Abide by the rigid man daytodays under the law. The Congressional Budget Office estimates the law results in 2. 5 million fewer fulltime jobs reflecting what we heard over and over again from employers who have no choice but to cut hours or delay hiring because of the laws burden mandates. Prices skyrocket. Health Insurance Companies are seeking rate increases of, quote, 20 to 40 or more. Markets are still adjusting to the quote, shock waves, set off by the Affordable Care act. After nearly 2 trillion in new government spending, its estimated more than 25 million individuals still lack basic Health Care Coverage. Yet, just last month, president obama said the law, quote, work the out better than some of us anticipated, close quote. Of course, for those who oppose this government takeover of health care, this is precisely what we anticipated and preciseprecise ly why the American People deserve a better approach. In closing, madam secretary, thank you for joining us this morning. It is our responsibility to hold you and the administration accountable, and we believe the country is moving the wrong direction. However, there are areas where i believe we can find commonground and advance positive solutions. Tonights hearing is a part of the efforts and look forward to the discussion. With that, i yield to Ranking Member bobby scott for opening remarks. Thank you, chairman, and welcome, secretary burwell, and thank you for being with us today. I look forward to your testimony. Well hear about the president s fiscal year 2016 health and Human ServicesBudget Proposal from the departments budget priorities. While the budget was released months ago, pleased to see the word priority is included in todays title of todays hearing. Budgeting requires tough choices, and a budget is reflection of prioritieprioriti. We decide what priorities are and how to best invest in the country. Pleased the president s budget request was reflective of many important priorities like protecting access to Health Care Insurance for all americans, giving all children a chance to succeed, and reducing inequality around the country. Many areas, i believe that weve made great progress on priorities, for example, the passage of the Affordable Care act has given millions of americans access to health coverage, some for the first time in their lives. The aca is also helped slow the growth in Health Care Costs, close the donut holes of seniors, and encourage and approved access to Mental Health services and preventative care. Just weeks ago, the Supreme Court decided in another case pertaining to the Affordable Care act in king, the legality of subsidies for those obtaining Health Insurance through the federal market place instead of a statewide marketplace was upheld. The Affordable Care act was structured and designed to improve health care cove ran and access across the entire country, and it has, and now those living in virginia have enjoyed access to insurance subsidies like someone in minnesota and because of the outcome of the case, they will continue to do so. I want to thank secretary burwell for efforts and departments hard work and implementing the aca, recognize the challenge that your agency faces in implementing the law with limited resources and unlimited attacks, but despite challenges, the aca is working. I was pleased to see it placed priority on giving all children a chance to succeed by ensuring robust funding to increase both access to and quality of Early Learning and child care programs. The republican budget adopted by the house earlier this year is not reflective of the shared National Priorities despite Research Showing that showing for every dollar spent on early education, there is a return of 7 in reduced costs in other parts of the budget. You must invest in quality Early Learning programs because all children deserve to enter kindergarten with Building Blocks of success. Decades of Research Show properly nurturing children in the first five years of life is instrumental in supporting enhanced brain development, cognitive functioning, and emotional and physical health. All too often, low income families lack access to childhood education, and these children tend to fall behind. In addition to this achievement gap, children who do not participate in high quality Early Learning programs are likely to have weaker educational outcomes, lower earnings, increased involvement in the criminal justice system, and increased teen pregnancy. Affordable high quality child car is not just critical for children, but for working parents because child care is a two generational program. Parents of Young Children need to have child care to go to work or school, and in a lack of stable child care is associated with job interruptions and job loss for working parents. Child care ought to be a National Priority for americans children and to grow our economy. Just two programs outside just two programs throughout the bulk of the federal roll and early education, head start program, and the Child Care Development block grant. Unfortunately, because of limited funding, too few children have access. This unmet need continues to grow. Only four out of ten eligible children have access to head start, and one out of six federally eligible families receive child care subsidies. We have decades of evidence that investing