy, because its such an important issue in the appeals, i just want to make sure theres a budget issue in terms of extending the number of people that we can have to review the appeals. Because there are legal judges that we have to bring in. Second, there are statutory changes. And on the senate side, the bill is moving to make changes that will help us. And third, administrative actions. The broader issue youve raised, with regard to the issue, i want to start by, this is an important issue that people have passion deeply on both sides of the issue. And whether thats the issues of research that are important for eyes, degenerative diseases, autism, and ill start there. My time is about up. Have you had any contact with planned parenthood yet . With regard to the yes or no . With regard to this issue . This sale of the no, planned parenthoods funding, the 500 million you mentioned i think is a number that is a state number. With regard to medicaid and states, those are issues with the state. With regard to the amount of money what amount of their money comes through the taxpayers . We are in a limited time. I found it absolutely amazing to me that planned parenthood could complain about a woman having an ultrasound before she terminates her pregnancy. And then use this, an ultrasound, so they can harvest body parts to be sold for fetal tissue. I find that absolutely astonishing. Mr. Chairman, i yield back. The gentleman yields back. Ms. Davis, youre recognized. Thank you, mr. Chairman. I wanted to go on and just ask mr. Chairman for unanimous consent that the cbo scores show the repeal of the Affordable Care act that would be entered into the record. Thank you, madam secretary, for your service, and joining us today. You mentioned nih earlier. I know that you care deeply that we continue to fund this at higher rates. We absolutely cannot fall behind the Global Community in how we address science and innovation. I think thats very, very important and im pleased that the president has increased that funding. But i also wanted to talk about not just the innovation piece of it, but really the access piece, and affordability. And particularly focus on the changes that you have recommended in reforming Medicare Part d. Specifically, in ways that you call for in the budget request in terms of reducing medicare costs, both for the government and the consumer, and looking at the question of giving authority to you, and to the department to negotiate drug prices. In Medicare Part d. Can you talk a little bit about that . And why that is part of the budget . And why you think that this is so important . I think that we believe that the ability, as we look and address the issue, one of the issues brought up, the question of the longterm health of medicare and how we work on that, is we look at some of the issues that will be driving costs. We believe drug costs are a part of that. We see that happening. We see that both in terms of the numbers we see now. In the outyear projections, we also hear it from the private sector. Having come from the private sector, and having come from a company known for its negotiating on price, walmart, the idea that we use Market Mechanisms to try and put downward pressure on price is something we think is important. So thats why weve asked for those authorities. So that we can try and work with the pharmaceuticals and negotiate to keep downward pressure on that price. Thats what we hope we can do. We see it as part of the overall issues that were being asked about, how we transform the system for the long term. We think there are things we need to do and pressure we need to put. What do you see as some of the key problems as you move forward with this . I think with regard to this particular issue, its not one it is a legislative and statutory issue. It will take a statutory change to grant the authorities to be able to negotiate. Thats not something that administratively we can do. So it is something where the action will sit with the congress. Thank you. For working on that. I know its not simple way of moving forward. But it does seem to make a difference. And there have been so many stories lately about how the high costs have not just bankrupted families, but made it very difficult for people to access important lifesaving drugs. I wanted to just for a moment also talk about the increasing access for folks here. We know that the aca really has been a huge success in helping to reduce a number of the uninsured. I actually have a constituent in my district who was going regularly down to tijuana to get the medications that she needs. And this now means, as a result of her being insured, that she doesnt have to do that any longer. And its been a big difference in her life. So i wonder if you could just talk a little bit about how dramatic the increase in the underinsured population has been, and what the additional coverage has meant in terms of the increasing Patient Outcomes . With regard to that, well try and be brief. In terms of numerically, the number i think you know is over 16 million, the number of the reduction in the uninsured. With regard, i think, what tells the story better are the individuals and whether thats the woman who was 26, uninsured, her mother told her to sign up. She needed insurance. But in the end she listened to her mom. A month later she discovers she had stomach