Integrating of the individual on the i. T. Side and the business side. Those are all three things that even right now at gsa three weeks ago implemented some of the things that we think will improve availability of providers to get access and work in that way. Thank you. Thank you, mr. Chairman. Thank you were senator hagen. Senator white house. Thank you, chairman. Welcome, ms. Burwell. In your summary of your very impressive career you describe yourself as having had the opportunity to lead large and complex organizations and work across a range of issues in each odds my role i worked on forming strong teams, forging relationships and delivering results. Has it been your experience that having solid clear performance metrics is an advantage. It is a an advantage to know where youre headed. Thats part of the accountability that you just described to senator hagen, correct . Yes. Knowing where youre headed and how youre going to measure whether you get there or not is important. Under the Affordable Care act weve made significant progress in cleaning up that. Thats been good. The access issue i think has been moved in a very good direction with 8 Million People signed. That leaves a third very, very big issue, which is the cost of the system. A very well regarded report came out recently that predicted that spending on health care which already consumes nearly 18 of the nations Gross Domestic Product will continue to grow 1. 2 Percentage Points faster than the economy over the next two years. An expert said this, if we cannot get Health Care Spending under control, theres no hope for the federal budget. The main hope if we dont get Health Spending under control is Global Warming gets us all first before Health Care Spending gets us all. So we can work on Climate Change separately, but theres a winwin opportunity to address the cost of health care by improving the quality of care. Its been identify by the president s council of economy adviser, the institutes of medicines and an array of private thing tanks and we proceed in that area i believe without adequate performance metrics. I would like to ask you your commitment, if youre confirmed, once youre confirmed, to work with me and work with a considerable number of other senators who share this concern to set some definable metrics for our progress at lowering the cost of health care by improving the quality and delivery of health care. Would you be willing to do that . Senator, if i am confirmed, i look forward to working with you and a number of your other colleagues, actually on both sides have brought up this issue. I look forward to working with you on it. To get it done. Senator, i think the core objective is to improve the way we deliver health care, to improve quality and reduce costs and thats what the objective would be. And you agree that clear performance metrics would advance that objective . I agree that metrics are an important part of that. I think one of this things that one wants to do is understand what are the right metrics. In my experience in terms of when youre trying to scale and do change, you need to think about what is the metric that you need to measure against. Exactly. And so determining that you can do that is the other thing that i think is important. One, is it measurable, it is the right measure and then can you scale against what youre trying to do. Those are the types of questions that i have historically considered when i think about the issue of metrics. Good. Well i look forward to working with you on these metrics. I this just to give you a preview of coming attractions, i think there should be a cost savings metrics, an actual dollar and a date that can be attributed to this process. And i think it might be helpful in getting to that goal and articulating it for regular consumers better to have a seethe of subordinate metrics like were going to knock down hospital acquire infections 80 by this date, were going to have this many doctors moved off of fee for service and moved on to more outcome baseds Payment Services by this date. I think we can successfully build a good suite of performance metrics that will address this. I appreciate the attention of the committee to this. Its been something weve looked at repeatedly. Were looking at it very closely from a Budget Committee perspective. I confer with the senior fellow, if we cannot get Health Spending under control theres no hope for the federal budget. And theres a good way to get it under control without hacking away aut fees and eligibility and you know, what people are entitled to under their policy, the coverage. Thank you. I just have to adds, 75 of spending under medicare are for preventable diseases most of which are preventable. Now or own budget person, senator murray. Thank you were mr. Chairman. I am really pleased that the president chose such a qualified competent and experienced nominee, someone obviously i know very well. Ive had the opportunity now to work very closely with director burwell for many years during her time as part of president clintons economic budget team, her distinguished service at the Gates Foundation and her current position now at the director of the office of management and budget. This is an impressive record and i really applaud you. Youve excelled at every step. Back in the Clinton Administration she played a central role in crafting policies that led to broad Economic Growth and Budget Surplus that we all remembered by