Otherwise have had it. People who have preexisting conditions no longer are canceled or cant even get insurance, the doughnut hole is gone. Millions of people in lower income categories are now insured through medicare, millions and millions and millions. Cost containment is beginning to work. Its beginning to work. The increase in costs, that rate is going down and so is youre livid because its getting better. Thats why youre livid. And im not surprised at yurour your fervor. We will be glad to take it on. We will be glad to take it on. And i think you just need to understand what this experiment is all about. It was combining increased access to medicare, to medicaid, with an increased reliance on the private insurance sector. Thats really what this is all about. An experiment. And you talk about government control . More and more people are getting insurance through the private sector. And the states that are denying their citizens further coverage under medicaid are essentially telling people well, get lost when it comes to health coverage. Get lost. And you have a governor, mr. Chairman, who is running around this country talking about the evils of healthcare when millions of people are benefiting from what happened. So you decided to turn this from budget to aca. Welcome. Welcome. Your frustration is millions and millions and millions of people are benefiting have healthcare when they did not before. So madam secretary i think theyve thrown down the gauntlet. I dont think you i dont feel sorry for you. I think you love this job and you like being the person who is administering this experiment in Greater Health coverage after 70, 80 years of nothing being done in this in this town or throughout this country. So i happily welcome you because i think youre a very happy warrior. I yield back. Id like to recognize the happy warrior now for your Opening Statements. The floor is yours secretary burwell. Thank you. Chairman ryan, Ranking Member levin and members of the committee thank you for the opportunity to discuss the president s budget for the department of health and human services. I believe firmly that we all share common interests and therefore, we have a number of opportunities to find Common Ground. We saw the power of Common Ground in the recent bipartisan sgr fix and i appreciate all of your alls efforts to get that work done. The president s budget proposes to end sequestration, fully reversing it for domestic priorities in 2016, matched by equal dollar increases for defense funding. Without further congressional abc the sequestration will return this full in 2016, bringing dis regs naer funding to its lowest level in a decade, adjusted for inflation. We need a whole of government solution and i hope both parties can Work Together to achieve a balanced and common sense agreement. The budget before you makes critical investments in healthcare science, innovation and human services. It maintains our responsible stewardship of the taxpayers dollar, it strengthens our work, together with congress, to prepare our nation for key challenges both at home and abroad. For hhs the budget proposes 83. 8 billion in discretionary budget authorize. This is a 4. 8 billion increase which will allow our department to deliver impact today and lay a Strong Foundation for tomorrow. It is fiscally responsible which in tandem with accompanying legislative proposals would save taxpayers a net 250 billion over ten years. In addition it is projected to continue slowing the growth of medicare by securing [ inaudible ] in savings as we build a better, smarter, healthier Delivery System. In terms of providing all americans with access to quality, Affordable Healthcare it builds upon our historic progress in reducing the number of uninsured and improving coverage for families who already had insurance. A recent example of this progress is the 10. 2 million americans who are currently enrolled in Health Insurance through the marketplaces in 2015. The budget covers newly eligible adults in 28 dates plus d. C. Where expanded medicaid and it improves access it to healthcare for native americans. To support communities throughout the country the budget makes critical investments in Health Centers and our Nations Health work force, particularly in high need areas. To advance our common interest in building a smarter, better healthier Delivery System it supports improvements to the way care is delivered providers are paid and information is used. To advance our shared vision for leading the world in science and innovation the budget increases funding for nih by 1 billion so advance biomedical and Behavioral Research among other priorities. It invests 215 million for the Precision Medicine initiative, which will focus on developing treatments diagnostics and Prevention Strategies tailored to the individual genetic characteristics of individual patients. To further our common interests in providing americans with the Building Blocks of healthy and Productive Lives this budget outlines an ambitious plan to make affordable quality child care available for working families. To keep americans healthy the budget strensness our Public Health infrastructure with 975 million for domestic and international preparedness, including critical funds to implement the Global Health security agenda. It also invests in Behavioral HealthServices Including more than 99 million in new funding to combat description opioid and heroin abuse dependence and overdose. Finally, as we look to leave our department stronger, the budget invests in our shared priorities of addressing waste fraud and abuse, initiatives that are projected to yield 22 billion in gross savings for medicare over the next decade. Were also addressing our medicare appeals backlog with a coordinated approach we are pleased that