in programs like head start and child car Development Block grant work. The time is to invest in the programs and ensure we are giving all children the chance to succeed. Lastly, its past time for congress to raise the sequester level Discretionary Spending caps that are starting the progress we can make as a nation in important areas like health and education. The caps threaten nearly every program under the jurisdiction of the committee from low Income Home Energy assistance programs to Older Americans act and others. The sequesters led to woefully inadequate investment in Critical National needs and puts us on a path to another government shut down. In coming back to the ideas of priorities, investing in our nations future should be congresss number one priority, not Corporate Tax breaks or lowering the estate tax, but focus remains on investments that strengthen middle class and help hard working American Families get ahead. So thank you, mr. Chairman, and secretary for being here today. I thank the gentleman. Pursuant to 7c, all members are submit written statements and remains open for 14 days to allow such statements and other extraneous material referencesed in the areaing to be submitted for the hearing record. Its my pleasure to introduce our distinguished witness. The honorable silver matthews burrwell, secretary of health and Human Services, and prior to joining in 2014, she was the director of the office of management and budget where she oversaw the development of president obamas second term management agenda. In the clinton administration, she was Deputy Director of omb, deputy chief, and staff director of the National Economic counsel. Welcome, madam secretary. Ill now ask the secretary to stand and raise your right hand. Thank you. Do you swear or affirm the testimony youre about to give is the truth, the whole truth, and nothing but the truth . Let the record reflect the witness answered in the affirmative. Before i recognize you to provide your testimony, let me briefly remind you or more importantly, my colleagues, of the lighting system. Five mimnutes for each witness o present, but i will be flexible on the timeline given youre the only witness and a cabinet secretary. I ask you, though, to limit remarks, because we have a lot of members with questions, and i will be strictly enforcing the five minute rule and perhaps the four minute rule. The secretary has a hard stop time at 12 00. Well honor that and ask the colleagues to be patient. Again, on the lights, when you start, and well put the timer on, but you can effectively ignore it if youd like. Its green, and then yellow with a minute to go, and red when the five minute mark is over, and that applies only to the secretary. To my colleagues, when the five minutes is up, its up. Now, youre recognized, madam secretary. Thank you, mr. Chairman and Ranking Member scott, as well as members of the committee. Thank you for this opportunity to discuss the president s budget for the department of health and Human Services. I believe firmly that we all share common interests, and, therefore, we have a number of opportunities to find commonground. We saw the power of commonground in the reauthorization of the child care and Development Block grants and Development Block grants that happened last fall as well as bipartisan sgr repeal earlier this year. I appreciate all of your work to get that passed. The president s budget proposes to end sequestration fully in 2016 to match dollars for the department of defense. Without further congressional action, this will return in full in 2016 bringing discretionary funding to its lowest level in a decade adjusted for indplags. We need a whole of government solution, and i hope that both parties can Work Together to achieve a balanced and common sense approach. The budget before you makes critical investments in health care, science, innovation, public health, and Human Services. It maintains our responsibility stewardship of the taxpayers dollar. It strengthens our Work Together with congress to prepare our nation for key challenges at home as well as abroad. For hhs, the budget proposes 83. 8 billion in discretional budget authority, and this increase will allow our department to deliver impact today and lay a Stronger Foundation for the nation for tomorrow. It is a fiscally responsible budget, in tandem with accompanying other proposals save taxpayers a net estimated 250 billion. The budget is projected to continue to slow the growth in medicare by securing 423 billion in savings as we build a better, smarter, healthier delivery system. To provide americans to affordable, Quality Health care, we build on historic progress in reducing the number of uninsured and improving coverage for families who already have insurance. The budget supports our efforts to move towards a Health Delivery system that delivers better care, spen dollars in a smarter way, and puts the patient at the center of the care to keep them healthy. The budget also improves access for native americans. To support communities throughout the country, the budget makes critical investments in Health Centers and our Nations Health care work force, particularly in rural and other high need areas. To advance our shared vision for leading the world in science and innovation, the budget increases nih funding by 1 