the end of the 90s. In her Foundation Work she took on an sbirly different challenge and managed a Successful Organization with a global reach and for the past year director boar wel worked very successfully here in congress to bring much needed bipartisan back to the budget process. At the same time she was over seeing programs from the medicare to the Affordable Care act. I really believe she has the necessary qualify sayings and im delighted to have just a few minutes here. I dont want to take much time. But i did want to say, take this opportunity and give us the chance to hear from you how your professional experience has really prepared you to meet the challenge of mapping a very large agency with a lot of different critical functions. I think that my time at the number of different agencies that ive been at have really helped with a couple of things. One is clarity of focus on impact. I think that comes back to the conversation we were just having with senator white house and how one needs to get in quickly and make sure that you define very clearly what your goals are and then build the institution, build the team, empower the teams and part of that empowering of the teams is making sure that they know what their roles are and what their responsibilities and accountabilities are. The other thing that i think is a particularly important part that ive learned in working in the Foundation Space and all of the jobs that aye had, when i think about the problem solving, you think about what is the problem youre working on, what is the solution space and when then the third circle is for whatever entity you are, whether its at walmart or the bill and melinda Gates Foundation or in the federal government, what is your institution best at . So youre applying the skills and what your part of the organization, the piece that youre working on or where you are best at. Ive had the chance to work in a lot of private Public Partnerships both inside and outside the government. And seen a number of Different Things. But i think really framing core goals, setting out building good teams and then empowering them to do the work are the most important things ive learned. Im looking forward to seeing you do that at this sergeancy. I did want to mention you know im a strong champion forEarly Childhood education. There are several key Early Learning programs that will be within your purview at hhs if youre confirmed. I wanted to ask you how youre going to continue your agencys work to expand and strengthen those key federal investments. I think those are very important investments. And i think we have a start and the process that started with murray ryan and led to rogers ma cull ski, we have proposals in the budget right now that are important parts of continuing on that that try and build on existing distribution mechanisms so youre not creating new systems. They build through head start and use other things but make sure that the programs in place have quality measures. Im hopeful we can work with, if im confirmed, in my omb slot or hhs can work with the congress of moving those issue of Early Childhood education forward, as you know, because vi a six and a half and four and a halfyearold you live it. I live it every day and i live that my children are so advantaged in everything they get and how can we make that a reality for all of the children in the country so they have the tools to succeed. My time is up. We have a vote coming. It was reported that the uninsured level is at its lowest point since january of 2008 when gallup first started tracking that. In states like my home state of washington that you know so well where we built our own exchange and expanded medicaid, the rate of uninsured is decreasing even faster where weve enrolled nearly a Million People for coverage. So i am delighted by that and i hope that you use my state and your state to really help replicate some of those good experiences across the country and i look forward to working with you. Thank you, senator. Thank you, senator murray. And senator sanders. Thank you very much, mr. Chairman. Welcome, ms. Burwell. Unlike senator roberts, i believe in a medicare for all sing payer system. I think there is something wrong when in our great country we are the only nation who does not guarantee health care for all of its people and yet we spend up spending more than other countries without particularly Good Health Care outcomes. In that regard in the aca legislation i put language in supported strongly by senator harkin that would give flexibility to states to move in different directions, including a single pair. As you know the state of vermont intends to do that. Right now we cant do that until 2017. We have applied for a waiver. The president supports that waiver. Will you help the state of vermont work with hhs to make sure that we can facilitate that process and give vermont the opportunity to lead the nation in that direction . Senator, if i am confirmed i look forward to working on that issue with you and the state. Okay. Another issue that is dear to my heart and i know to senator harkins heart, weve worked together on it and to many people, the crisis in primary health care and the need to go forward with Community Health centers. One of the reasons i voted for the Affordable Care act is that the majority leader and others worked very hard to substantially expand Community Health centers. In fact in the last four or five years i think