Transcripts For CSPAN2 Capital News Today 20130418

number two, missile defense and our ability to defend the homeland. i want to start that much discussion about sequestration that the current budget and the department will hope fully in the month of may comply with the scots that present short-term challenges of long-term challenges. in addition, they contemplate a renew commission process going forward. i would suggest of assessing sequestration in the short-term and long-term and cannot brac process that a component should conclude consideration to the degree with which we can reduce the prance overseas, reduce bases overseas command manpower overseas, consistent with essential imperative for national security. the first question i wanted to ask secretary hagel as to what extent is the department complying with these financial pressure is our ability to drive down overseas footprints. referable to reduce overseas and here at home if it can be done consistently national security and to what extent is it apart and engaged right now in that assessment and analysis? >> thank you. let me also clarify a point you've made so there's no misunderstanding. i don't want an expectation that may be inaccurate. we will present a plan for dealing with sequestration. we had the strategic choice management review i asked for but come back to start make assessments and decisions, which obviously affect complying with the law of the land if we have to. >> if i may follow-up, do you have an intention for a timetable for when the department would get back to the committee on it intension and plan for complying? >> i have to look at the review the deputy secretary of defense, chairman of the joint chiefs are leading and preceded on that basis. i don't want an expectation that isn't correct. that's why want to make sure i understand what is expected. as to your questions about overseas and other adamant however and the observation about assessing what you have to do to comply with these new realities. yes his affairs. we have been consolidating and closing facilities overseas the last few years. we'll have a study complete at the end of this year, specific way on additional recommendations of consolidating overseas. should be i agree. i think the leadership, dod donate to the terror infrastructure in this country as well. >> can i just had a couple of facts? there's about 30 more scheduled over the next 30 years in addition to the consolidation. we've been looking at overseas perspectives. >> thank you very much. general dempsey, and a two gigahertz about how grave a threat to north korean situation poses what is their capacity right now with missile defense to enter set and defend against a hostile launcher in north korea. >> senator, there's been whether they've been able to let the nice. the chairman of the joint chiefs, who will react to their worst-case scenario. with filesharing to intersect in and destroying any ballistic missile launched at facilities or personnel and rear posture to do that. >> i would know that the president's budget, while not accounting for sequestration, nonetheless cuts $500 million from missile defense and in my judgment, given the threats we are seen for north korea potential threat we have from the nation of iran can reduce and commitment to missile defense at this point seems ill-advised in nt, our current posture is at a minimum of two minds and not wearing now deploying a system to qualm and reinstating ground-based rescanned old in alaska, both of which are reasonable and positive responses and that seems inconsistent with reducing funding for missile defense and driven by any means rather than a strategic plan for a missile defense and i welcome that that's a secretary hagel or general dempsey on that issue. >> the budget reflects the priorities of our missile defense program and plans. missile defense is a component for the interest of this country. i certainly would never sign off on any budget that would lessen that ability to fulfill that commitment to this country and every theater in the pentagon. it is my sense that it does comply with requirements. >> in the interest of time, senator, i'd be happy to have someone give you lay down of what we've done this year and where we think this is going. illicit missile defense is an important investment. it can be extraordinarily expensive. rebalanced defense and offense. i used the phrase at some point you have to stop worrying about the arrow and start writing about theater chair and i would suggest will have forgotten the capabilities to deal with the archer. i would think all three of you. >> just relative to the facilities overseas, we do have rules as to the reimbursement to us for the improvements we made in overseas facilities. we just issued a report, which we hope you'll take up the show and the failure of the department to achieve the reimbursement in the way in which it is supposed to be made and it's been going on too long. part is a failure of oversight, but mainly a failure of the department to enforce rules relative to me in her cement my allies for the improvements we've need in those facilities returning back to that. i was a report released yesterday. we look forward to your response. >> one comment about the overseas facilities. all of us know in western europe that quite a few thayer and one of the problems that came up this environmental controls over they restrict and germany, for example, our ability to use a live range to so many hours a day of the may days a week. finally, we had to say if we can't train them are going to leave and that got their attention. we need to use the tools we have two most efficiently train our people as we are supposed to be doing over there. >> 's thank you, senator inhofe. >> i am just going to jump right to it. i'd like to say a word about sequester, a word about sub tab and a comment about syria. i agree with senator sessions that are earlier. i do have the ability and makes me feel criticized to make a sixth of the budget. that was foolish. to make one eighth nondefense discretionary take 50%, that was foolish. it's important to acknowledge no alternative. we had an alternative with 53 votes. that's a majority of the body that wanted to turn our sequester endured a different way. unless filibusters and the president already. in this instance, filibuster was about to any weapon devotes. there was a sufficient vote in this body to turn off the sequester have been in my view a significant negative effect. senator mccain situation was an extremely helpful. if there is any chance of this congress considering an alternative to sequester, the more people that have an understanding that the good faith most considered judgment about what is qaeda if we knock the extra 52 billion off, the more specifics, the more we look and say we don't want that to happen here we better come up with an alternative is so specific and granular in player. it doesn't put any pressure to come up with an alternative. on brac, i worry about for that testimony this morning said we've done five backgrounds and 65 and has billion dollars annually. but brac was announced, every community that has military assets, whether on the chopping block or not, i have a public relations send an economic effect of uncertainty that can have its own economic effect. if it's been $12.5 billion for five brac rounds come if we do love that to produce savings, i wonder if it's worth the trouble. it is important to lay out potential pets to do with budgetary realities. as governor, and $80 billion budget and in four years i cut $5 billion out of the budget. i didn't convene a mission to do it. i made very specific reduction proposals and gave them to my legislature. democratic and republican in successive rounds that was a heartless joke for everything i proposed. after they spent time going through everything, they ended up approving 90% of what i propose. that was the regular order process. i didn't make every last person or community in virginia by announced theme something like that favorite pet to lawyer up in lobby. the one thing i would encourage you in my committee members i know senator inhofe has some concerns is whether that is dealing with the need to make challenge, but whether a sub 10 round, when you add in the economic effect and the external transaction cost that it generates is a brac approach the best way to produce cost? >> one of your predecessor, secretary hagel, secretary gates is joined forces is not the best expenditure of money. it is inaccurate that might've been inspired by a secretary of defense. if the joint chiefs of staff had offices near each other, why do we need a separate joint versus command? he just sat on me to do this. the local community came forward and said we think this is a bad idea and they reached an accommodation were essentially the structure was dramatic, but military emissions provided continued to be provided and there is compromise. that was done not in a process, with dod lane, should get rid of this and members of congress saying we think you are wrong in a compromise being reached. i would recommend as an alternative to brac to produce to do that and a $2.5 billion savings, which by my quick math is about 1% of the savings and that's what it will produce. i'm not sure the process associated with it is worthwhile i would commend you to ponder that. i just want to say a word with your permission about syria. there's the personnel aspects of the nda proposal and i think i'll do that. i'm on foreign relations. i have sympathy with senator mccain and others. he said we need to explore the recommendation potentially nonlethal to legal assistant. my concern is that looks more and more sick care and that assad as an hour wait is becoming more of a struggle for the community, which is a sixth of the population. if they believe the only outcome is that they survive or whether they are purged, this would be a fight to the death whether we offered the delayed or not. i know of the factors that must weigh in heavily is what the opposition can hold the weapons in the wrong place. if the opposition can do things that will bring à la whites into the opposition and commence the minority that it's not a prairie chickens that would also have the gr-based elements of the opposition and in your caring off nonpermissive, permissive or collaborative. it matters who would undertake the opposition included members of the minority so alloway's wooden fearing that that purge in the conflict would make our decision easier. that would make the consequences less severe and i would put that on the table as part of the discussion and i've not said a single thing. for purposes of committee members and others that want to state that. >> thanks, senator. we'd be happy to have you put a chair with us and testify this afternoon. >> senator, thank you. i listened carefully to your parents and they make a lot of sense. we will take all of your points under advisement. >> can i previously had laws that stop us with a certain model under those search through the exceptions. i don't know, sounds interesting to me. i think we've got to think about it. >> i'm suggesting you fine away that would create less trauma. >> has to do with wiring a and consultants by the mention of the possibility and would urge constituents because it's got a long way to go to prove another background. the implied suggestion is wise. secondly, i hope you suggest, mr. secretary, the congress, both senate and the house and the president did not comply with the law in your 2000 budget requests. the requirements, in order to avoid sequestration, the president avoided it in a way, which is different from what the house did. hopefully now the house and senate would get together and adopt a joint touch it. i hope you did not mean to imply in any way the three budgets now out there or not in compliance with the budget control act and i hope you didn't mean to imply your budget are not in compliance. they do it in different ways. one has greater paths of cuts and ravenous. one has a greater balance yet on revenues. they are in compliance. >> yes. i did not mean to imply that. my point bringing that up was in reference to somehow interpret implication the budget was out here and in fact all three budget were closely aligned. >> is a set before, i agree with what senator mccain said. i said it before. it will be helpful to avoid sequestration if you can get to us as quickly as you can the details of what the specific impacts would be. >> we intend to do that as i said, but at the same time, we want to make sure whatever we come up with we can defend and make sense and that's why a preference to review. until we get that review could not go forward. i agree with the. i got it. >> senator graham has shown that peter just in time -- >> i want to congratulate you and are responsible north korea. >> 2013 will be a major year for national security issues. >> t. believe if we don't do with the nuclear programs between now and the end of the year were probably in trouble one way or the other? >> i've been disappointed to progress in and the urgency will only increase. >> as we've been negotiating with p5+1, intelligence tells us the level of enriched uranium has gone up, not down. do you agree with? >> it's been transitioned to stay below the threshold he is >> information i received is the amount has actually increased over the last six months. i very much support sanctions and diplomatic resolution to the problem. secretary hagel, when it comes to afghanistan you're making an evaluation. >> post 2014. >> as. >> to equate the arabians are watching us the terms of our resolve? >> yes, i do. i said that publicly. we have a global audience. >> that's why i'm so upset that we would pick now of all times to basically cut our military. do you agree this is a time of great national security risk that we live in pretty dangerous times? >> i do. >> we are on the low end of defense spending is that correct? >> we are for me were talking about this the other day as the ups and downs, pitcher ray. >> it is not a cat reform that reduced 489 alien. 