billion to advance biomedical and Behavioral Research among other priorities. It invests in precision medicine. A new effort focused on developing treatments, diagnostics, and prevention strategy, tailored to the individual genetic characteristics of a patient. To further common interest in providing americans with the Building Blocks of healthy and Productive Lives, this budget outlines an ambitious plan to make affordable quality child care available to working and middle class families, specifically the budget builds on important legislation passed by Congress Last fall to create a continuum of Early Learning opportunities from birth through age 5. This change would provide high quality preschool for every child, guaranteed quality child care for working families, grow the supply of working families for kbrouYoung Children, and eve based Home Visiting programs to keep americans safe and healthy. The budget strengths public and Health Infrastructure with 975 billion for domestic and International Preparedness and invests in behavioral Health Services incoming more than 99 million in new funding to combat heroin and other abuse. Finally, looking to leave the department stronger, the budget invests in our shared priorities after addressing waste, fraud, and abuse. Initiatives that are projected to yield 22 billion in gross savings. The budget addresses the departments medicare backlog with a coordinated approach. The budget makes a significant investment in the security of the Departments Information Technology and cyber security. I want to conclude by taking a moment to say how proud i am of the hhs team and employees that work on ebola. Their work every day and commitment every day. I assure you im personally committed to a responsive and open dialogue with members of this committee as well as your colleagues. I look forward to working closely with you, and i welcome your questions. Thank you. Thank you, madam secretary. The light did not even turn red. [ laughter ] im unprepared now. Im at a loss. Seriously, i want to thank you, madam secretary, for your ongoing efforts to keep us informed about the departments progress and implementing the child care and Development Block grant act of 2014 as well as opportunity for Committee Staff to communicate directly with your staff. Can you update us briefly on the timeline for the release of guidance and proposed rules in accordance with the act . With regard to, i think, our staff had an opportunity to go back and forth, and i think thats helpful in producing the guidelines, and hopeful that i think that im not sure which particular piece you are referring to, and i want to make sure and can follow up on that, but we have made progress and hope to get them out. One piece with regard to the implementation of the authorities you all gave us, theres an important piece of the budget related to the implementati implementation, and one of the things that we were told with regard to the authorities improve the quality, improve the safety, and, also, improve our ability to serve communities that sometimes are not served such as parents that work in different hours, and so theres funding in the budget were talking about today on discretionary side that i think is important to do that, and i do want to raise that as a part of the conversation, part in doing the implementation, there is funding to do that. Okay. Im not sure thats exactly what i was getting at, but thats good. Ill get the specifics of the timing. Happy to come back. Just trying to get a feeling of the timeline. Very much appreciate the exchange between staff, very, very helpful. I want to take remainder of my time, no doubt, and trying to be brief; but there is an issue having to do with the Affordable Care act thats just sitting out there, that really, really needs to be addressed, and that is the max amount of out of pocket limits for cost sharing im sure you heard about. I heard from several employers recently about this unilateral change the department made to cost sharing, maximum out of pocket limits, and we cant seem to determine where this is coming from. The statute is pretty clear. There are two separate and distinct types of coverage, selfonly and other than selfonly coverage, each with respective out of pocket limits. Before this new rule, any combination of family members out of pocket costs count towards the maximum out of pocket family coverage limits. Now the department declared starting in 2016, the individual out of pocket limit applies first before the family limit applies. That means the cost of the employer coverage will increase because insurance will pay 100 of the out of the pocket costs sooner. I understand that youre aware. Ive been led to believe youre aware of the concerns as im sure that employers have raised this issue directly with you and your staff, probably many times. They certainly have with us. Wed like to understand under what Statutory Authority you did that, and then id like to enter into the record letters from the industry committee, the American Benefits counsel, National Coalition on benefits convey grave concerns the departments new embedded maximum out of pocket rule. The letters also convey compliance not possible by 2016 given employers plans are already set for next year and not until may that Additional Guidance was issued that larg