The ebola and zyka virus. Stressing the need to prevent the viruses from becoming a problem. Secretary burwell also presented the president s hhs 2017 budget request, calling for 82. 8 billion in discretionary spending. This is just over 2 hours. It is my distinct privilege to introduce secretary burwell. It would appear that senator widen, grassley, grapo, the indomitable senator schumer are not here, they have conflicts. None intended, and im going to ask unanimous consent that the statements by the distinguished senator from oregon, Ranking Member mr. Wyden and our distinguished chairman mr. Hatch be inserted into the record at this point, without objection. Our witness today isle th and huchlage Services Second burwell. Shes been leading the department of health and Human Services since june of 2014. She has a long history of Public Sector service including her previous position under president obama. In the clinton administration, she served as the Deputy Director of omb, the chief of staff to the treasury secretary and staff director at the National Economic council. She has not served as the secretary of agriculture however. She has 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. She received her degree from Harvard University and a bachelors degree from Oxford University where she was a rose scholar. Thank you for being here today we would invite you to please proceed with your five minute opening statement. We have inserted the statements by the Ranking Member and the chairman for the record. We will proceed with questions following the secretarys statement please proceed. Thank you, senator roberts and members of the committee. I want to thank you for the opportunity to present the president s budget. As many of you all know, i believe we have common interests and share Common Ground. And the last legislative session, this committee embraced that view of bipartisanship and leadership when it took historic steps to pass the medicare authorization act of 2015. I want to thank that committee for the leadership, a very important piece of legislation for a number of reasons. The budget before you today is the final budget for this administration and my final budget. The budget makes critical investments to protect the health and well being of the American People. It helps ensure that we can do our job to keep people safe and health healthy, accelerates our progress, and expands and strengthens our Health Care System. It helps us continue to be responsible stewards of the taxpayers dollars. For hhs, the budget proposes 82 billion. Our request recognizes the constraints on our budget environment. And includes targeted reforms to medicare, medicaid as well as other programs. Over the next 10 years, these programs would result in savings of 419 billion. It invests in the safety and health of all americans. We work to stop the spread of the zika virus. The administration is requesting 1. 8 billion in emergency funding. We appreciate congresss consideration of this important and timely request. As we implement the essential strategies to fight this virus. I know the recognize in opiod misuse affects americans. Every day, 78 people die from opiod overdose deaths. Too many of our nations children and adults with diagnosable Mental Health disorders dont receive the treatment they need. This budget proposes 780 million to fry to close that gap. Research shows early interventions can set the course for a childs success. Thats why we propose expanding and extending the Home Visiting program to support the childs growth. We must relentlessly push forward the frontiers of science and medicine. This budget includes the president s cancer initiative. Each 1 drop in cancer deaths saves our economy approximately 500 billion. Not to mention the comfort and security it brings to families across the country. Today were entering a new era in medical science, including 45 million for the administrations brain initiative. We can continue that progress. For the americans to benefit from these breakthroughs in medical science. We need to ensure that all americans have access to quality Affordable Care. The Affordable Care act has helped us make historic progress. Today more than 90 of americans have health coverage, the first time in the nations history that this has been true. The budget seeks to build on that progress by improving the quality of care that patients receive, spending our Health Care Dollars more wisely. By advancing and improving the way we pay doctors, coordinate care, we are building a better, smarter, healthier system. I want to thank the employees of hhs who in the past year have helped in the Ebola Outbreak in west africa, and have helped millions of americans enroll in health coverage, and done the quiet day to day work that makes our nation healthier and stronger. Im honored to be a part of that team im personally committed to working closely with you and your staff to find Common Ground and deliver impact for the American People. With that, id be happy to take your questions. Thank you. Thank you very much for your statement madam secretary. You recently stated that you believe we have more work to do with the Affordable Health care act the marketplace is stable. Im going to take the opportunity to remind you that one of the five insurers offering coverage in the marketplace from my home state of kansas left the exchange this year, and that insurer provided coverage for nearly half of all kansas residents last year. When we hear stories like this, when we say we have assured stability. It becomes a problem i think the data of your own department shows the premiums will increase 16 this year in kansas thats an increase thats causing a great concern. So with insurers