600 billion paper he will make the floors at a time when need it most. i would urge you estimate that the president does a lot of bipartisan support for the idea it is unacceptable to get a nuclear capability. there's no good ending to a nuclear armed iran. it would just take the whole region and thrown into chaos. do you agree with that? >> i do. >> how to evaluate the security situation in iraq at this point? >> well, obviously that is a country dealing with the internal issues and they are unfortunately playing out in some sectarian ways al qaeda and they still have difficult jobs. >> it seems to be al qaeda in iraq is on the rise in the political process is frozen. when it comes to afghanistan, it's a frustrating country and i think you really resolve issues in a good way for us. my question as it is now the time to be engaged in sequestration? >> senator, i wish we were. i am right with you on this. as i've been constantly reminded, it is the law of the land. we have a responsibility to do with that thought reality. >> i think we have the ability to replace it. i do want to destroy the military in the process. between now and the end of this year we've got to deal with syria in more detail. we've got to do with how we end the war in afghanistan. general dempsey, what would winning the clinic in afghanistan? >> let me thank you personally for your help on the detention issue. >> you also make good resolution. what with losing look like in afghanistan? >> the inability to control urban areas as well with the a loss if we didn't have a lot term relationship with it. >> s. morale effect date by insurgent in the budget process? >> absolutely. >> the chairman of the joint chiefs of staff has told this to many that we are hurting morale by not having a better budget solution. i hope the tape back to her. secretary hagel, what would you like to see the congress to this year if you had a two or three item wishlist hope you confront the threat we all face? >> i would start with certainty and dylan were sequestration on the budget and if we could get that as we've said this morning and particularly the chairman comments, it would give us the time, the flexibility to adjust to the realities from two wars and the consequences that come with that. that would be my main priority. >> service and al qaeda elements on the pakistan of the border. is that correct? the program has been successful. >> it has been coming at us. >> the infrastructure are identified and events in pakistan and afghanistan and neutralize their ability to hit us i hope we don't dismantle. i hope we realize this is the place that al qaeda still exists in that region and a secure afghanistan would be a tremendous win for us. i look forward to talking to both of you about keeping the afghan army at 352. this'll be one of the most important decisions a president makes. thank you offers service. >> thank you, senator graham. senator blumenthal. >> thank you, mr. chairman. thank you go through being here and thank you for your service to our country. i want to begin by following up one of the questions that was asked earlier concerning the soul. i understand their purpose under preparation to be delivered at the end of march regarding changes in recommendations and i know you've answered a number of inquiries regarding sexual assault. i wonder if you could tell us whether the report is received and whether you can commit to providing that to us? >> thank you, senator. i request of the office of general counsel sl as the secretary of the air force was given to me that one request was to give thoughts on recommendations on how the police section 60 should be amended. they accepted those recommendations. we are now moving forward working with our council to draft legislation to ask the congress to look out. >> is not exactly were were. recommendations that will get back and asked them. >> if you could prevent them, i would appreciate it. i want to turn now to an area very important to national security come is summer program. you and i have talked to various points and i believe the president's budget is building in the cisco you're going forward in the next. i assume you share his view submarines are more important than ever to the strategic security. >> yes, i do. >> on another issue that's not been covered, if you could bring us up to date as your reviews regarding an essential platform for air superiority. >> you know the background and the issues, so i won't traverse that to that territory. i met with the director of the program two weeks ago and asked for a writ port. it is my ss that we are making progress. we are not there yet. our partners, other allies who went on joining us in procurement are essentially hanging with us on this. they delayed most countries on their orders, but the program is moving forward. we put a lot of money and is the largest acquisition program we've ever had, but it's the answer >> i appreciate that. >> first of all, they are truly our asymmetric advantage globally. no one comes near her capability of us got to keep those advantages prominent. >> the squadron in eglin. i was open-minded to hear whether he thought it was good or bad. i didn't have any predisposed notions, but he convinced me and i will say this. we haven't been attacked since april 15, 1953 and i'm not going to be the chairman on whose watch that's reversed, so i'm an advocate. >> i deeply appreciate both of your views because i strongly share commitment, not only because they are stealthy, strong and asymmetric extraordinarily versatile speaking about the suffering and the joint strike fighter and is my view the linchpin to air superiority against the aggression you alluded to many years ago. they thank you for those answers. one of the reasons i was proud to support you and so grateful you have been concerned is your commitment to the well-being of our troops. on health issues and health care, on their well-being while they are in service, but also you share my view that more needs to be done to enable and prepare them for their service, particularly concerning employment and skill training in the minute plus i have left here will be an adequate to answer for you and general dempsey, but perhaps you can give us your view as to how we are doing or where we should go in terms of preparing many of them who will need to service in the very near future for civilian life. >> thank you. i'll ask general dempsey for his comments as well. i share absolutely your comments for the reasons he noted. these are young men and women who come forward and serve our country unselfishly with tremendous sacrifice that in most cases they make with their families. we do have some responsibility here. we have programs now underway we continue to fund to assist that transition. can we do more? yes. q-quebec courtney got better that better? yes. other services are in complete agreement on this. no one is more committed to the joint chiefs and senior enlisted and general dempsey as i am. you have my continued commitment. >> transition assistance programs are going well. they can continue to be improved upon their resources and budget submissions. we are working on credentialing, state says he now vanishes to be wolters elsewhere. working with career trackers so by the time a man or woman comes in they think about transitioning until the last six weeks. we also know are going to make the challenge of the more challenging. we are ready for it. >> thank you offer testimony today and for your service. >> thank you, senator blumenthal. >> one of their branches going last is most of the questions have been asked. i do have one nature requests. yesterday we had a briefing by jim clapper on the intelligence budget going forward and produced a chart, which basically showed the ongoing sequester budget and other i would ask if you could check within perhaps, it is chart number 11 in his presentation. give us a similar visual breakdown of what your budget looks like, including as we now know the sequester on an ongoing basis. if we don't do anything about it, what does it do? i found this information yesterday to be very important because it shows real cuts. not cuts to grow, the real teeming nations of the funds available and it would be helpful to the committee to see that data as the books over the next 10 years, you look at the direct is chart and you'll see what i'm saying. >> we will, senator. thank you. >> one other quick comment and i'm sure you fellas know this as well as i do. one of the first things is deferring maintenance. but deferring maintenance isn't saving. if they cause someone has to pay in the future and i'm sure you agree. >> we do agree. >> you actually end up paying more. as i said earlier, i apologize for not being here at the end tire hearing. it is turning around and retention and those kinds of intangible assets that are somewhat porton, with such an important part of our force structure and troops readiness. is that an accurate statement? >> it's absolutely true, senator. i have a formula that says today's readiness challenges are tomorrow's problems if your lab reading this, the young men and women to come into his turban he trained and ready will not stick around long. >> that is the essence of the deal is the personnel. >> general dempsey, you've been involved with two drawdowns and once at the end of the cold war. share some experiences that might be beneficial in this situation. >> although i'm not happy you reminded me how long i've been serving, a couple things. one is to draw down produced hollowness each time. the first time this manpower hollowness. the second time as equipment. but the cms is a readiness hollowing of the force. although we find lessons each time, it's been a different challenge and i think it's a layer above are time. we have incredible young men and women so the personal site is good. our equipment has been recapitalized instead overtime. equipment is adequate although it cecchini we don't want to start modernizing. where we are suffering now is in readiness. we are not training because of sequestration and it mechanism. the other factor in terms of the three different -- the three different drawdowns is each time you start from a much lower start point. a million men in uniform in vietnam down to 781 by the end of the 70s. you drive down in the 90s to roughly 500,000. today we're starting up 490. will be active as a result of the budget control act for 87. that's where you start to observe sequestration. i think we've got to remember that. >> thank you offer your testimony. >> thank you very much, senator king. one quick reference to article lx. i believe it's understood what you are considering our generic changes in terms of the convening authority spyware not relating to sexual assault is a generic change for major offenses. >> thank you yet that's what we understood. senator inhofe has a quick last comment. >> senator leahy came and expressed a concern. i don't think he had time to fully develop, but to what degree are we influenced by russia in our missile defense decisions we make? it goes back to the decisions the president made the first year he was president to pull the rug out from under poland and the czech republic, ground-based interceptor. i can remember talking at that time and he said were going to go ahead and do this. can we be sure you're not going to pull the rug out from under us? that's what i refer to and he did in the first year. i will always think of it as a result of this effort to get along with russia. he answered his questions about not having the influence. i would call your attention and i'm sure, mr. secretary, you said communications with the defense minister whose name i never pronounce ray from russia, who said he wanted to carry on conversations with video as this developed as a national missile defense. it kind of implies senator leahy is pretty accurate in his concern over how much influence that would be over us. do you have any thoughts would be willing to talk about now? >> thank you, senator. a couple thoughts with your response. first on poland and the announcement regarding the phase approach. they were supportive of overdoing and i spoke to the minister about this. >> i saw how good the latest announcement during the crown basis. >> four years ago, the decision that was made. the >> nothing i can say about that. i can say again what senator leahy asked me that i'd announce that decision, the conversation but the defense ministers that the decision was made and announced. he did say one of the things we did talk about this further missile defense issues. that wasn't the intent of the call, but it was after the announcement was made. >> i'm glad were not afraid to talk to people. we will recess in 30 minutes will be 10 minutes to 2:00. [inaudible conversations] >> president obama and the first lady will be in boston thursday to honor the terms of the boston marathon bombing aired the first couple will attend the cathedral of the holy cross. see it live at 11:00 a.m. eastern on ark pinon not her, c-span 3. >> she came into the white house is a 47-year-old lady who is well known hated politics. she was obviously deeply did press at the death of her last surviving son, especially under the terrible circumstances in which she died. she didn't have any men friends, but she did have a family who kept her going and always seem to be somebody fair. i don't think she did very much. she was this very intellectual woman, highly educated. they seemed wasted on some way. >> homeland security janet napolitano testified before the senate homeland security committee on her department's 20. as they are in the secretary and the boston marathon. see the testimony on c-span and any time a c-span.org. >> i'm a former prosecutor and i've got a question that i just can't keep from coming out. based on the evidence at this point, is there any difference between sandy hook and boston other than the choice of weapons? >> well, in terms of intent, for death and destruction in injury, no. methodology coming at us. we don't know the motivation behind certainly boston. we don't know whether it's domestic, international -- >> or identical to the motivation in sandy hook. >> we don't know the answer to those questions. i think that it's impossible for me to sit at the table today and say they are identical except in effect dead pact. >> as i look at the evidence available, you have mass destruction and violence and slaughter of innocent. in neither case do we know motives. the irony is we are so quick to call boston terrier. why are we calling the man with