The flagship collection we have here in corpus. He made it his life to help local and beyond mexican americans learn to be more civically active and to get the benefits they had coming to them as veterans which were sometimes very difficult for them to obtain. This represents a case of private longoria which was an incident that occurred early in the g. I. Forum. Private longoria served the United States during world war ii and was killed by a japanese sniper toward the end of the war. His widow arranged to have his funeral conducted by the only funeral home in her hometown of three rivers texas, which is near Corpus Christi. They were willing to conduct the funeral but not willing to allow his body to remain there in the funeral home overnight for fear of offending the white citizens of the area. She appeals to dr. Garcia, and he conducted a Letter Writing Campaign to people with positions of influence. A response came from Lyndon Johnson who had been recently elected senator. He states his belief that it is wrong for a soldier, a fallen soldier to be discriminated against after death. He offered burial in the Arlington National cemetery and that is where private longoria was laid to rest. Watch all of our events from Corpus Christi today at noon eastern on cspan 2s book tv and sunday afternoon at 2 00 on American History tv on cspan 3. President obamas budget request for fiscal year 2016 proposes 84 billion in discretionary funding for the health and Human Services services. Hss secretary Sylvia Burwell recently appeared before the Senate Finance committee to talk about the budget plan and took questions on implementation of the healthcare law and an Upcoming Supreme Court case that challenges the laws provision on tax credit subsidies. The committee will come to order. Good morning. Its a pleasure to welcome everyone to todays hearing on the fiscal year 2016 budget for the department of health and Human Services. H. H. S. I want to thank you, secretary burwell, for being here with us today. This is your first hearing before the committee since being confirmed, so welcome back in your official capacity. I told you we were talking at your confirmation hearing that the job you now have would be a thankless one and you were undertaking an enormous responsibility. At that time we also discussed three main areas that i encouraged you to focus on during your time at h. H. S. Responsiveness accountability, and independence. Id like to talk more about each of these areas today. Lets start with responsiveness. During your confirmation hearing i raised the importance of this to congress and this committee in particular. You assured me this would be a top priority of yours as well and under your watch we would see a marked improvement. In the past year this committee has written at least 20 letters to h. H. S. Or c. M. S. Asking questions about serious issues such as fraud, prevention, hacking of health care. Gov website, Medicaid Expansion and many others. I understand that we have now received answers to nearly every one of those outstanding letters just in time for your appearance here today. With the last two responses coming just last week. This is a great improvement over what its been in the past. I appreciate the effort being made to provide these answers to us. However, i hope it will not require calling you to testify before the committee to ensure more timely responses Going Forward. If it does, then i suppose well have to look forward to seeing you for a hearing every 30 to 60 days. You dont want that. They get worse after time. Thank you for continuing to make this a priority. Good communication between h. H. S. And this committee is paramount to a good working relationship and you understand that and i know that. Lets talk about accountability. One of the big issues we discussed at your confirmation hearing was the absolute need for fiscal accountability given the huge breadth and scope of h. H. S. s programs and budget. Overseeing them requires constant vigilance and effective management. When looking at the size of the budget for h. H. S. For this coming fiscal year we see just how big your job really is. In fact, the expression, too big to fail does not really apply here as the h. H. S. Budget is so big one would argue it is destined to fail. The h. H. S. Budget for fiscal year 2016 is just over a trillion dollars. In real terms if h. H. S. Were a country this budget was its g. D. P. , it would be the 16th largest economy in the whole world. I think we have that chart over there that shows that where the red arrow is youd be the 16th largest economy in the world. To put it in a more american context, the total budget of h. H. S. Is more than double that of walmart and five times more than apple. My concern is the savings and efficiencies in the overall h. H. S. Budget are very small when compared to the overall spending. The president s proposed budget would save just under 250 billion over the next decade, which sounds like a lot but that is only 3. 