weve added 4 million more people to gain access through Community Health centers, in my state about one quarter of the people will get their primary health care through Community Health centers. We are in a difficult problem right now because were facing a cliff, as you know. And that is as a result of the aca funding we were able to expand Community Health centers. If that cliff goes into effect it will be an absolute disaster. You and i have chatted on this on a number of occasions. You working with the president have provided a strong budget for Community Health centers and for the National Health service core. Will you fight to make sure that we continue to strongly fund Community Health centers throughout america . Senator, as you and i have had the opportunity to discuss being from a rural place in the u. S. , i actually understand the role of Community Health centers in communities like the one i grew up in. I believe its an important part of our system in terms of prevention, a topic weve talked about in terms of treatment, as well as and i believe it is an important part of efficient and Effective Health care in terms of costs. But heres my question. Stay with me. We are looking and in fairness, the president and you have helped make his budget strong. But will you help us fight to make sure that we continue to have that funding and not see that cliff which would be a disaster for Community HealthCenters Across the country . Do i have your support on that . Nart you do. The budget we put together is the first step in that process to the that. Good. Okay. In a related issue, were not going to have strong Community Health centers unless we have the phenffe physicians and the and the other staff we need. We tripled funding. Thats a whole lot of money but is still not enough. I think as you understanding, and correct me if im wrong, we face a crisis in terms of the number of physicians and other Health Care Providers that we have to getting out to underserved areas in america. Will you work with some of us, with myself, senator harkin and others, to make sure that we adequately fund the National Health service core to do Debt Forgiveness or scholarships for medical School Students who want to practice in underserved areas this is an issue that throughout the budget you see support for. And whether thats in the issue that you just raised in terms of the National Health core, its also in how we think about not just positions but there are also provisions that are about nurses and other people that are part of the primary care system. Thats exactly correct. I think thats another important piece that we need to work on. What i worry about thank you. I agree with you. Were looking at the expiration of a very Important Program called the Teaching HealthCenter Graduate medical Education Program. And that is a program which allows people to get their graduate doctors to get their training in Community Health centers et cetera. Are you familiar with that program . The graduate medical Education Program, yes. Yeah. It is looking to it may expire. Will you work with me to see that it does not expire. The graduate medical Education Program there are a number of provisions that are attempting to improve and focus on primary care. Thats something thats a prt of the budget and a series of bringing pieces together that include how we think about the National Health service core as well. Yes, that is something that is part of the budget process and would look forward to working, if confirmed, in a new role. Thank you very much. Senator scott, have you voted already . No, sir. Were down to about maybe three or four minutes left now. Ill recognize you but were close to be out. We have four or five votes, right . Four votes, yes, sir. Senator scott go ahead but were going to have to be very short. I wont take more than five minutes. I promise. The senator time allows for 15 minutes to vote but i also takes 30 minutes to count 15 minute in washington. Its part of the fuzzy math that happens here in washington which really is one of the questions ill be asking you about. One of the questions will be the fuzzy math about obamacare and the other one about programs made and promises not kept and whether youll be the ambassador of health care. Certainly you come before us with a great reputation. I voted for you for omb, my good friends have Great Respect for your intellect and integrity. Ill take that into serious consideration. My questions will focus on obamacare and the dismal rollout and the challenges ive had with the numbers. Hopefully you can get us some clarity as we rush to make sure we make the last vote here. In numbers, fuzzdy washington matt, 1. 4 trillion price tag, the fact that after spending nearly 1. 5 trillion well still have 31 million americans uninsured by 2024. The fact that the as b ca as siphoned 716 billion from medicare and somehow thats supposed to improve the outcome of our seniors. Perhaps one of the more frustratings number that ive seen in obamacare is 8 Million People have signed up for obamacare. One of my questions will be at the end, how pray tell do we account for 8 Million People signing up for a program but they dont pay the premium, yet we count that number as a part of a true number that reflects the number of americans that are actually eligible for Health Insurance if they dont pay their premium. It seems to me that if mum before 8 Million People signed up for obamacare, which whe