already pulling out of the marketplace, im troubled that cms is taking steps to increase government control of the plans available in the exchanges and ultimately reduce Consumer Choice through the new notice of benefit and payment parameters. The notice claims that an excessive number of Health Care Plan options my question is, does cms believe there are too many planned choices available on the exchanges . I cant imagine you would say anything else but no . With regard to the question of the stability in the marketplace, the marketplace this year most of the folks that came into the marketplace, 9 out of 10 had an ability to be in a market where there are three or more issuers, thats where we believe competition occurs. I believe we need to continue to take steps to further stabilize and make sure the market stays stable with regard to the payment notice, i think you know were in the middle of that and will be completing that payment notice. Our objectives arent about limiting choices for the consumer, instead, making it easier for the consumer to make choices. A number of steps we took this year in open enrollment are about that. We created tools in the marketplace this year, you could search plans and understand if the providers that you were looking for are a part of that. The other part of that is create a tool thats called the total cost tool. Its a tool that allows you to figure out your deductibles and premiums for the year. We can continue to promote stability in the market and make sure there is Consumer Choice, not to limit it. I appreciate that. The acting administrator recently introduced the rural health council. I know that you havent had time to get up to speed on all the details, but i would appreciate any more information you can provide to the committee after this hearing opinion im very much interested in how you see this new effort functioning. The distinguished senator franken is the co chairman of the Royal Health Care caucus. We i need to know or we would like to know how this new council will coordinate with or utilize the work already done by the hhs Rural Health Task force and the National Advisory committee on rural health and Human Services. We have a lot of folks interested. There may be some duplications and i hope we can pull that together. With regard to the council. The council that acting administrator slav ago has pulled together is in response to topics we discussed in this committee. Any regulation that was coming through to cms to me, there were questions about Rural America i would ask every time, and i think what we are now doing is formalizing a process by which those analytics are important for us to understand, because i believe rural markets and urban markets in our country are different. It is formalizing a process that we have been doing informally over the past year, in terms of that rule making, well be happy to work, i think you hear its an issue of interest wed like to work. Make sure we consider the right things as we answer these questions about Rural America. Always good to see you, and thank you for your work on the budget. The implementation of the basic health plan, which now some states have taken up, i want to get your commitment that youll continue to implement those plans across america. My understanding with new york, its already targeting lower premiums and plans of that are better drivers of driving down cost in the marketplace, so definitely want to get your commitment on that. I think you know in the time ive been here, weve engaged in a number of these and now with new york and minnesota we look forward to other states coming forward with proo posals that do a number of things. It has to meet the basics to ensure the number of people that have access would have access. If needs to meet the requirements of Health Benefits already. At the same time, we know these plans are about access, but theyre also about states coming to approaches that are doing Delivery System reform. We look forward to working with states as they come forward with their plans. I think its very telling when you look at this model. Clearly were talking about the lower income population that was always hard to serve in general. That is to get them on an affordable plan, maybe because their employer didnt offer it or didnt have market leverage. To look at new york of low monthly premiums of only 20. Its quite astounding to see we can provide great coverage for a huge population, as ive always been a fan, focused more on managed care which also drives down the cost as well. I look forward to your commitment to working with other states on that. As the administration looks at internal payment models. How are we making sure were moving ahead, particularly for low medicare rate states like washington, that wants to see the improvements and wants not to be penalized but to reward it for that. How are we making sure that were transitioning off of fee for service and on to this payment model in rapid fashion. A number of things were doing. Last year in january, we committed as an administration that we would transfer 30 by the end of 2016 of our payments in medicare, the payments based on value, not volume. That and by 2018 it would be 50 of the payments. We are on track to meet that goal for this year, its important were a large portion of the dollars, its important because of the signal sent to market. Whether thats private players or medicaids where that happens. Rewarding those who are making advances in quality and affordability. We also with our Accountable Care organizations. We took the feedback we have received and in the next round of those, we have put forward changes that hopefully will protect and reward those who are already leading in