8 of total medicare and medicaid spending. More accountability is critical here to ensure these programs have sufficient resources to continue to provide benefits for years to come. On the policy front, the Administration Needs to be up front with congress about their contingency plans. If the king vs. Burwell case is not decided in its favor. Depending upon what happens in the Supreme Court and in late june and probably late june, h. H. S. Could have to figure out how to provide services for millions of americans who are currently receiving tax subsidies to enable them to pay for Health Insurance. I can only assume the agency has a plan in place for dealing with this possibility. Secretary burwell, i hope youll share that with us today. That brings me to independence. For some time now, i have been concerned about the amount of influence h. H. S. And the administration has or have over the operations and policies impacting the entitlement programs. Certainly those run by c. M. S. The budget released this week indicates that spending on just medicare and medicaid is expected to exceed 11 trillion over the next decade. In fact, c. M. S. Accounts for 35 of the total h. H. S. Budget. These are astonishing numbers. They also reinforce for me something that ive long believed. It is time to Start Talking about making c. M. S. An independent agency apart from h. H. S. Nearly 20 years ago Congress Passed and the president signed into law a law, the Social Security independence and Program Improvements act of 1994. That law separated the Social Security administration from h. H. S. And made it an independent agency. At that time, s. S. A. Was the largest operating Division Within h. H. S. And accounted for about 51 of h. H. S. s total staff and more than half of h. H. S. s total annual budget. I intend to introduce legislation to move c. M. S. Out of h. H. S. Whether or not c. M. S. Becomes an independent agency is something to consider Going Forward but the accountability and transparency problems we currently see in c. M. S. Programs cannot wait. I hope that we can Work Together in the coming months on both the Affordable Care act and entitlement issues to create situations and solutions that work for all americans. Finally, i want to note that while there is much in the president s budget with which i disagree, there are areas where i think we can find common ground. For example, i appreciate the provision in the budget that addresses the issue of over reliance on congregate chair facilities or group homes for children and youth in foster care. For years ive been working to call attention to the deplorable conditions in many of these group homes. Recent Research Indicates these group homes are unsafe, expensive, and too often contribute to profoundly negative outcomes for the children and youth who are placed in them. So i look forward to working with the administration to end the over reliance on group homes. Secretary burwell, i look forward to your testimony today and to working with you to ensure our most vulnerable citizens get the care they deserve. I do appreciate how difficult your job is and appreciate the openness with which you considered with both senator wyden and myself and others on this committee. Senator wyden . Thank you, mr. Chairman. Secretary burwell, let me start by saying that my assessment is that you have set a new bar for cabinet secretaries in terms of reaching out and trying to be responsive. I hear about it with respect to citizens, apparently youre in virtually every corner of the country taking your family. I can only imagine the challenge of that. Youre getting back to senators. I hear senators in both Political Parties conservative liberal saying the secretary actually got back to me. I mean, its like such a quaint idea that somebody would actually do that. And i understand youve got discussions either coming or have already begun with governors. So my sense is you have really set a new bar in terms of reaching out and it is obviously very, very welcomed. Now, too many people in america, including millions in our country and in my home state, feel like theyre falling behind. They just feel like the economy picks up steam, theyre not getting ahead. And its our job to make sure that doesnt happen. The finance committee has played a big role in this, almost like a triple header this week. We had yesterday and then you and secretary liu tomorrow. And the budget obviously articulates the priorities of today but it also talks a lot about what our priorities are for the future. And were looking forward to having you lay out how the proposal would strengthen health and Human Services programs, promote economic mobility, and assist our middle class families. I do want to take a minute just to talk about where i believe American Health care has been and then talk briefly about where its going. This year marks the 50th anniversary of medicare and medicaid and a lot has taken place since those programs were created. The congress came together to create the chip program of course for children and has reauthorized it three times. The congress has improved and expanded medicare and medicaid. The Affordable Care act makes access to high quality care a wider than ever. What i think is particularly important, it has signaled that america is not willing to go back to the days when healthcare is for the healthy and wealthy. Thats the way it was when you could go out and clobber the people with a preexisting condition. Obviously, the job is not done. And so there is a twofold challenge in my view. First protect the progress thats been made and, second, clear the way for more progress in the future. For medicare, that means guaranteeing that the programs benefits fully meet the needs of this year of seniors and the demands on medicare are clearly very different than they were 50 years ago. The big ticket medicare costs of 2015 are no longer things like kidney stones and broken ankles. Theyre chronic conditions like cancer diabetes, and