the high-capacity assault weapon and the high-capacity magazine, why are we calling him a terrorist? >> i don't know the answer to that question. >> i think it's important we talk about cutting government and it may be that way for the motive of both been indicted in sandy hook was political in the motive in was sent and the motive in sandy hook was sent. i made it both are suffering severe mental incapacity that wants than to slaughter a bunch of innocent people. but you know, as i look at it with the eye of the prosecutor and the evidence available right now, i find it troubling when is characterized in a way that causes so much more fear and deception and everyone's daily lives than the other one. not that there are bothers all of the country afraid to send first-graders to school these days. there are. i was certainly urge you to take a look at this and see if the government has a responsibility to when and how we characterize an act of terror, when there is not evidence yet to support that characterization until they now with the motive is. it just is troubling to me about the time maybe have identical motives. bunches of military style weapon but the magazine and the others chose to make a homemade bomb. >> senator paul's comments came wednesday at the "christian science monitor" interview. this is about an hour. i'm not [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] >> okay, everybody, here we go. i'm dave cook from the monitor. thank you for coming. today's the first visit with the group or in texas, attended the university before being admitted to duke university where he earned his medical degree. as an antitax group caught kentucky taxpayers united and in 2009 in his first bid for a lack of office, our guest ran for the seat vacated by senator tim bunning and the primary and won decisively when a guy to the senate he quickly hide the tea party caucus. finally, a group that i may be the only member of her 38 member breakfast and had a father and son isaac s. we have stated ron paul and 2011. so much for biography and part this trivia. >> please know that law again were treating. no sign of any kind with the breakfast is underway. there's no embargo except c-span has agreed not to use video to session for at least an hour after the breakfast ends against those of us in the room a chance to file. if you'd like to ask a question, do the traditional thing and send me a subtle nonthreatening signal. we will start off by offering our guests the opportunity to make opening comments in the two questions the table. thanks again for doing this. the floor is yours. >> astounds with all those rules that we will really create some news this morning. a >> we live and how. >> out of sync i was sort of in a wedding receiving line. if anyone feels compelled to send me a wedding gift, i can get your address. though have to be under $14 to make the senate gift limits. i was told anything short of 13 hours of speaking with a fine, so i'll keep my remarks concise. question-and-answer will do this better. i am glad to be here. i came to washington to make a difference. i think our nation faces significant problems and if we don't address the deficit, i've become more and more convinced that we don't necessarily go gradually and problems that could go precipitously and i say that with reference to 2008 and the crisis that there is, even when things go pretty well, there are some lurking dangers within our economy. one would be interest rates rising. i asked this to people i consider to be smart, big bankers, nature capital centers of the world. can they control just raising keep interest rates below? is there a point at which the central cannot keep pace. interest rate to 7% are when i was a kid, 19% were 21% would be catastrophic with this burden of debt. he seems to work right now, but there is a certain allusion of wealth in the stock market and evolution of the peace we can manage our debt. those are my concerns and because of that, we have to do long-range things. i propose several things since i've come. i propose fixing a security problem. to me it's an actuarial problem. you raise the age gradually 27862 thirds of the social security deficit. fix the remaining by testing the benefits. the president has occasionally sad he's for entitlement reform, but is not shown much leadership on this premise seems to benchmark per se, but any with him at least a 47 republican senators, we sat around a table that he and the vice president a year and half ago and i told them i think we should give people on both sides to essentially fix social security. .. into the federal employee benefits plan, federal health insurance plans so i said this is a democrat idea, this will be easy. i be easy. i will just go to john kerry and say let's use your idea and a friedel country but for senior citizens and let everybody of the federal employee health plan. i think the public would like it if they are still getting the same health plan is their congressman is and should be eminently sellable. similar to what paul ryan talks about give everybody the federal health employment plan. it saves 1 trillion over 10 years and actually according to our projections would eradicate the shortfall for medicare. so i guess i would stop there since i affect social security and medicare. i don't want to really brag or anything. i had a few vote to support my ideas but we didn't get any support from democrats on my ideas. i try to talk to someone who i thought might discuss the issue. their main complaint was that obamacare got rid of four congressman we are no longer part of the federal health care and play program and is a question whether not it needs to go into some kind of exchange like obamacare. they said we couldn't do it because we are getting rid of the one part of government that actually works, the employee health care plans. i will stop there and i will be happy to answer questions. >> a larger than usual turnout in one reason is there is a potential presidential contender for 2016. what are you thinking on that possibility? >> i want you be part of the national debate so whether run or not being considered as something that allows me to have a larger microphone. we will continue to travel to the early primary states. i'll be in iowa and new hampshire in the spring and i'll also be in south carolina in the summertime so we are considering it and we won't make a decision before 2014. 2014. >> the last question for me and then we will go to stephanie. i won't attempt the last name. i think mark shields is waving his hand. mark has a question. >> just one though. >> in your view to the bombings in boston have any policy implications either on gun control or immigration? >> you know i think it's largely a mistake to talk about issues in the wake of the crisis, the wake of a tragedy. the one thing that disappointed me i think gun control is a legitimate issue for our country to debate and decide where and how we can fix the problems of violence but i hate to see -- i'm a parent and i have three boys and i have -- hate to see them use people as props and politicizing people's tragedies. when i see the fathers and mothers testifying and i know there are going volunteer -- voluntarily. it saddens me to see them and i think in some cases the president has used them as props and that disappoints me. the way i look at it, a little bit in the sense of a tragedy how could we have prevented the tragedy and that is why come down the side of not being in favor of any of the proposals because not of the proposals address the tragedy. >> stephanie k from the times. [inaudible] >> no i have not voted for any limitations. they're been several amendments on sending people people to guantánamo bay are not sending them there and i have not voted on any limitations on that. i don't know that i have a great answer to tell you the truth. there is a part of me that really does believe if you ought to capture them internationally people could be held indefinitely. i objected strongly to sending americans there and it surprises me that there are members of the senate that would send americans to guantánamo bay without charges or trial indefinitely. it disappoints me that the president who when he was a senator appeared to be a little more of a civil libertarian has said well i'm going to sign -- but he said the same thing on drums. i don't intend to use them. to me that is not strong enough language and you should never sign the ndaa because we should not have on the books for any of power to guantánamo bay without a child so for americans i have strong feelings. for others it is difficult knowing what to do and i think you're sort of a spectrum. i think americans, anybody accused of a crime in america gets due process without question without exception and i think it's an absolute. if you are overseas and captured on a battlefield, i think you get no due process. probably zero due process if you are firing a weapon or involved in the battle and it's sort of murky in between for those who are committing battle in the daytime and sleeping in their house at night. what he do when you capture people ask where do you take them? there are a lot of questions and i don't think they're there are easy questions on this. i haven't come down on the issue of closing guantánamo bay. >> after your primary most of the calls talking about how terrible you were for from republicans who were loyal to senator mcconnell and there was a rift between the senators so i guess my question is how much, how hard you going to work to get reelected? >> i have endorsed him and raised money for him and you know i will work to try to get him reelected. he is good for -- >> is he a mentor? yes someone you are learning from? >> you know, thoreau was a mentor. i think -- when we call people a mentor or i think that overstates. we are colleagues and i do respect him and he has a lot of knowledge in the senate and we worked together on a lot of things. down in kentucky working on the federal government out of our fishing rights next to the dam so we interact on a lot of things. really to tell you the truth that think what i would say about senator mcconnell is that i don't think he ever personally disliked me. people work against each other in campaigns particular people involved in politics for a long time don't take it very personally. so the one thing he did which was a very i think significant thing for me and for the party was he called us all up three months before the primary and said i want you to sign up promise to come to unity rally three days after the election. then we didn't bicker and it wasn't the establishment against the upstart. everybody showed up, all all the republican congressman and my opponent showed up in both of my opponent showed up and it was a good thing that it was a smart thing on his point. [inaudible] >> think he actually didn't know at that point. point. the poll said really shifted. this was a month or two before. we had actually done pretty well in the polls. some thought i wouldn't sign a pledge but i did. i wanted to be no question that i was supporting the republican nominee. i said i was going to support the nominee once my dad knowledged his nomination was over. >> senator i want to salute you to mentioning mcconnell and thoreau in the same sentence. i wanted to ask you what president of the other party do you most admire and why? >> probably grover cleveland. oh okay. >> we have lots of rules here. >> i have to ask her his -- answer his question? in my lifetime a democrat i guess kennedy was president when i was six months old. he was shot in 63 in the summer or the fall? i am six months old so it would be from kennedy on forward. i'm not an lbj man definitely. i think he is sort of a creature of something out of washington and there are a lot of things that i think are bad to come out of washington. even though he is from texas i wasn't too happy with lbj. then you have jimmy carter who is the best ex-president i would put in that category. and you have clinton. you know i think the only one that some conservatives point to and i might as well would be people point to kennedy in reducing taxes and actually growing the economy as well as reducing unemployment as well as increasing i think revenue actually increased and he cut rates so i would probably say kennedy. i think kennedy captured the american imagination somewhat. i think falsely sometimes because the media gave him a pass and nowadays i don't think that would happen to either side but i guess i would say kennedy. >> you spoke at howard university last week. do you plan on doing any more outrage and if so what will you do next? >> about three days later i spoke to simmons college which is a historically black college. i thought my receptionist howard was much better than the reception by the left-wing media. i didn't appreciate your reception at howard i think was very fair. i never met curt schmoke before but i was the fan. i've told them i remember back when he was mayor writing about him trying to decriminalize penalties for nonviolent crime which i have always been a supporter of and so i enjoyed meeting curt schmoke. we have the bill on mandatory minimums and i'm working with leahy and we may try to see the bill come back and testify if he likes the bill. i think the reception was good. i think, i will give you an example of how sometimes reporting is not accurate. one young man stood up and said i work for a pro-obama super pac registering voters. someone in the media describe him as someone who was from a generic voter registration group he worked for the president. that is a difficult person to get considering republicans so he was the beginning of the conversation. the other thing i would say is that you know things that annoy me is people want to just -- as completely lasted as some of the left-wing for being out of touch and knowing nothing about the southern strategy and that is why african-americans became democrats which is flat out wrong. look at the facts. in a huge way the statistics aren't great in the 20s but they say, some say hoover may have gotten two-thirds of the african-american vote and by most of the statistics roosevelt got two-thirds of the vote. a change in a huge way in 1932. the south side chicago was republican and had a republican congressman. he was elect good 26, 28, 30 and 32. he becomes a democrat in 1934 so for people to tell me there's a reason republicans are hated at the african-american community, it may have cemented the change but the change happened during the great depression and i think it's wrong -- to the change happened and i said this in my speech and most people ignored it. the change happened among whites and blacks. a lot of people change their registration in the 1930s. roosevelt won over victories but the one thing he did with it african-american vote changed in 1932 and increased in 1936 when truman endorsed the civil rights in 1948. the pope becomes overwhelmingly african-americans voting for truman and the integrated the armed services. you get to 1964 civil rights act that 90% of the people african-americans voting for lbj and the southern strategy by most reports is after that so it solidified but it didn't cause the change. people who write that are factually wrong but they do it simply for partisan purposes because the republicans not allowed to be part of that debate and talk about a? it had a a lot to do it then everyone has an opinion on a lot of things but it had a lot to do with economic the lack of economic emancipation of african-americans. they wanted more and they didn't feel like they were getting it from the republicans. >> in terms of doing more for the republicans. >> i plan on doing more and i've done one already at simmons college. we will continue to do that but anybody who thinks it's going to be easy and then i'll the sudden, i would say the one thing that's encouraging from history is the amazing race of 28 to 32. if he could get republicans to switch their vote from 28 to 32 all of a sudden things would be topsy-turvy. 