Something that we believe will help with the issue of drug prices which i think is part of the first part of your question in terms of making sure that we can make progress both on quality as well as affordable in healthcare. With regard to the delta in that particular year, i will defer to my colleagues but having been at o. M. B. My guess the date in the year will be one of the elements if it is that large of change as well as other things but ill let andy speak to that. Im going to endorse what the secretary said. First smart comment. So theres a couple of things i think hes referring to his own not mine. And yours. There is a timingish issue and that is a significant driver and we can take you off line and go how that works. Second, specialty drugs, theres thats a driver there and then i think theres a small factor for growth in population but i think the first two factors will be the biggest driver in part d. Youll actually i think well be able to take you off line but well cover that theres a couple of spots theres reassurance and overall costs. Thank you. Yeah ricardo in ap. You can provide detail on how you envision these negotiations to work and should they be limited to medicare. Medicare is very important. Its a biggest payer, but what about the Medicaid Programs as well . Could you so i think with regard to this type of proposal as with our entire budget this is a conversation well be having hopefully with the United States congress. As we work through how they are thinking about it as well as how were thinking about it. In the earlier response i think this is about us trying to find ways that we can continue with what we have talked about as a real priority for us. Delivery system reform and thinking about how we improve quality and cost efficiency and we believe this would be a tool that would help us on both of those front. How would you define high cost drugs . I think that is something that we would work out. As i said this will be a statutory provision in terms of getting the authorities and that is something that we would work with congress to define and determine. Thank you. Hi. Melanie. I want to know a little bit more about the funding request for unaccompanied miner children and how that trigger for 100 million how that was decided upon to address the issue. Ill have mark continue the answer. What we were trying to do with the Contingency Fund is meet the two objectives that sometimes in terms of budgeting one thinks about how can you meet the objective of making sure that youre appropriately prepared for an extreme situation at the same time youre budgeting together in a fiscally responsible way. The concept of the Contingency Fund is our approach of meeting the needs of the congress to be clear when you would need money. Were hopeful theyll never come to pass in terms of the numbers that would trigger that type of fund and thats what we were going to work against. Based on experience we apt to make sure that we are putting forward the required needs if we have a change. Mark, did you want to add anything . Very quickly. So as the secretary indicates, were seeking to both prepare for our best expectations whats going to happen but also recognizing that there is inherent uncertainty in the prior three years that have been very dramatic growth in the unaccompanied children peaking in the summer. Since that time numbers have declined in a significant way. It is based upon what we see at this point that we believe our Budget Proposal would be sufficient for what we would anticipate at the same time the experience of the program has been one where sometimes unexpected things have happened and so we feel that its crucial to build in the ability to prepare for contingencies. The secretary has time for one more question and after that ellen will take over moderating. Thats mark greenberg. Make sure you have that. Happy to take another question. You you i was curious about funding for any new emerging viruses like the ebola virus. And are they going towards emerging viruses flu or anything else like that. So the answer to that question in terms of that type of preparedness is centered in three different places in the department. Doctor will come nicki ill invite you to say a few words. And in terms of our work at the epidemiological work and dr. Collins would have a few comments on exactly in each of those budgets we have levels to work on the issue of prepare edness. The 16 budget puts a strong foot forward when it comes to bio threats. And these are to deal with the bio threats that are traditional threats and microbial disease. Whether its ebola or another pandemic or something we havent seen before. There are substantial funds and good increase in 2016 to an address those different categories. We continue to see that Mother Nature plays tricks on us and its own bio terrorist and we have to be prepared to meet her wherever she shows up. Not only viruses and biological events but man made events. Its very important focus of this budget and substantial initiative to combat in fact across u. S. Initiative to combat the rise of it and allow us to establish protection in every state and the amount of testing thats done for Drug Resistance and organisms and to have Rapid Response in this country to improve Infection Control to stop outbreaks of drug resistant organisms of bacteria and viruses in the u. S. And Drug Resistance globally because its an area where if a resistant strain emerges it may be a threat to us. 238 million putting to good use in terms of therapeutic trials even as we speak. With regard to the Antimicrobial Resistance we have an Important Role to play with wonderful collaboration with our colleagues so there is 100 million of additional funds proposed in fy 16 for research to help us with the effort to set up a Clinical Trials network that