cancer. And had the coverage she needed. That coverage both helped her from her health, she is now actually recently married. In addition to that, though, the Financial Security in terms of her business and her availability to continue on in that way as well. So i think its the individual stories, combined with the numbers in terms of what were seeing of what the extended coverage means. Right. Yeah. I particularly have heard about that when it comes to type 2 diabetes. And the prevention, its made a real difference for those folks. Thank you for your service. Mr. Wahlberg, youre recognized for five minutes. Thank you, mr. Chairman. And thank you, madam secretary, for being here. And thank you for reaching out to us before this as well. I want to ask you, the first question, how many fictitious claims have been paid since the inactment of obamacare and how much has been lost due to this fraud . Just to bring it into context here, earlier this month gao had various undercover test performance throughout the 2014 coverage year. The report revealed some stunning things. That the marketplace approved subsidized coverage for 11 out of 12 fictitious applicants created by gao, resulting in a payment they state of about 30,000 to insurers on behalf of these fake enrollees. For seven of the fictitious applicants, gao intentionally did not submit all the required verification documents to the marketplace, and the marketplace even then did not cancel subsidized coverage for these applicants. Despite the inconsistent and incomplete information. And so subsequent to that, how many fictitious claims have been paid since the enact of obamacare, and how much has been lost due to the fraud . So, with regard to the example, we take very seriously the issue of Program Integrity. We want to continue to improve it. We look forward to the gaos recommendations out of that study. We look forward to understanding what they are, because we welcome the opportunity. With regard to the question in answering the number, because gao didnt find actually that there were fictitious claims, they did when they had individuals who came through the system. First they came to health care. Gov, the marketplace, couldnt get through. Then they actually came through the phones. Thats where they got through. At that point, because they are gao, they were able to do things that for everyone else would be perjury, that would have up to a 250,000 fine affiliated with it. And they were successful. And were successful in breaking the law. In terms of what they were doing to go through. With regard to the next step, and there are a number of gates. Theres the gate at health care. Gov in terms of that was where it was caught. Got through at the point, you know, the question of confirmation of information. Then because they did not file taxes, what will happen to these individuals is in this year as per statute, they will no longer be able to get subsidies in the next year because at that point the irs will let us know that they have not filed taxes. We dont know how many fictitious complaints may have been filed already, other than gao . We know of the 11 examples of gao. We do know that. 12 examples, 11 got through. With regard to, those are the only examples we know of. As gao said in the report, they didnt know of other examples other than those that they had created. They dont, yes. But you dont know either . With regard to the things we have in place, what we do know is we do have a number of steps in place. Within 90 to 95 days, we go through data matching. This year already, 117,000 people who have not we dont know theyre fictitious. We know they have not provided the right documentation. And the First Quarter of this year, 117,000 people came off. Several other over 2,000 people received information we did not have enough justification for their income. And, therefore, their aptc, their tax credit would be adjusted downward. Were on a constant path of making sure we have the information that aligns with what we have been told. And if not, were taking action. Without getting into specifics of these cases, that were successful, again, which shows that there should be concern, can you explain to the committee what processes likely failed to allow these fictitious applicants to gain subsidies . There are a series of processes that occur. And in terms of the gates, when people have lied about their information, is something that can happen in the system. It can happen in all of our sis 2e78s. The way we catch that is in the data matching and information. So it depends on whether theyve lied about which part, and that could have to do with which ones failed . Pardon me . Do we know which ones failed . No. Because we have not seen the gao examples. One of the things that would be very helpful to us would actually see the example. What we know is what you said. And if we have the information, then we can find where the system may not be working. In terms of the system, are the examples i gave you. What is keeping you from getting the examples if thats the case . This came out earlier in july. At this point the gao has neither given us recommendations or have you asked for it . We have asked the gao in terms of can we understand how you did this. They say theyre protecting their sources and methods. Mr. Grijalva, you are recognized for five minutes. Thank