5% of african-americans voting republican to 5% of the sudden ohio comes into play. >> we will go to john ward, jim schlesinger -- >> summoned raise the subject and talked about children being used as a prop was frankly a red herring because that is really not what the issue is. do you think there is a problem that needs to be dealt with? >> if it's a red herring you are saying that president bringing his family here is a red herring? >> i was wondering what you think should be done in the area if you think something should be done in? >> it's a red herring for they president to bring up the children's -- parents of the children who were shot. i am someone who is presenting a face to the public in the face i want to present is that i do care about those kids. i understanunderstand the grief they are going through and i do care about is that politics is in about only facts but whether you're being empathetic and i want people to know i understand their grief. >> to think there's anything the federal government not to do that could create more safety by restricting access or by registering guns so criminals and terrorists can't have access? >> the current background checks found 15,000 people to be felons and they were kicked out of the system. we prosecuted 44 of them. i'm supporting senator cruz's legislation to shift money around and increase the prosecution for felons. i think it's simplistic to say oh we stopped 15,000 felons from getting guns. maybe they went to another dealer that wasn't as precise or maybe they bought them illegally. if he didn't prosecute them you didn't stop them from getting guns. he stopped them at that place from getting a gun. i think what we ought to do is make sure the background checks we have for working in a two think the bill may do a few other things. and ultimately this is the way i look at it and this is my opinion. the shootings at sandy hook, that young man who committed the atrocious murders was not interred at the death penalty. he is not deterred by life imprisonment. he was not deterred by being killed because in the event he killed himself. most of these killers are exactly the same. they are not afraid to die so i don't think if they are not afraid of the death penalty somehow they are going to fear and registration and the gun registratregistrat ion would deter them. they seem to be choosing places that are gun free stones so another thing that i would do is this involves local law and federal law but if i were in charge of that school district i would be lobbying to allow teachers to have a gun locked up in a desk your order to have it. ultimately that is only thing that i know that might have saved lives in that situation. we have done registration of their and the cities with the most significant gun control seems seem to have the most significant crime in our country. >> what is wrong with the concept of universal registration? see the problem is mass shootings by young men gun free zones. registration works for law-abiding citizens. if you look at crime nearly 90% of crimes committed by guns that are bought illegally already. if you look at gun shows i think in 2004 they did a survey of inmates and 1.7 were permitted by guns from gun shows. if the background checks while -- were quite a way endorse what we have got. a lot of things in washington are done as window dressing. it's a dog and pony show, it's a parade and theatrics and histrionics. all of the show people that something bad happened which it did, something terrible and tragic happened and i don't want to in any way lessen that is the response to it is hey give me i did something even though in the end, richard cohen in "the washington post" is not considered to be a right-wing zealots on the second amendment that he wrote yesterday that the background checks won't do anything. you talk about rule of law and due process. can you talk about -- i'm curious what your opinion of abraham lincoln is? >> there is a great book on lincoln called forces of glory by bennett. it's buyer reconstruction republican. here's a quote in the chapter and he says lincoln shouldn't be allowed to write into glory on somebody else's hat. i think he was a great politician but he was not god. he was a politician and came because there were people greater than he was. people i would consider to be greater than lincoln was the abolitionist who pushed emancipation. in the end lincoln was a great president. the emancipation is something to be very proud of. i think our history books, all the description of abolitionists were zealots and crazy and it's a lot more complicated than that a lot of fog the battle for 30 some years. i think the abolitionists deserve more credit than they are given. >> i just wanted to go back to your concern that the whole thing was for trade -- and exception was many points were pretty good but there was that moment where you seem to be assuming the students knew about history. is that an accurate assumption? >> no one i think that was misreported. i simply said something and it was something that i was asking a question. i didn't know the answer. this is my first time to go to a historical black college so i asked them people said you should know the answer but that's part of the reason we were going there is that i didn't know the answer. i said did they know that the naacp was founded by republicans and in retrospect it is a question but republicans haven't been going to howard for 20 years and maybe by going there i'd did learn something and i learned that everyone there knows that everybody there knows here is a good question for you and this is where think it's unfair with the media tries to do to me on this. here's a good example. when the iraq war started after 9/11 they polled americans and they said how many of you or who do you think attacked us on 9/11 and over 50% of the public thought iraq attacked us on 9/11 if you asked the american public and this includes a lot of white people who have and had black history but even some people in u.s. them were the republicans a primary part of voting rights and naacp and ending jim crow and did you know most african-americans were republicans at one time? i was told that in no uncertain terms that i think the vast majority of the public has no idea that republicans helped to found the naacp. some people think it's presumptuous and i shouldn't be talking about it. but we need to talk about it. i messed up on the senator's name and it's like i'm human. i forgot his name. i knew his name but i forgot it. it was in question and answer. i forgot his name. the point i was making that was from edward brock was he was asked about the rich history of their pup can party and african-americans and he was asked, his response was he said well if democrats did it you hear about it nonstop. it was a problem that republicans didn't talk about it. it's harder for me. i'm not african-american and it would be easier for an african-american republican to go rather than me trying to preach to people about their history. it's all of our history. there were whites involved with abolition and emancipation. i'm a little sensitive to some of it in the sense that i think the people who write on one side of it right simply because they don't like republican so anything a republican says, the left-wing media has done that without looking at the facts. i think they are completely wrong on the southern strategy. the southern strategy cemented a change. >> jim? >> i have two questions and the first one is on the immigration bill. i wondered if we could get your reaction to what has now been written and are you now willing to endorse a pathway to citizenship? i use that particular word for those who are undocumented and the second question is will this bill immigration reform help america's drug problem and would it help in the rand paul of america if you criminalize the use of drugs if there is an immigration reform bill? >> the bill is pretty long and last night when i left, and assuming does anyone know if it's on line? we are going to read it is the first thing we will do and that all take a while. there are a lot of details but i will tell you i am for finding a place for those in our country whether documented or undocumented and finding a place for them if they want to work. it's not that i'm going to be doing anything with rules though. conservatives have always said they want want secure borders and the guys complain about the 1986 bill that promised security and we never got secure borders so i will have at least one amendment that will probably have three or four amendments i want to be attached to the bill that i think will make it stronger. it's important for everyone who wants immigration to reform to realize it has to pass to the house. the house is conservative in control by republicans who haven't into excited. in order to get it they need to at least engage with people like me on immigration reform but are on the conservative wing. the amendment i have this trusted and verified and says each year in order for the reform to go forward there has to be a report on border security. this should include the opinions of the governors and the should include the governors -- borders either the fencer border has been secured and should include statistics on how many are being returned to come here illegally and how many people are getting background checks and that kind of thing. that reporter thing should be voted on by congress. i'm not a big fan of administrative reports. we are supposed to get a report on whether they give foreign aid or if they exempted every year. i don't think there is enough really seriousness on the part of any administration. i would haven't voted on by congress. i am for immigration form and as far as a pathway to citizenship the other thing is i think it's important for conservatives to support the bill in a pathway to citizenship. my opinion all along has been that if you are here and you are undocumented and we give you a work visa family of you to get in the same line as someone in mexico city so if you are in mexico city and you want to become an owner can citizen there is a line. if you are an undocumented billion and we give you a work visa you get in the same line. you have a certain amount of years that you try to make it where you don't get in front of someone in the other line. some of this is a rhetorical point but it's important to a lot of people who don't want the new pathway so it's the same pathway with a better chance of passing immigration reform and that's something we look at. you are supposed to show up with your driver's license. no matter who you are you should be run through the work visa database to make sure you are not here on work visa because there are millions of people here on work visas now and they shouldn't be eligible to vote just because they have a driver's license. all of these have an exclusion for welfare but if you are not allowed to ask for check whether you are here illegally are not -- with all the rules guess i'm in favor of it. we will see how many of these things i can get attached to it that i think some of these things will be popular in the house if we want to move them forward. hopefully they will address some of these things. >> you sort of lost over the -- [inaudible] how would you characterize the parties roles in civil rights. >> know if you go up to 1964 new look at it for example there were two civil rights bills in the 50s that didn't pass and kennedy voted against both of them and the majority of republican senators voted for it and the same thing happened in 64. the vast majority of republicans voted for the civil rights act of 64. the southern strategy i didn't mention and i didn't go there to mention that things that don't make us look so good in the republican party. that was one reason for not bringing up the southern judge in the comments by kevin phillips were unsavory and not something that would help us and probably did hurt us in solidifying the african-american vote frankly. my point is they didn't cause that and was or something else you are asking? >> people have told me they think the willie brown ad was racist and people talking about -- reagan talking about welfare queens was racist. what did i say? i do make mistakes. anyway that's what i meant but i think yeah i think there is some basis in argument of some of the tax takes through the years and so i think the other thing is whether it's fair or not fair there is a perception out there by the republican party and this is what it is in general. there is a perception that republicans don't like people of color, black