Fourth year and the future years, they can actually utilize what is already being used in a local property tax or sales tax for these low income people. For these low income people. So, what i would ask, if the state chooses not to expand , what wouldto 138 you think the department would plan to handle be states rick states request to continue with business as usual . Senator, with regards to the specifics of the discussions thaten hhs and the state, is something in my current role i am not familiar with. What i can talk about is the philosophy of how to think about these issues in terms of medicaid and medicaid waivers. There are a couple principles. I think it is important starting the conversation to be clear about what the fundamental Core Principles that are essential to implementing our, whether that is the Affordable Care act or state waivers other states may be applying for. I think the second thing that is an important principle is flexibility. Differentates have situations an
That is important to point out. Im discussing changes that will be there for my generation. People will have to except that are Social Security and medicare will be the best in the world compared to other countries, but it will look different. It will look different because it has to and because we will work longer and live on her. Makee going to have to that change. That is a choice we will make. If we dont, all i can tell you is that these programs will not exist as we know them. Socialstion is not if security will be reformed. It will be, one way or the other. The question is whether it is performed in a way that is productive or distractive. Or whether they are reforms in a chaotic way. As you would expect, your remarks have generated questions on other topics. Week you rejected the assertion that human activity is causing climate change. Action taken to curtail this activity will destroy our economy. How do you propose that the country deal with the impacts these ships could have
Diseases for those who have run out of other options. It includes the National Institute of health, the fda, the center for medicare and medicaid. Cms is the Largest Health insurer with an annual budget of 800 billion dollars. I believe you have the qualifications to do the job, but there is much that you will need to do in order to assure members of the committee that hhs is heading in the right direction. It is a turbulent time that lies ahead. One of the greatest challenges shoring up the exchanges and making sure that they are operating efficiently. Recent reports of the numerous issues faced by the state exchanges at something to implement the law have been cause for great concern. States are required to have a Healthcare Exchange where citizens can go and shop for Health Insurance. They have the option of starting their own exchange, using the exchange provided by the federal government, or in hybrid will stop they are determining what type of exchange to implement. Were given in
We have seen for the past five years. My question is this. Do you think it is possible for you to change the by any means necessary culture at hhs that some of us in congress of you as bordering on lawless . , thank you. Harkening to my experience at the office of management and budget, there are challenging issues. Ais, iook around this d have had the opportunity to talk with you on a number of things that are positive and difficult. That is something i consider it my responsibility to do. I hope people feel in my role at omb that i have done that. Whether that is moving to more timely responses, the regulatory agenda is sometimes a controversial thing. Since i have been the director of omb, we have been on time getting that out in the spring in the fall. The midsession review, a document with a lot of numbers and some may use this way some may use another. It came out a week early. That is something where i did not wait for congress. I hope that there will be direct communication if
At a point of pause in the direct negotiations that were going on for the last nine months. And we have made clear and my message to both sides was that the only sustainable solution to this tragic conflict is yet a negotiated twostate solution. That is our view. That is the position of both sides. But they are not yet ready to take the steps, i think, to actualize that. And also we have underscored in the meantime as we manage this moment of pause and as they manage this moment of pause more precisely they ought not to take steps either of them that make the circumstances more tense or more fraught. What has happened the last several weeks is that some of the u. S. Officials involved in those negotiations are now saying that it was the israeli governments expansion of settlements, specifically Prime Minister netanyahu to build 14,000 more Housing Units that sabotaged the peace effort. I think you have heard american Officials Say quite directly and what i have said and what others hav