you, mr. Chairman, and thank you, madam secretary. With regard to the gao question just received, the gaming of the system and the process, is this such a rampant phenomena, that it is undercutting the very pinnings of the Affordable Care act, or are we dealing with an issue that as you get more information, to deal with it . At this point there are a number of gates, and efforts on Program Integrity in place. And thats the initial information gathering, which we check at the hub, at that point. When that goes through, we also, when we dont have data matching, as i said, within 90 to 95 days, we review those cases. We take action. At the point of the filing of taxes, and the examples that were given, folks didnt file their taxes, thats thats the point at which subsidies will go away. We have a number of gates in place. We are implementing those. If we can understand place where is people think those arent working, we do want to understand that so we can work to improve. The gao shared their methodology with you, and those examples we are waiting for that, correct . We are looking forward to gao coming out with recommendations which is the part that has not yet occurred. Thank you. The president s commitment to Early Childhood education, its reflected in the budget proposal, 1. 5 billion extra for early headstart and for headstart itself. Briefly, if you can tell us, the budget levels and spending caps established by the majority, whats that going to do to the fact that you are trying to build capacity, you are trying to stress quality and accountability for providers for these children . And what does that do to capacity . With regard to the levels i think that if you are going to meet those levels and you want to fully fund headstart, what it will be are dramatic cuts to things like nih or cdc in terms of other places. I think we have put together a budget that is a budget that as i mentioned there is savings in terms of deficit reduction that comes from the hhs budget as whole. That we put together a plan and an approach that affords us the opportunity to fund all of those things. But at the current cap levels you would not be able to do that. So you would not be able to implement the changes in headstart or you would have to make dramatic choices in other places. One of the largest budget areas for hhs is nih. And i think the last point, Community Health centers, that was mentioned briefly in your testimony. At least in my community thats an essential network for Health Delivery, an essential part of the Affordable Care act delivery system. If you could talk to the committee as to that role, and how the budget that you are talking about is reflecting an continued commitment that the president made to the Health Centers at the inception of the Affordable Care act discussion. We appreciate the work that was done also in the Sustainable Growth rate bill in terms of these issues. The Community Health centers serve approximately one in 15 americans actually are served by Community Health centers. We think they are an integral part of care, an integral part of primary care. A very important part as we expand access that we have an ability to serve. Thats why he was extended as part of the original Affordable Care act and are extended now as we see the number of uninsured drop so there is places for people to go because of that. We believe they are an essential part of coverage especially in communities that dont have as much, rural, minority or other communities, that these are an important part of that. They are also an important part of integrating the Behavioral Health and primary Health Together so we can get to the place where that type of coverage is one. Thank you. I yield back to the chairman. The gentlemen yields back. We are going to move members to four minutes. We are watching the clock. I cant seem to get it to slow down. Mr. Guthrie, youre recognized for four minutes. Thank you. Madam secretary thank you for being here again. I appreciate it. I want to talk about through employer sponsored Health Insurance, the small market Group Definition. Affordable care act in section 1304 expands the small Group Definition to 100 employees. Particular concern are employers from 51 to 100. If you are below 50 you are not mandated to provide. Once you start growing then you are able to self insure when you have got a bigger pool so a lot of bigger businesses arent having the same issues. So the trap seems to be and ive heard from a lot of employers and insurers, and actually a lot of colleagues on both sides of the aisle have been working, how do we fix this problem. Ive seen estimates of a 30 increase from different studies but the issue is employers from 51 to 100, if they go into the small market Group Definition will have expensive mandated benefits. And there is a big concern. As i said its bipartisan over here in the capitol. So i just wonder if you have looked at this issue and what actions are you looking at taking . Looking at the issue right now, one of the things i would and if we could follow up with you and your staff to make sure we are getting the comments you are hearing directly from employers or other groups. It would be very helpful. There is another side in terms of expanding the other market that people argue but would love to hear directly if you have those comments as we are reviewing that. Absolutely. It