people or brown people or people with different color of skin. that's not true but that's a perception whenever, and the way we overcome that is by showing up and saying over and over again that it's not true. i wanted part of that to be talked about a rich history in civil rights and that's an uphill battle too. i got a lot of grief for having the audacity of mentioning it. i don't know i will keep trying. i don't give up easily. so i will keep trying. >> we have 15 minutes left. we will go to the back table now. >> senator you said you are skeptical of the administration report but of course the bill that the senate -- that's how people get legalized. the department of common security has to submit to reports in six months so you'd sounds like you are skeptical. on a separate point reaching out to hispanic and african-american community? >> yes. i spoke at the hispanic chamber of commerce not too long ago and that was the beginning of what i would consider to be trying to go and talk to -- when i first ran people said you need to ask mrs. smith for a vote and i know it's corny. you tell people who you represent and they go home and make a decision. symbolically that is true with republicans and different ethnic groups where we do not seem to be doing well. to show up into us for a vote, it sounds corny. i showed up at howard and did i get anybody to change their minds? i don't know but i showed up at simmons two days later and one gentleman came up and said he wants to start facebook for rand paul, african-americans for rand paul. maybe that was only one person out of 50 but i think i think overall border security is more important. you talked about whether the executive branch makes determinations on who gets the visas. it has to be part of the executive branch and i'm not completely opposed to that. i'm just saying border security is what they have complained about them what they are fearful of. there are conservatives who will never vote for immigration reform and there are other people conservatives that i think i'm part of that will vote for immigration reform if they are assured and reassured that the burger -- order will be secure. there's a huge amount. i don't think it's a great thing for the house if it takes 180 democrats and 40 republicans to pass over in the house or at the house has 50 democrats on our side in five republicans, you know? i'm looking for a way to make more the republican party come over and in grace immigration reform. >> do you think that's a problem? the very first portion of the senate will is the administration says this is our plan the people get legalized six months after the bill is enacted and do you think that's an impediment as you pointed out for conservatives? >> all the conservatives in the house and the house plan is to do a bunch of different bills. i was a fan of that and everybody said you will never get comprehensive reform. i think everything in washington is rocha and because every bill is too big and every deal tends to be too big. on tax reform tomorrow i would lower the income tax. we can compromise on the number. i would lower to 17% tomorrow. just do it. i don't care people predict less revenue. it would be an enormous boost to the economy and like under kennedy and under coolidge and under reagan when you reduce rates sometimes you get more revenue. the same thing with immigration. we make it harder on ourselves or that the commission, we make it harder when we have 1000 moving parts. it's why the public is upset with us. why don't we ever pass anything and why can't we get along? that will be the sweetener for the bigger deal that we never seem to get so why not break up these big deals into smaller deals? i try to pass the stem technology thesis expanding those. i tried to pacify unanimous consent and schumer came up and said no but how about passing mine by unanimous consent and i was actually quiet. they would have been shocked by that but they would have gotten something done. it would have been great fun to see we passed immigration reform by unanimous consent. >> i have to ask you about grover cleveland. >> if i was allowed to go back to when i wasn't alive, he seemed to be opposed to special interests and the also seem to be -- veto a bunch of bills and i think he it was a time period and i think some would call him a populist. part of me feels that way. >> we can probably get into more. alex and doyle. >> you're raising money for the national association of gun rights and he reported last week this came up for conversation and the steering committee. susan collins was pretty upset about that because the national session is gun rights is running ads and she is afraid it could cost party your seat. are you going to not do that in the future or change your course of action and will you be jeopardizing its? >> when you say raising money i have designed fund-raising letters for them. for me to have a direct connection with the group or talk about what ads they run or not it's illegal for me to call them up and say quit running ads. i can make a decision the future whether i will continue to do it and i haven't come to a conclusion or thought that through yet. but i can say i don't agree with every tactic of every group out there. that includes a lot of grooves. there are three big gun groups, national association of gun rights gun rights american the nra. i am on the side of wanting to protect the second amendment and believe it's just as important as the other parts of the bill. i don't know with regard to that i have never worked against any republican in a primary and i don't anticipate running against a republican in the primary. >> what role we have in the the republican primary and the republican primary and you see yourself involved in a race? >> we got involved in some open primaries where there is an incumbent but at this time i don't have plans to oppose any incumbent republican. >> doyle. >> filibuster was on drums and turned to drones overseas. what is next on your agenda on that issue and the democratic civil libertarians working with you and one particular issue as you know one of the -- is being waved under military force that was passed in haste 11 or 12 years ago. are you working to re-examine that? >> ron wyden is the one i worked with closely on civil liberty issues and the drone issue and he was nice enough to come to the floor in support of the filibuster. he and i continue to work on a range of issues. we worked on the sofa legislation together. we are co-sponsors of a federal waiver for growing in the states and things like that. issues of war and i don't want to talk about his position but we worked on it together. the second -- the authorization of wars. i think we have a chance to talk about this. it will be tricky to see and where we can go with this. senator corker is talked about this in the foreign relations committee. it's a significant problem and part of this thing i was talking about with drones. there are people in my party who think the battlefield is everywhere and the war has no limits and this authorization of force to go to war in afghanistan is for war everywhere all the time without limits. i have a real problem with that particularly when they say the battlefield is here because i do of knowledge that if you are engaged in the battlefield for example in afghanistan fighting soldiers over there we are not going to give them her and her rights. there is no due process in a battle. it becomes more for a question if they are being dinner at their house and a bigger question if they are being dinner in america in a café or in their house so that was a huge question that works after the spectrum and also can you go to war in molly or india under the authorization of force. i would tell you how hard this battle will be. i try to remove authorization of force for iraq last year. the war is over there. the war was already done and the reason why think it's important to take the use of authorization forced back, that's a people's power in congress's power. it's ultimately the people's power to congress but the power is separated and as long as we have a dangling out there we give carte blanche to any president any time anywhere and the debate of whether or not they can infringe upon civil liberties here at home through that for so now i don't think we'll completely get rid of it. what they will do is try to revise it. i am for ending the war in iraq and the war in afghanistan and i would resent both of them. i would have debates over where you want to go again. that is what they intended that we would debate and discuss whether national security is involved and molly is different than afghanistan. the country's universal united. i don't know if the public is entirely united on going to syria molly or libya. i keep saying why don't we ask 1 million christians in syria what they want. they were displaced from iraq because they didn't like the government they got in iraq after the war and are they going to like their new government in syria? some of the christians may object. >> i promised we would be up and moving by 9:25 and i don't think we have time for another question. thank you. my apologies to my colleagues who had another question. we will have him back. thank you. >> my pleasure. [inaudible conversations] >> attorney general eric holder is on capitol hill for hearing on the 2014 justice department budget requests. >> when the war began, the congress came into session in july and issued a statement ever since the clinton resolution that articulated the consensus for goal of the united states. and it was very simple. it was very clear. the purpose of this war is to restore the union and it is not, and it is not to disrupt the social institutions of the south and everybody knew what that meant. it meant not to disrupt slavery. >> abolition of present lincoln 's views on slavery university of texas at boston professor on the political and bigger -- legal factors of emancipation. >> senate finance committee chairman max baucus said the oakland demonstration has to do better job with public outreach and it's implemented a health care law. secretary kathleen sebelius testified about her agency 2014 budget request. the president's budget includes $80.1 billion for hhs, up nearly $4 billion over 20 twelfths budget. this is one hour and 30 minutes. it's the senate will come to order. quote prices what you pay and value is what you get. this morning we are here to discuss health care proposals in the president's fiscal year 2014 budget. as we do we must determine the value it will contain. specifically i would like to focus on the value of medicare and medicaid. these programs touch the lives of more than 100 million americans, nearly one in every three citizens. also want to examine the progress it ministers made in implementing the health reform law. the administration implements it correctly millions more americans will gain access to health care next year as the result of it. these programs fall under the purview of secretary kathleen sebelius. the president's budget affects all these programs. i'm sure you're quite busy madam secretary with just 167 days millions of americans will be able to enroll in health care plans in the marketplace. in short we need to use each of these days to work with states to make sure the marketplaces are up and running ready to help uninsured americans access the affordable coverage. the president's budget request a total of $5.2 billion for program management in the centers for medicare and medicaid services. of this, $1.5 billion will be devoted to establishing and supporting health insurance marketplaces. i'm concerned that not every stage including montana will have an insurance marketplace established in time. i want to hear how the money requested in the budget will be used to ensure those marketplaces will be ready to go. the president's budget also request $554 billion for outreach and education for the health care insurance marketplace. for the marketplaces to work people need to know about them. people to know there are options how to enroll and the plan leading up to enrollment plan that begins october 1. what has been done? i want these new marketplaces to be simple and successful. it will be good for small businesses to focus on job creation and not confusion. more pertinent want to know the plans moving forward communicate the benefits of the affordable care act. i'm concerned that the lack of clear information as leading to misconceptions and misinformation and people generally dislike what they don't understand. a year from hear from people on the ground of montana their views about the impacts of the new rules and how marketplaces will affect their families businesses and i specially hear that from small as this is a montana. they just don't know what to do. i reached out to the montana senate for rural affairs and she is traveling across the state talking to business groups and consumers about the marketplace and she reported few people are attending the informational meetings and those that are expressed a lack of understanding about the marketplaces and what they offer there is a lot of misinformation about haul if is going to work. this difficulty is compounded by the unknown as to what the marketplaces will look like. my constituents don't understand the role because they simply don't have enough information. the administration needs to do a better job. it's not just montana but the family foundation found 57% of americans say do they not have enough information about the law and don't understand how it will affect them. the lack of clear information as leading people to receive incorrect information 40% of americans thought the law establishes end-of-life decisions for medicare. 