the Senate FinanceCommittee Last week passed Bipartisan Legislation and we look forward to working with this committee on t i also want to assure you im personally committed to responding promptly and thoroughly to the concerns of members of the committee. I want to close by taking a moment to say how proud i am of the hhs employees from their work combating ebola to assisting unaccompanied children at the border, the commitment that they show day to day day in and day out as they work to help their fellow americans have those Building Blocks of healthy and Productive Lives. I look forward to working closely with you to advance our common interests on behalf of the American People. Thank you. Thank you. Let me first start off by saying where we agree with the administration, we work with the administration, this weeks action on trade is a perfect example. But on this healthcare law we could not be more opposed to what the administration is doing. We really think this is doing a great harm to the Healthcare System and to the people we all represent. So let me start by just addressing the big elephant in the room. Any day now the Supreme Court as you well know because your name is burwell, in king versus burwell, is about to rule and if the court rules against the administration then millions of people will be stuck with a government designed Health Insurance that they cannot afford. So, i mean, the big question is then what . What about the people who are going to lose their subsidies, and possibly their coverage . Is the president going to dictate to us how to fix this flawed law or is the president is the administration, going to be willing to work withes us to give families greater freedom in choosing the healthcare that work best for them . So with regard to the question of the courts, i think you know we believe that we are implementing the law as it was written, as the statute is written, as it was intended as cbo has scored it for all these years, as recent articles have reflected that those that were part of writing the law indicate that it should be. The idea that citizens in the state of new york should receive federal subsidies that taxpayers contribute to and citizens in the state of texas is should not is not what we think the law inn i understand your opinion on what the court ought to do but it stands to reason that theres a pretty decent chance that they may not go your way. So the question then is then what . So if the court does decide and if the court would decide for the plaintiffs in the idea that the court would say that subsidies in the federal marketplace are not eligible those states that are part of the federal marketplace, that those citizens cant have those subsidies, if the court makes that decision, were going to do everything we can and were working to make sure we are ready to communicate to work with states and do everything we can, but the rhetorical decisions, if the court says that we do not have the authority to give subsidies, the critical decisions will sit with the congress and states and governors to determine if those subsidies are available. So here is the question im trying to get to is the president going to stand up and wave i have a one sentence fix, take it my way or the highway . Is that going to be administrations position or is the administration going to be willing to work with congress to find a way to give people more healthcare freedom . . Thats the question im trying to get at. With the question of healthcare freedom it is it is important to reflect the marketplace is a market, it uses private insurers, people that sign up in the marketplace are not on so they have many choices. As a matter of fact, in the marketplace this year there were 25 more plans. Thats more choice thats more competition, that is why let me ask it this way because i want to be kind of everybodys time. Let me ask it this way, if the plaintiffs prevail, if the king side wins and then the exchanges are deemed unconstitutional, not legal in the federal exchange states, then the individual mandate is effectively struck down for those taxpayers in those states. Is the president going to say reinstate the individual mandate . Ive got to tell you its not real popular and we here at least on this side of the aisle arent eager to reinstate the individual mandate, we would like to free people from some of these mandates. Id say that the administration has been a little twosided on this particular issue, mandates, where youve delayed the employer mandate twice. That goes away as well. So is the administration going to take the Position Congress must reinstate this thing and all these 37 states reinstate the individual mandate reinstate the employer mandate my way or the highway, or is the president going to be willing and flexible to work with congress to fix this mess and negotiate with congress . Thats what im trying to get at. I think its actually very important, though, with regard to the decision before the court, the decision before the court is who receives subsidies and whether or not those subsidies can be given in states that have a federal marketplace versus a state marketplace. We understand that. That is the decision and that is the openly decision before the court right now. Okay. So so with regard to what happens if that decision occurs. Yes. Three things occur. The first thing that occurs is for the people secretary burwell, we know what will occur we all know this. The question is what will the administration do . Will they stand up with one piece of paper and say my way or the highway or will they work with congress to address this the situation . So the problem that occurs if the Court Decides against us is that they have made a decision that the subsidy youre not going to answer the question, are you . No, the