would be ready to test a new antibiotic that might be developed and we hope and expect that will happen. But you have to have that network in place with access to individuals who may have pneumonia with resistant organism and you cant do that on the fly. You have to have that set up ahead of time. Well continue to work intensively on the effort to develop an influenza vaccine. We are in the early stages of stage two trials to develop vaccines that dont work for this season or next season but would work for all influenza viruses that have the shared structure of the hemogloben and protein. Dr. Hamburg, you can see this is a real cross your question hits it. What is an h. S. S. We have to take it through the epidemiological part of cdc when were developing those vaccines in terms of future development and as part of that fda. So doctor, do you want to say a word . We play a Critical Role in the chain of activities that will lead to better answers treatments and strategies against resurging infections disease threats. We obviously play a role in the development, review and hopefully availableability of new products, diagnostics vaccines and with respect to the huge challenge of Antimicrobial Resistance that the doctor touched on fda has a broader role. Were very involved in helping to achieve the most Efficient Development plans for new diagnostics, drugs and vaccinees, but we also are involved on the Animal Health side in terms of the use of antibiotics in Animal Husbandry and agriculture and moving forward with a program to remove apt tie antibiotics from Animal Agriculture in terms of their use of growth promoters and to bring this important class of drugs under the oversight of veterinarians. So thats a very exciting activity in this proposed budget will allow us to continue those activities i think you can see the broad range of what we do in the department. Ill leave you in the capable hands of ellen murray and the team. Ellen, ill ask to you come up and moderate for us. Do we have any other questions . Ill leave it to the microphone people. Jeremy with cnn. Talking about vaccinees, governor christie and senator paul talked about vaccinees should be optional or voluntary for parents to give to their kids with the recent outbreak of measles and mumps. I think ill ask dr. Freeden to response. Vaccinees are tremendously important in protecting children. While we understand the concerns of parents that theyre understandably concerned for the safety and ethicasy of vaccinees, part of the challenge we have is that the vaccinees have been so effective, the diseases they protect against are less familiar. 92 of American Kids are effectively vaccinated against measles, however there are communities where a large proportion of parents are not getting their kids vaccinated or in a timely way. What that means is theres a gradual buildup of those susceptible of measles. It can be quite serious, although some children get over it quickly. It cause severe illness or even death. The vaccine is safe and effective and choosing not to vaccinate your child also endangers the health of others in your community. Neighbors whos children may bend the age of six months or medical condition that prevents them from being vaccinated. In the year 2,000, United States eliminated measles ever since that year every case of measles in this country has ultimately been traced back to spread of mels somewhere else in the world. That emphasizes our need to continue to strengthen vaccination programs throughout the world but also emphasizes that we are all connected and that not vaccinating your child has implications not only for your family but also for families around you. The science on this is very clear. There was one study that has since been shown to have been fraudulent that alleged to show problems but review after review by independent agencies emphasizes of course a vaccine can make your arm hurt and give you a slight fever. There are no long term adverse consequences from the mels vaccination. Its also as one last point to make important that although there are some parents who are not getting their kids vaccinated, the vast majority havent gotten around to it yet and not the small number who have strong beliefs of the vaccine and what it it may lead to. We hope increasing number of parents, especially in communities that have had increasing refusal rates get vaccinated for their own sake and the sake of their community. Are they intended for the Medicare Savings Program . You can take that . Sure. I think the question is about the a. C. O. Items inside the pwupbl et. We have i think released very positive results over the last year which have shown we can improve quality while managing costs in a number of communities around the country there. Is more of this inside this years budget and i think theres also bubbedled payments incredibly important and primary care demonstrations and state based initiatives. All those things are a big part of the budget this year. Just to follow up on an earlier question on the negotiations. Just to follow up on the drug price negotiations, is that going to be a statutory proposal or is this more in the nature of an invitation to a dialogue . Its a statutory propose until when will that be available . Is that available now . Andy, do you know . I dont. I do not know. Thank you. Question for dr. Collins. Is there still funding in the 2016 budget for the Brain Initiative . Where is that at now . There most certainly is and were delighted about that. In fact the fq 16 budget proposes an increase of another 70 million on top of the 65 million which is included by the time you get to 15. This is in a ramped projection which is very much what this initiative needs in order to see the full opportunity realized. This is one of the more excite things going on putting together the expertise from a variety of disciplines to understand how the circuits in the brain do what they do. And the first go round of grant applications nor which we just funded a few years ago produced just the kind of scientific excitement that we had hoped for and we want to see that continue to grow over the course of the next 12 years because that is the plan that was put forward by this remarkable panel of experts led by cory band bill. If it want to see more about it its up on the web in the advisory page. What is it . 