40% thought that. of course the law does not provide that. the poll found that 57% of americans thought the law included a public option. it does not do that either. the menstruations public information's campaign on on the benefits of the affordable care act i think deserve to be fixed. the budget offers belt tightening measures to address it in the presence budget proposes $379 billion for medicare and medicaid spending reductions. wealthy beneficiaries who pay high premiums. also we shouldn't pay private plans offering medicare benefits the higher rate than traditional medicare and efforts to it -- not reduce fraud because every dollar invested fighting fraud generates 500% taxpayers money received and that is good. but the other qualities that concern me here at i'm concerned the proposed level of cuts to nursing homes may be too high and reduces access to care. also concerns over the presence chained cpi proposal moving to chained cpi not only impacts social security but also reduces payments to medicare providers and increases out-of-pocket costs to some seniors. cutting social security and medicare will hit our seniors with the one-two punch. these chained cpi changes are on top of the $360 billion in cuts to medicare the president specified in this budget. cutting our debt will require compromise and we need everyone to pitch in but we can't do that on the backs of seniors. the plan to reign in budget deficits cannot just because to medicare and packaging tax increases. we need a balanced approach that is federal. demonstrations budget recognizes the need to work with congress to reauthorize the temporary assistance to families otherwise known as tanf. this program is a vital lifeline for nation's nations poorest families. i look forward to working with my colleagues to update the program so it is more efficient job creator and the pathway out of poverty. the path of the budget makes investment of $5.9 billion in early learning including childcare. this will allow us to make sure over 100,000 kids start on the road to success with early education. montana families understand the value of a good education maintain our responsibility as parents and neighbors. secretary sebelius as we think about these issues and the effect on the budget let's remember mr. buffett's advice. the value is what we see but what were receive is what matters. if. >> thank you mr. chairman. last week the president released a proposed budget for fiscal year 2014-ounce of the budget was 65 days late it does not appear did administration gives x. or time to find ways to address the critical problems facing our country. perhaps the most significant fails to address the challenge of health care entitlement spending in any significant way. with this document encourages more than makes up in the same partisan rhetoric and policies. keep in mind cbo director doug elmendorf has stated that her health care entitlements medicare and medicaid are quote fundamentals the school challenge unquote. if this budget is any indication the administration is not interested in taking up this challenge. under the president's budget medicare and medicaid spending will reach nearly $11 trillion over the next decade and mandatory health spending will double from 771 billion in 21321.4 chilean in 2023. that is if the numbers are right although we are projected to spend nearly $7 billion on medicare in the next seven years the hospital trust fund will continue to run significant deficits. according to the 2012 medicaid medicaid -- medicare trustees report the trust fund has $5.3 trillion in unfunded liabilities and it's expected to be insolvent by the year 2024. under this budget to fund will continue on its path to insolvency. the budget also fails to address many problems facing medicaid even though we will be spending more than $4 trillion on the program over the next 10 years. under this budget federal medicaid spending as a% of gdp will increase by 25% from 1.6% to 2% over the next decade thanks to the expansion of the program courtesy of obamacare. it is unacceptable that a program that is the biggest line item in most state budgets crowding out spending in education and public safety is barely addressed. all told we will spend more than $22 trillion over the next 10 years on our major entitlement programs. medicare, medicaid and of course social security. the president's budget will reduce that amount by only $413 billion or roughly 1.8%. no one seriously disputes entitlement spending is the main driver of art debts and deficits yet for the most part this budget has opted to ignore that reality and kick the proverbial can even further down the road. these programs needs serious structural reform if they are going to be around for future generations. entitlement reform is one of the fundamental challenges of our time. it will require an effort from members of both parties. sadly this budget fails to show this much needed courage. we will all be able to come to the table. i believe the president wants to do the right thing but we need action. as you note january 1 i went to the senate floor and then failed five bipartisan entitlement reform proposals, five structural reforms to medicare and medicaid that have been supported by both republicans and democrats in the recent past. i put these ideas forward in hopes of starting a bipartisan conversation on entitlement reform. i have shared these proposals with the president i'm ready and willing to work with him on solutions to these problems. secretary sebelius i look forward to talking with you about these critical issues and i want to thank you once again for being here and thank you mr. chairman. >> thank you senator. welcome secretary sebelius. appreciate you coming here. you have got a big job. tell us what you think and let her rip. >> good morning and thank you chairman baucus and ranking member hatch and members of the committee. i appreciate the opportunity to be with you today to discuss the president's 2014 budget the department of health and human services. this budget supports the overall goals of the president's budget by strengthening our economy and promoting middle-class job growth. it ensures that the american people will continue to benefit from the affordable care act. we provide much-needed support for mental health services and take steps to address the ongoing tragedy of and violence. strengthen education for our children during the critical early years to help ensure they can succeed in the 21st century economy. it secures america's leadership in health innovation so that we remain a magnet for the jobs of the future and it helps reduce the deficit and made allen's sustainable way. i look forward to answering the members questions about the budget but first i would like to briefly cover a few of the highlights. the affordable care act signed into law in march of 2010 is started benefiting millions of americans and our budget their budget make sure we can continue to implement the law. by supporting the creation of new health insurance marketplaces the budget will ensure that starting next january and americans in every state will be able to get quality insurance at an affordable price. our project also addresses another issue that has been on all of our minds recently, mental health services and the ongoing epidemic of gun violence. i know mr. chairman that the senate later today will deal with legislation around keeping dangerous individuals from getting their hands on it done. as a secretary of health and a mother and a new grandmother i hope that the senate gives very serious consideration to that common sense legislation bipartisan legislation that could indeed make this tragedy that is seen every day on the streets across america less than we see each and every day. now we know that the vast majority of americans to struggle with mental illness are nonviolent but recent tragedies have reminded us that the staggering toll that untreated mental illness can take our society and that is why the budget proposes a major new investment to help ensure that students and young adults get the mental health care they need including training of 5000 additional mental health or rational's to join our behavioral health workforce. .. they have a huge potential for improving care coordination of public health. even as their budget invests for the future, it helps reduce the long-term deficit by making sure programs that medicare are put on a more stable fiscal trajectory. medicare spending per beneficiary grew a forecast of 1% thanks in part to eat hundred dollars in savings already included in the affordable care act and the president 2014 budget would achieve my savings. for example, the budget will allow the wind comes beneficiaries to get lowered medicaid raise, resulting in savings of more than $120 billion of the next 10 years. in toto, the budget would generate $370 billion in savings over the next decade on top of the saving are at an care act. today is a time, our budget reflects our commitment to reducing rates across her department. for health care fraud and abuse control or brand, an initiative to save the taxpayers $8 for every dollars last year. and were investing in additional efforts to reduce improper payments in medicare, medicaid and chip and strengthen office of inspector general. the sad story budget by the industry should start of a thriving middle class to promote growth and keep our economy strong in the years to come all helping to reduce the long-term deficit. many of you have questions and i'm thankful for you having me here today. >> thank you, not a secretary. senator hatch, one that you take over one antitakeover inaugurate back. >> secretary sebelius, i am curious as to how your department of funding overall offers now that much of the initial funding has been depleted. a quick review of the hhs budget in brief seems to suggest you are diverting funds from other areas jupiters implementation. some master plan is to manhasset $9 from other portions of the budget. would you describe the authority under which you believe you have the authority to conduct such transfers and whether you believe congress should be notified of these transfers occur. >> senator, we get request additional funding with the continuing resolution in 2013 and were not given additional resources by the united states congress although we have the duty to implement the law. i have for 23rd team can use both a transfer authority, which is cacciatore and our budget as well as the nonrecurring expense fund for one time i.t. cost and its portion of funding for the prevention fund to use for outreach and education. you heard chairman described the level of concern and questions and states around the country and they want to make sure americans fully understand the benefits coming their way and decisions they can make. we have requested in the budget before you an additional 1.5 william dollars to fully implement the affordable care act. the mac federal medicaid spending as a percentage of the economy to the budget that will increase 25%, driven by the affordable care expansion is more than $4 trillion over the next decade and that's not the children for dollars state full text not medicaid. according to the national governors association, medicaid rep since the single largest portion of total state spending. this budget backs up the proposals for lower spending on medicaid such as the blended rate and provider tax reductions. this is especially discouraging since there are bipartisan proposals that would achieve significant medicaid savings and improve patient care. in fact, her predecessor under president clinton, donna shalala said medicaid per capita cat being dare i know i sent his first dates people who need medicaid are able to receive it. your fiscal year 2014 budget only purpose is to save one half of one man? reforms to the medicaid for program. one of the countries fundamentally most serious charges. >> senator hatch, there is a very positive tori to tell about medicaid and is a former governor, i am dealing with my former colleagues >> last year between 2011 actually decreased by 2% per beneficiary. that is virtually unheard of and we are engaged in a series around the dual eligible population and individuals you referred to in nursing homes around progress on reforming high quality lower-cost medicaid health care delivery working with states engaged in with states to the best, which is innovative strategies that can at the overall health care spending. i think the medicaid story is enormously positive, work governors are very much engaged and we been placed at the number of governors who are interested in expanding their population and providing health benefits for some of the lowest income workers. in a cost effective strategy. >> i'd be happy to work with you on not. >> thank you, mr. chairman. >> the sign-ups and exchanges the veteran and are very concerned and not enough is being done so far. very concerning. i am home. small businesses have no idea what to do, what to expect. they don't know what affordability rules are and what penalties may apply. i was talking to one cpa pa just been straight with me said i've got to tell you, my client, small-business people are throwing their hands up and i don't know what to tell them. just turn a small business perspective, let alone would be arising here. as i discussed earlier and as you well know, a lot of people have no idea about this. people just don't know a lot about it. a kaiser poll pointed that out. i don't know if that's money down the rain because contractors like to make money. that's their job and worry about shareholders and what not. another agencies are all involved. people will be really confused. look at some to someone stop shopping to get the answers. i just value, i see a huge train wreck coming down and i don't see any of his elves. all these cheap on the country wondering what in the world we do. >> mr. chairman, as you know and we've had these discussions the number of times, we certainly take outreach and education theories. it's one of the reasons we were incredibly disappointed for additional resources. they were not made available in the cr 2013. having said that, we are engaged at the small business administration who is doing regular meeting around the country with the original person now. we have just released a request for proposal from the ground they will be weakened walk-through scenarios, we do regular seminars and webinars, but we also understand people and deploying resources to answer those questions and get folks to gauge an open enrollment on october 1st. >> to have benchmarks? states by which a certain number of people know what going on. all these polls so we are not making much headway. do you have a cold that 30 days from now the sample is taken to ask% and people know where to go on what to do. are you surveying becomes proficient with businesses to get a certain% to feel