alzheimers, and those conditions are tougher and they are more costly to treat. The h. H. S. Budget, in my view, begins to acknowledge that reality, but clearly, there is a lot more to do. Treating chronic disease, in my view, is the future of the medicare program. So whats needed is a road map to efficient and effective care for chronic disease that boldly moves away from the outdated fee for service model. Patients and providers told this Committee Last summer about the need to address chronic care in a different way. Theres bipartisan support for this in congress. I look forward to working with you and the administration to make that a reality. Now, i was also thinking about the announcement last week about Precision Medicine, because this, too helps to provide something of a road map for the future. Medical professionals understand that a treatment will often affect susan in a different way than it affects george. With the right research its going to be possible to learn what drives those differences and how to tailor treatments to fit an individual patients needs. The Precision Medicine initiative thats in the president s budget follows an innovative test program that was really created in this committee. It was part of our discussions. I dont see senator carper here. He had been very interested in that issue. But weve got another big challenge. And the next step will be to design a Payment System for this innovative field, Precision Medicine, that can do so much for the future of patients and taxpayers. The president s Budget Proposal also continues the progress made by the Affordable Care act to reward the quality of care rather than the quantity. The congress can do even more bypassing bipartisan, bicamera legislation to improve the way medicare pays physicians and chairman hatch obviously had a lot to do with putting that proposal together. The president s proposal also takes a vital step by including four years of funding for c. H. I. P. There are more than 10 million kids in america who get Health Insurance through c. H. I. P. Including more than 75,000 in oregon. The child who starts life with quality Health Insurance has a better shot at a successful, middle class life than a child who doesnt. Renewing c. H. I. P. , in my view, is a no brainer. Families and state agencies across the country are waiting for the congress to step up and act on c. H. I. P. Theyre also there are also steps congress can take to help guarantee our Health Programs remain strong for generations to come. That are lifelines for countless americans and as a result millions of families will never have to choose between paying for a loved ones care and sending kids to college. Millions of americans will grow up with access to quality care that keeps them healthy and out of the Emergency Rooms whenever possible. Of course its important to remember health and Human Services does a lot more than oversee medicare, medicaid, and c. H. I. P. No department plays a bigger role in americas safety net. This committee has a long history of working on a bipartisan basis on policies to strengthen our federal Child Welfare programs for vulnerable kids. Just five months ago the congress enacted the preventing sex trafficking and strengthening families act. The department is helping turn this bill from a piece of paper signed by the president into new tools that will help states move more vulnerable kids out of harms way and into safer and permanent homes. The president s Budget Proposal shows that its possible to build on this momentum by expanding programs to keep kids and Families Together and healthy with a special focus on getting involved early with vulnerable families with programs like Home Visiting and this is especially important to the firsttime parents. Were talking about multi generational support. And those prevent the longterm costs associated with homelessness abuse neglect, and foster care. So were talking about the people who are trying to get ahead in a tough economy and have just not seen the recovery make it to their neighborhood. Thank you for joining us here today. Weve got a lot of opportunities in my view for working in a bipartisan fashion and ill have some questions. But i do want to wrap this up by saying that having been in public life and worked with a number of secretaries, i think at the end of the day there are going to be big differences of opinion. The only way you really make progress is by reaching out and you have sure met that test. Thank you. I look forward to working with you. Thank you, chairman hatch. Thank you, senator. Our witness today is department of health and Human Services secretary Sylvia Mathews burwell. Secretary burwell has been leading the department of health and Human Services since june of 2014. Ms. Burwell has a long history of Public Sector service, including most recently serving as director of the office of management and budget under president obama. In the Clinton Administration ms. Burwell served as Deputy Director of o. M. B. , deputy chief of staff to the president , chief of staff to the treasury secretary, and staff director at the National Economic council all of which are very important positions. She also has extensive private sector experience, including serving as the president of the walmart foundation. Before that as the president of the Global Development program at the bill and Melinda Gates foundation. Ms. Burwell received her a. B. From Harvard University and b. A. From Oxford University where she was