135 million. 70 thats new and 65 that was there from 14 and 15. Probably the first time in 4 or 5 years an afford press conference hasnt led off the press conference. How much money are you asking for next year to implement to with the Affordable Care act and go through the exercise where you tell us where you managed to scrape up money to run the law last year . By last year you mean 2015 . Right. Well, again, as in most years we will use program management. We have more fee income in 15 than we did 14 and more in 16 than 15. We could use the secretary of transfer and the expense fund. I think as time goes on, funding for these exchanges will be funded by the fees. Some of the activities cant legally use fee income to do so like running the hub which is a federal responsibility. But the need for prop rated dollars will be less as the years go on. But, andy, you can add to that . Thanks for the question. Yeah what allen said is exactly right. I give a couple of highlights. I believe in this year coming budget 70 or so will be taken care of by user fees and we think thats going to continue to grow. As it gets close to its natural limit. The other thing that happened is our ask for major expense items like Information Technology are going down year to year. Well see rediction of close to 200 million. So i think between getting the program to third fourth year of stability as well as the stability of user fees and so forwards, i think well see a sustainable path funding the exchanges going forward. Any other questions . Yeah, hi. Sara from nature magazine. I was intrigued by consolidating food services. You can talk a little bit about what the authority of that new agency would be and what it would not be and if that would would have any regulatory we hope to work with congress to develop this proposal. Right now theres no details in our budget money for food safety. But this is something we hope to work with congress through the year. It seems that fda oversight for drugs and medical products relies more than half on user fees and that seems like a larger percentage than it has been in the past and im wondering if that represents a significant increase and if thats permissible under the current user fee arrangements. We have as you know a kpwupblgbudget that reflects the contribution of Budget Authority and user fees and theyre negotiated on a regular basis with the relevant industry and then codfied in legislation and several years ago the bill was passed which laid out a five year plan for user fee spending. The at the present time our user fees are different in different programs within the medical products area and there are some areas of activity that are not paid for by user fees but strictly by Budget Authority and others where user fees play a Critical Role. In all honesty i dont know what the specific percentages are in the different domains and we could get that to you if the president s proposed fiscal year 15 went forward. But i can assure you that the numbers reflect a careful consideration both of critical needs and problematic areas of activity and also of course the requirement thats are put upon us as part of the User Fee Program and the various tar gets and triggers that are components of that legislation. Any other questions . I see none. Thank you all very much. Look forward to seeing you all next year. President obamas nearly 4 trillion budget request for 2016 includes more than 83 billion for the health and my Human Services department 49 for hughesing and urban development and 41 billion for Homeland Security. That according to the White House Office of management and budget and on wednesday, secretary nominee will be there for a confirmation hearing. He served as Deputy Defense secretary. Well have live coverage 9 00 eastern also on cspan3. Now officials from the state department and u. S. A. I. D. Have their 50. 3 billion budget request. This briefing is 25 minutes. President obama released his budget and im pleased to be joined here by administrator to take a few of your questions. I just want to note that this is actually his last budget rollout. Couple of weeks hell be moving on and i want to thank him for his service. He has been a really effective and dynamic leader at u. S. A. Id and pushed forward and innovative efforts and galvanized our response to unexpecteded emergencies and well miss you. Two weeks ago, president obama said if there is one thing this new century has taught us we cant separate the work at home from the challenges on our shores. We see it in action every day. And our fq 16 budget request makes critical investments. Strengthen the u. S. Economy and Global Markets and support u. S. Citizens and development presence overseas. First the top line. The state and u. S. A. Id budget request totals 50. 3 billion. Our base budget request is 43. 2 billion and this will allow us to address security challenges and carry out our Development Mission and advance the signature policy and Development Initiative and honor our commitments to partners and carry out Peace Keeping activities around the world. Weve also requested 7 billion in overseas Contingency Operation funds to respond to National Security requirements. Oko funds will support afghanistan, pakistan and iraq and respond to the conflict in isil and u