confident? you need data. you'd never given me any data. just concepts frankly. government is not a business, but she have to have some data benchmarks to figure out the progress you are making. >> we do have benchmarks for how many people know what they don't intend pulling and testing in terms of what people know. we do have specific benchmarks around open enrollment, have the campaign and plan to lead up to enrollment. >> what is it? >> mr. chairman, there's people on the ground this summer. >> i can't tell you. >> what point in the summer? this is the kind of information i'm asking for. they're only going to do a decent job if you know the answers to these questions. >> i'd be happy to give you specifics. but just put out the request for proposal. i can't tell you the numbers because we don't have the information back about how many people in which states are going to be actively engaged on the ground, but i'd be happy to share that with you as we move forward. >> there's a lot of factors here. >> the request for proposal at this point is on the state for marketplaces will be in place. >> with the navigator class >> an individual who will be available to help educate individuals or groups of people. >> how many people know what a navigator is quite >> i have no idea. >> we have to a year. i'm going to keep on this until i feel better about it. thank you. >> thank you, mr. chairman. madam secretary, thank you for your public service. back when it passed the health care bill on this committee, i was formally an austrian amendment that there is great angst taken in the white house for my amendment, which was that the federal government in paying for drugs for medicaid recipients, when they became 65 years of age were eligible under medicare for their trucks with the prescription drug bill, but lo and behold the taxpayers of america were not going to pay for the price of the drugs with the discounts or rebates they paid with never 64 years of age, but when they turn 65 they got their drugs under medicare and we were paying premium prices for the same drugs. my amendment was defeated 10 the third team and a very strong position was taken by the white house and opposition. the president has reversed course in this budget. when i offered the amendment saved $117 billion over 10 years. now it's 123 billion savings in the president budget and cbs quarries at and says it is something in excess of $140 billion. why the change? >> while senator, the wisdom of your original proposal has finally been seen and there's no question again. you and i have worked at the state level in prayer lies in having negotiated medicaid rates as a governor and then having that same individualized the same move into it premium class didn't make a lot of sense and particularly looking to not only save dollars in these public insurance programs, but dollars for the individual who is responsible for part of the tribe benefits. this proposal captures what you're trying to do years ago. and will save these important programs send significant dollars at the state and federal level, which is all good news. >> you know the attacks against the president proposal and the amendment for your sick i was going to refuse research, limit access, going to resolve in prices. how do you respond to those attacks? >> well, i think we have a pretty good track record and medicaid negotiated rate and a wide variety for drugs available in the medicaid program and there's no question into a eligible population, the 9 million americans are often the most expensive population in any program in any state of the country. having a sensible and proven way to lower some costs around the population are not slashing benefits is a win-win situation. >> madam secretary, were losing a lot of money to medicare fraud, medicaid fraud as well. we're going to be having a hearing on this in the aging committee. can you give us some sense to see that we're going to be making any progress, what new activities are trying to stop this hemorrhage gene of all the money? it is so bad in miami that people open up a storefront and there's no lack tvd and they start really medicaid. just recently there was a person down there that was the line, ended up getting $50 million for mental health services. that is one way to save a lot of money. >> senator, i could not agree more and that's one of the reasons the president budget has asked for additional mandatory fraud resources because we have a very good story to tell. the president asked the attorney general and meet to allocate the anti-fraud effort to a cabinet level. we created a new joint task force and fortunately, you live in your state are the hot spots in the country. we have implemented a variety of strategies, more prosecutions, more money than ever before and in fact we doubled the amount returned to the medicare trust fund and medicaid beneficiaries. in addition, implemented with credentialing for some of the known areas where providers serving during the program and filling. we have a much fair standard in the first place and implemented a computer-based system to track the billing irregularities the same way a credit card company could go after someone has church i buy a flatscreen tvs from two by tear credit card and they can call you in advance full text the payment going out the door. we finally have the capability within the medicare system that never existed before. i think the story is good, but there's a lot we could do. returning $8 for every dollar we spend is very good news, but clearly this is a huge program. thousands of providers, millions of dollars go out every day and we take fraud and abuse incredibly seriously and want to use my resources to beef up the efforts that have proven successful. >> mr. chairman, in closing i would say all the new doctors need to implement the health care bill we can't keep cutting graduate medical education, which is medicare subsidies for residents and that is happening to my state. it is happening two years date, nevada and that is inadequate in the president's budget. thank you, mr. chairman. >> thank you, senator nelson. >> mr. chairman, could i be so rude to interject here that street i let them take one question not of my time. i have to leave, too, but one relevant point with regard to chairman baucus' question on the navigators. he was the composer of the secretary. >> madam secretary, so excited about navigators. whereabouts were at 50 for $9 to hire navigators in the states but the exchanges it is that correct? get cms rule hamas ratio is putting agents and brokers to put them on a business because that's the ratio. we're cutting out most of the people who provide services in the air, which cost the government nothing. that the legislation but ms. landrieu and others to amend that as we need to revisit the medical loss ratio will and see what effect it has on people getting credible information to make a living doing it and have for years. >> senator, i would be happy to take a look at the legislation there is no prohibition at this stage model we certainly have not nominated the ability to do their jobs and bring people into the insurance comes in a test i had for a lot time. it deals with what is characterized as medical costs, as overhead caused that the world does not include an agent and broker salary or commission as part of what is characterized as a medical costs. >> i appreciate your that keen on it because it's supplied, what it basically does this preclude people from being compensated by the major ratio applies. >> they could easily be in 20% of overhead. it's basically 8020, they have to go to medical costs. >> i think the senator for his question and as secretary will take in a hard she certainly has that background. madame secretary, 83 hospitals are designated critical access hospitals. in the budget on page 53 i notice we are going to take a whack at the critical access hospitals, medicare reimbursement rates and there's some mileage requirement. number one we had somebody at that point btw. i hope we don't go back to that. we look at the critical access situation to chairman committee and a lot of other rural areas. on page 56 of the budget, there's a line here. i think we probably be at odds at that. they will set the reimbursement according to a formulary. it's a growth rate to meet the target and josé 4.1 billion out of the crypto access hospitals in regards to are not even set up yet. i just don't understand if they haven't been set up and we have no idea how the recommendations are going to be and we are going to expand and strengthen. i wish he was a kid and see if we could get back to us. i apologize for having three questions to you, but because of the time on that, i wanted to cover these three. about 53 people have died and over 700 people have become alice result of the meningitis crises. the fda has put forward a proposal on my blog and city funding is necessary to support the inspections of other oversight at today's in the framework which will include registration or fees. and so are other members of the committee that it be held close to guarantee the efficacy of the program and access to compounding. it's not mentioned in the president's budget that i'd like to mechanic at a cost estimate. if you could provide that with a legislative proposal put together by the commissioner, i would greatly appreciate it. if you could comment on matter anything else i brought up coming of got about two minutes. >> first of all of us at a specific cost estimate for the very important legislation you and your colleagues are working on with the food and drug administration, which would give additional authorities over the nontraditional compounding and make sure traditional compounding can move forward. i don't think the fda has a legislative proposal that is specific. they been working around principles, so that may be part of the confusion. i think they've been providing tech go assistance to the house committee. i will see where we are on a dollar recommend a shame. the president has recently sent to the leadership of the house and senate majority and minority requests for recommendations for potential candidates at the president is making appointments in consultation with the house and senate, so letters have been received by leadership. the president's budget does suggest the independent payment advisory board would not kick in unless medicare spending exceeded the inflation by more than .5. we don't anticipate that would hit until about 20 night team on the track that we are on. so we are in the process of consulting leadership around, but as you know, members would have to be confirmed by the senate, so there will be multiple stops before the board would ever occur. i'll share your concern about the incredible importance, particularly in communities that will take a look at the specifics of the budget ended back in cash. >> appreciate that. thank you. >> thank you, senator. senator casey. >> thank you for the great public service is up for the hard work you doing with regard to health care and other responsibilities and appreciate the time prior to the hearing. as a preface to that, wanted to note in the budget a couple of highlights, some achieve party referred to, but the price of the budget that focus specifically on children bear mentioning. the home visiting program as well as early had starred in the childcare partnerships, both of which he set forth on page four. the childcare quality find and fatherhood initiative are so important and i want to commend you and the department for that. i know that nih, the proposed increases for hundreds of anyone in dollars is commendable and necessary despite all the challenges we had it for not investing in making big mistakes. i wanted to focus may be two questions on children, first with regard to the children's hospital graduate medical education program. i am told we have three great examples in pennsylvania, to infinitely, one in pittsburgh and then saint christopher's in philly. i am told these hospitals comprise less than 1% of all hospitals, yet trained nearly half against 49% of all pediatricians. this is a budget allocation, which has been in the six-figure millions in the proposal in the budget is just $88 million in funding for the program. and therefore not -- i don't know how were going to get to train pediatricians we need if we don't have that investment. if you could give us the rationale for that 89 and. >> seminar, first of all i don't disagree at all of the children hospital provide not only incredibly important surveys and health care for children, but also training opportunities for pediatricians for doing double duty. what the president's budget reflects his graduate medical education direct costs. what is eliminated for the recommendation is the overhead and administrative costs, we feel that a sufficient to children's hospitals operate frankly had a more significant margin than other hospitals to end it is not a choice he would have made him better budget times, but providing a number of residency spot currently in hospitals is one which make sure we train pediatricians for the future. >> i hope we can spend some time on that because when you have that small% of hospitals providing that level of training, we should go back to work on that somebody can spend some time on that. i also wanted to ask and i raised a similar question or two with regard to the confirmation hearing. as it relates to how children will fare in the exchange is and how you see the department's row on the impact of children or the impact on children with regard to the exchanges in making sure if a child but under different circumstances get a particular level of care, that they'll still get the same kind of care and treatment under the exchanges. >> it's a great question. senator, the chip program, which does software enhanced benefits for children missing out 10 years to exist. one of the benefits for children is an indirect benefit, but can be very real is there is a lot of evidence that indicates that parents have insurance, children are more likely to go to the top rhetoric as a basis. in spite of the fact that a child may have access to services at the family doesn't have family coverage, the likelihood of accessing services is diminishment. there's some value-added benefit around family coverage that don't exist