answer is the problem that gets created is subsidies arent available they arent available for millions of americans, they lose their insurance, it drives up costs in the individual market. To solve that problem the critical decisions are going to sit with the congress. Okay. Right. Or states. For a bill to become a law, house, senate, then the person at the other end of pennsylvania avenue, the president signs that law. Is the president going to come out and say only my way or the highway, one sentence one page fix, or is that president of the United States going to be thinking less about digging in and defending his law as exactly written or is he going to be willing to actually teal with the issue which is Affordable Healthcare for millions of people who are losing their Health Insurance, is he going to work with congress to address this situation or is he going to put concrete around his ankles and say its my law or nothing . Thats the question im trying to get at. So the president and we have said the administration has said all along with regard to improvements and we believe that there are improvements that can be made, we look at three things and a fourth underlying. Affordability, access, quality and the issue of how it affects the deficit and our economy. We will look at anything and have that conversation. Okay. With regard to the specific that you raised i do think it is important, the issue of the individual mandate that is related to a very fundamental part of the system which is preexisting conditions. It is our experience at least it in my conversations across the country that most americans believe that you shouldnt be kept out of insurance or banned. If i have a child that has a condition thats born with a particular condition that i shouldnt spend my time worrying that that child will never get insurance once they go off mine mine. Youre going off topic. Im going to cut you off there. We both know there are ways of dealing with those problems without having to impose an individual mandate. Let me leave it there in the interest of everybodys time, mr. Levin. Well im not surprised at the tone, but i really think it is so counter productive. Chairman, you talk about twosidedness. The two sides when you say you worry about the millions who will lose their insurance when its your allies who brought the suit that would deprive them of insurance. You talk about about concrete, having feet in concrete. Thats exactly where youve been in terms of aca. Your feet have been in concrete while you have you have brought up bill after bill to try to destroy aca. And when you say will the president be my way or the highway, thats precisely what has been your approach to aca. Precisely. Youve never sat down with us to say how could we make some changes. Instead, you have been out to destroy aca. And you say wheres the president s plan when the president believes the court will and should uphold the law . All youve done is issue opeds. And bills. And bills. Contrary contradictory bills. So you dont have any plan. Like you havent had a plan for 60 years. So you can keep going after the secretary and she will keep trying to spell out i will ask you when i finish how many people have been receiving subsidies, madam secretary . So 7. 3 Million People have received subsidies through the that are in the marketplace right now. So when you shed tears about 7. 3 million, remember or about the law, its 7. 3 million. Whats been the average subsidy . 272 per month is the average subsidy. And in terms of those that are in the marketplace that are subsidized thats the 7. 3. So 10. 2 Million People are currently in the marketplace overall, about 85 of those receive subsidies. The average subsidyvin is 272 per month, which is what results in the affordability. And just quickly tell us how many people have received additional care through expansion of medicaid. The question of the total number because there are people in terms of the expansion itself, about 10 Million People are the estimates in terms of those states that have expanded. So add those two together and were talking about individuals with families and the republicans come here and castigate you and this president. The shoe should really be on the other foot. I yield back. Mr. Johnson. Thank you, mr. Chairman. I hardly know how to follow that. I guess im supposed to thank you for being here but i have to tell you im not in agreement with much of what youre saying. Let me just ask you you know were trying to get the healthcare back in shape and it sounds like to me that you want to go your way and not try to work with us. Let me just ask you if there are any proposals that hhs supports that will reduce costs for consumers without setting price controls or imposing other restrictions that will reduce access to care . Yes in terms of there are a number of things that are part of our budget and were currently implementing that are reducing costs. We know since the passage of the act but it looks like to me everything is going up. Well medicare spending if we look at what it was projected to be in terms of the previous ten years up to 2008 where it has been since 9 through 14 we saved 300 billion. With regard to per capita healthcare costs in the country in 2011, sae 12 and 13 the cost growth is the lowest that it has been in 40 years. So thats taxpayer savings, thats also but the insurance rates are going up, not down. Everybody is paying more for it. So insurance rates before the Affordable Care act were going up on in the individual market well above double digit numbers. So what weve seen since the implementation is while those rates are still continuing to go up theyre going up at a much lower rate. Okay. Let me just change subjects for a second and ask you about an effort that my colleague Lloyd Dogget