would be helpful to hear the specifics of why people assume it will work the way that you describe it working. There are others that argue the other side of this issue. It would be helpful if we can follow up on that evidence. What i understand in terms of a policy perspective, and then the question is would have we have authorities. Those are the two questions were examining right now. Its a timely conversation. If i could ask that we follow up with your team or you directly absolutely. To have those comments i would appreciate having the facts from the field to inform our conversation. There is a bill, hr 1624, it is 158 cosponsors and bipartisan. Its not just a it is a very bipartisan look at whats going on. Having said that, mr. Chairman, i have a letter. Well share it with you from 19 employer groups regarding this. Id like to enter it into the record. Thank you madam secretary and i yield back. Gentleman yields back. Mr. Courtney you are recognized for four minutes. Thank you mr. Chairman. Thank you madam secretary for your accessibility since taking over. Much appreciated. Just for the record i wanted to note we had a great opportunity to talk about observation coding issue which still is a widespread problem out there for folks who are discharging from hospital and unbeknownst to them find themselves in a coverage gap for medicare to cover medically prescribed services. Since we spoke about the two day midnight rule yauv got ive got a sheaf of information from folks that again i will show you with why this is not a solution to this problem. But i will move on. If chairman mentioned earlier about the insurance rate increases that were reported a while ago in the press. I would just point out coming from connecticut, a state which embraced this law is now in year three of the its exchange. Just a couple days ago some of the insurers who participated in the exchange revised down ward their initial rate requests. Anthem came in at 6. 7. Revised down to 4. 7. This is prior to the rate review. The coop came in with a 13 rate increase. They revised down to 3. 4 . The largest insurer on the exchange, they came in with a whopping 2 increase earlier. They have now revised downward to. 7 . I point this out because there is a cohort that has claims experience under its belt now. The fear amongst actuaries that the walking wounded in the exchanges were going to spike up in recent years. Were actually seeing incredible stability in terms of the rates. We are also seeing new insurers coming into the marketplace. Harvard pilgrim is now knocking on the door and is coming in to sell their product in connecticut. Again, your department has been boosting the Insurance Department rate review piece of this. I was wondering if you could share from a global standpoint, you know, whether or not some of these fears are overstated. With regard to the rate issue, it is i think what you are pointing to is one of the things about the act that is important is about adding transparency and the light of day to things in the marketplace to make a market work so that individuals have information and that there is pressure in the market to make it work. And that was one of the ideas. And so when people saw the rates, the rates that were reported are only the rates really in most states that are above 10 because thats required. If a company is going the raise the rates above 10 part of the law it it has to be posted we have to report it while the Insurance Commissioners review it. Thats the other part. It needs to be reviewed. It doesnt just happen if they propose it. If they are going to propose above a 10 they need to justify it. Thats a part of the process at work. What you see in terms of connecticut and what just happened is, that creates downward pressure in terms of the public pressure and the requirement that you have to justify rate increases. We think overall what we have seen last year is that the rates come in here and there is downward pressure. We also see in states like connecticut and actually california just came through yesterday. And their rates were at 4 , lower than their increase of last year. So thats what we will continue to watch and monitor. The reason we recently had a conversation with the state insurers to make sure they know and are using that tool of rate review to put that downward pressure which we believe is an important thing to do making the market work. As a former small employer who double digit increases were just a matter of of course, to see a 2 or a. 7 , really, that is eye popping in terms of the stability. The difference. I yield back, mr. Chairman. Gentleman yields back. Mr. Barletta, you are recognized for four minutes. Secretary burwell, my district is home to businesses that sell cigars to adult consumers. They are concerned about the expansion of the fdas Regulatory Authority under the Tobacco Control act. Their shop serves a distinctly adult clientele. I dont believe this category was the intent of congress in 2009 when the law was passed. Can you tell the committee what steps you are making to ensure such businesses which are a staple of main street america are not regulated out of business . With regard to right now as we are in the middle of a rule making process i think you probably know that we actually proposed two different alternatives as part of the rule. To gather the evidence and