that will be a case in the future. while the exchange program will not have a specific mandated package of benefits for children, but i think that's exist in commercial market right now, particularly the employer market model that the benchmark plan is a robust set of services around children's health and is fair because an employee demand. we are working with you in your office and working out for america's children and one of the areas if you've taken a great leadership role on estes plans are implemented. >> i appreciate that. i hope that some of the benefits play out for families that will have a positive impact, especially children with chronic and complex medical conditions. >> certainly the medical home model uncoordinated care model both offers some enhanced benefits for children who have chronic or multiple conditions. right now, too often the cary segmented into a variety of specialist who don't talk to one another or may not coordinate with families. testing some models around chronic conditions, what people often think of it as an older americans issue, there are cases where it will be of enormous and if it to some of our youngest patients. >> thanks very much. >> senator clerk. >> thank you, mr. chairman. adam secretary tommy thank you for their service during a difficult time. i want to bring up a couple subjects of subjects in recursive implementation of the affordable care act would've answered those schools. shortly after passage of the act commune i had a chance to talk about the commitment made to health disparities. the elevation of the institute at nih and the office is another other relevant agencies, including hhs. you made a commitment then to adequately fund this initiative semites and a thank you for following up on this commitment. there is some concern today as to whether there is adequate support to implement the type of grantmaking in the offices, including your office for minority health and whether the institute at nah has adequate resources in order to make the type of progress food like to see made as a matter of what is a policy for this country can you give me an update as to how your strategy is implemented to fund this commitment? >> yeah, senator there's no question we have taken seriously the charge to not only track health disparities, but reduce health disparities. the passage of the affordable care act and the full implementation they think will advance that cause probably faster than any other single thing we could possibly do to close the gap in health coverage. having said that, while the budget in seven of the offices of then the secretary's office may have a reduction of some grandson, they have a significant increase in funding for minority health issues and one we take seriously. there are an additional couple hundred million dollars within the nah. unfortunately, nih funding does not increase significantly as we would like unveils the last $1.5 billion through sequester kies. we are in a room more restrained situation that we would he otherwise would not only a tight budget moving forward, but a phase if it can cut in their grantmaking authority that hit in 2013. >> thank you. i understand the challenge of sequestration and i would urge us to be a strategic as we can to make sure the server. i'm going to make a request of you to personally take a lack of regulation issued by surveys to pediatric dental care. before this committee i question her and submitted questions for the record. you're in the process of implementing a regulation that would allow for stand-alone pediatric dental policies that have separate deductibles with no assurance that in fact individuals will have that coverage. both of those actions by hhs are contrary to the intent of congress, but to the legal ability to issue such regulations. we intended pediatric dental would be an essential benefit companies people have affordable coverage. his $700 to that poll is not a quality plan. it is second-class coverage. those families will not reach $700 a year. by the date then buy insurance, it is not going to be required? that is contrary to law. i would ask of you personally reviewed this regulation and the legal basis and make an independent estimate do you believe this is the right policy to take as it relates to pediatric dental. >> some manner, i will commit to do that. i know concerns have been raised about what is a proposed regulation. the comment. it's very much up in, so this is not a settled formula going forward, but i hear your concerns and i will commit to taking a personal lack of exactly what the impact would be on the families want to serve. >> thank you. i appreciate that. >> thank you, mr. chairman. adam secretary, thank you for being here. i have worked with several colleagues on a white paper issued yesterday and outlines concerns about the electronic health record program created by the stimulus bill and one of the chief concerns is the program wasn't thoughtfully planned in cms are insufficiently focused on the issue of nr operability. i'm also concerned the office as if the loss be focused on the blue crocheted federal taxpayer dollars out the door and using the dollars out the door as a measure of success of the program without sufficient oversight of those payments. i'm wondering if you agree with that. >> i do not. >> is noted in a report that the fighters self-report they've met the necessary criteria to receive payments for adoption of health i.t. with no documentary evidence necessary. few regency's office has warned this is a potential problem. he issued a report saying medicare does not verify the accuracy of the self-reported information they hope providers, claiming incentives prior to the payment and even a few examples of providers who reported themselves eligible but have not met the requirements. my next question is, do you agree self attestation is a problem in terms of them certifying themselves eligible? >> senator, we take the adoption of health records seriously. i can imagine any industry which represents close to 17% of our gdp, which is trading information on paper files. this is a significant move forward. we have a third of individual providers with another third in the? and two thirds of the hospitals in the process of adoption. i think what has to be attested to my understanding of the firmly able to be tested more thoroughly on the interoperability standards go live in 2014 and meaningful stage to is not up and running. it is sort of the gold standard of electronic health records. we understand that, but it is not life inventing and has been the focus of the policy committee and production committee from day one. >> in response to questions from this committee, the nominee to head cms commented there would not be debate implementation. given that it seems clear that lead to interoperability is not possible from the existing requirements from stage two to stage three. what are your plans and ensure taxpayer dollars are white lady addressing operability. >> we haven't gotten to implementation comest you are are reading the final chapter before relaunch it. january 2014 is in the portion of stage two that joseph meaningful use of be up and running and i think we have four plants in and a timetable to move to stage three, but we don't right now have a plan about what coder could not happen because we need to fully implement stage two. >> aren't the rules final for stage two? >> the timetable hasn't been reached. >> this is the leap from stage to requirements with regard to interoperability. the challenge faced by a lot of rural providers. the next question is what are you doing to ensure rural providers needs are being considered in terms of stage two of ultimately stage three. >> senator, part of the framework of this implementation was really to create a gourmet chef and technology exchanges in every part of the country. they are focusing most specifically on critical access hospitals, knowing the luxury to have a big i.t. department for people that can implement this in a significant. time were not there. in every state, there are individuals that i compare them to the farm extension services, folks on the ground is literally come office to office, hot adult hospitals spend time how to convert the best strategies, how to be engaged and involved and we have found in a state like kansas, which is not terribly different from the challenges you seniors date that strategy has been enormously effective in small providers are engaged in unrolled with this extension operations and finance to be their service team on the ground. >> the only thing i would say is i hope that as we move forward with this but the focus really will be on the issue of interoperability. we've asked questions numerous times at the committee of folks who testify in front of the committee about what is happening. maybe a lot of providers create their own health electronic records, but the idea somehow they will communicate with others seems to be nonexistent in many cases. you've got the stylus out there, but until they talk to each other, we haven't solved the problem it seems like a focus that's gone out the door seemed to be the matcher eric, what is the matcher eric are the measuring stick or whether we succeed for interoperability. >> i would say again and certainly agree with you that has to be the north star of other records for coming up with a paper files are in somebody's computer, but whether you can share information not only across the state, but the country and conceivably across the globe. so that has been part of the framework of the formula to look at what sort of i.t. systems will qualify, with the specs have to be. it's part of what has to be attested to the conversion to electronic records system has to have the capacity to get to stage three and demonstrated as not to be part of the operating system from day one, but has to have capacity to have that on. there are specific specs as a part of what qualifies. that has been part of the technical committee that has been an adviser to the office of national coordinator from the beginning has been focused at the end of the day you make sure systems work. we were strongly advised, senator and cannot dismay of some of biggest i.t. companies, but we were strongly advised not to choose one system not to have one winner in this market and everybody else they lose their, but rather to focus on a series of specs i would make sure systems are inoperable but allow providers to make conversions of the systems they have corp. purchased in a variety of new equipment and that's been the framework to have a more open source, but certainly with interoperability at the end of the day. >> i'm glad to hear you're focused on the specs. again, the self attestation model used seems to lack the kind of documentary evidence the folks who are eligible are actually focused on the straight matcher accenture talking about. the only thing i would say we look forward to engaging with you in your anonymous and will continue to solicit feedback about where they are in this report we put out the put a fine point an additional focus on it. >> thank you, senators dan. madam secretary, appreciate that very much. also, thank you for the president's budget estimate of eight to 1 billion for mental health programs for substance abuse and mental health services and the mental health block grant services will go a long way to help states deal with these issues. very much appreciate that. wanted to follow-up on my colleague from pennsylvania's question is related to graduate radical education. this is a big issue for all of us with the shortage we're looking at. something like 90,000 specialists and primary care physicians by 2024 s., washington, wyoming and idaho are even below the national average, so that's what he cares so much about the issue. when it comes to figuring out the impact on children's hospital, which i could say the same about seattle's children's hospital, but the issue is trauma centers at harborview hospital. when you look at this reduction and indirect medical education, and impacts the work force. they have residents they are not reimbursed for hundreds of model. how do we look at this issue when there specialized training that goes on at trauma centers. how do we look at those and make sure these facilities can keep running and operating during the time. >> again, senator, certainly the training of new doctors is of critical importance that we know what an import role graduate medical education funding through medicare plays in the training, which is why i would say in difficult budget times was an attempt to make sure funding the direct cause as well as an additional lack that where there were real gaps in services. a lot of the workforce analysis that could power it indicates it is in primary care providers, gerontologists, either as we often significant gaps. we have not only try to have a budget that supports the direct cost of graduate training, the shift key on yours gme spots are areas where focused on peschel t. care into primary care, pediatric care, hoping the answer to address people's preventive care needs at the front-end movie that with a health care provider. we would be interested in working with you in hearing about your hacktivists on a critical center burned center and trauma centers in your area. >> thank you. i think people are concerned that will be the intended consequence because those costs are covered. if you could comment to the university of washington we try primary care physicians. we are also very high on the list in the top five institutions with nih funding. the nih budget issue is a big issue that we understand what she's done. obviously institutions hoping to get closer than you think that is close. why does that matter? the economic research, 8800 jobs and wages. this would be a big impact to us. one of our professors was quoted asking whether i should leave science, end quote. given what is in the budget and what is discussed this fire sequestration, i would have been a chilling effect on the investment of time and in what we can do to mitigate the sequestration impacts on nih funding. >> the president has proposed a budget going forward and away to have a sustained and balanced approach to reducing the deficit, but making critical investments

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