the space. On graduate medical education, theres something that you guys have entailed on setting the standards for emerging needs in health care as it relates to medical education. What are those standards going to entail. What were trying to do . We want to make sure the monies that are for graduate medicare are targeted toward those in the medicare population. We want to ensure were focusing on primary care, where we know we need more services as well as the issue of specialties where we do not have enough people. What were going to try to do is create standards that target the money and guide it to places where it serves the population its supposed to. But b, its target to the places where we have shortages. The problem that we have, that we need to focus on is that given a state criteria, were not you can be in seattle and be well served but be in spokane and have a shortage, we need to focus on the fact that even within a state, you can have great geographic differences and what youre doing to serve graduate medical education. So its a priority for us to have that graduate medical education in spokane. Our colleagues here have to understand that while there is a cap on medicaid expenses right now in puerto rico, if tens of thousands of people come to the United States, theres no cap on that so we are just digging a deeper hole in our budget by not fixing the problem in puerto rico. Thank you much ill let my colleague get to that when he addresses it. [ inaudible ] the need to be objective on the analysis and we thank you for that. As you know cbo recently came out with an estimate that said that in 10 years of without addressing mandatory spending in other issues, the mandatory interests will consume 99 of all federal revenues. Obviously thats unsustainable. You and i have been together in rooms talking about budget issues. When you were o b director, we werent able to reach an accommodation, either going big, so i decided if we couldnt do that, i would go small. Every week i would go to the senate floor and talk about waste, fraud and abuse. One of the issues that im going to be talking about today is the igs report regarding improper payments through cms. Its my understanding that the Inspector General listed 25 implemented recommendations for improvement and protecting taxpayers dollars. With cms. Cms said it wants to address this, but its short on resources. This is a catch 22, theres an estimate that cms could save 1. 76 billion if it had followed the installation of improving automated claims and a number of other things. My question is youre asking for more resources. Just like to bring this to your attention. There are ways to free up money for absolutely necessary functions for cms. And some of these recommendations if for all of these recommendations, if theyre implemented can help with that process. So i wanted to bring that to your attention. Id like to get your response to that in terms of the ability to go forward in these recommendations implemented. We agree, and i thousand you probably know the 71 statistic. For every one dollar we believe we can save 7. Last year together with the justice department, we had the largest takedown we have had in the fraud area. It was over 700 million in one takedown. We believe we need finances to change and do some of that automation. We asked for some of those resources i think you may have had an opportunity to speak with administrator slavitt. Fraud is a very important part that i think we can go at and go aggressi aggressively, with data getting ahead of it. The other part we need to consider is, with improper payments, theres fraud and that whole category that people arent providing the right information. As we tightened requirements, in order to do things like requiring paperwork before payment, so we get in front of it. We see greater numbers of people not getting the right payment. Thats a place where the resources are important many. Giving your experiences, i know this is something in your wheel house. As secretary of hhs and overseeing cms. Youre exactly the right person, in the right place to get this done we wish you success in getting these things implemented here, it can free up funds for programs that may be waiting for those funds. Absolutely, and thats why were hopeful our budget request. That particular part of the budget request, results in greater savings. The 71 number is what weve seen on the average of the last three years. Thank you. I have 40 seconds left which i yield back in the interest of a vote coming up. Whos next . Thank you, mr. Chairman. I will only ask one question on this round given colleagues being here. Were very pleased the secretary is it here, secretary burwell in my view gives Public Service a good name. We are glad that she is here. The issue of opiod abuse is widespread across the country. Its of particular concern to oregon i think colleagues know that ive opened an investigation into potential conflicts of interest between opiod manufacturers and the pain industry. The concern here is, the manufacturers may be trying to influence opiod prescribing practices and will have more to say on that in the days ahead. Now oregon has been among the states with the highest nonmedical use of prescription pain relievers. One in 15 people who take prescription painkillers for nonmedical purposes are going to try heroin within 10 years. Nationally, Health Care Providers write prescriptions for every adult american to have a bottle of pills. Many studies and experts found that physicians are inadequately trained on pain management. This past week i sent a letter to the cdc director to offer my support for the cdcs Draft Guidelines for prescribing opiods for chronic pain. Set aside for purposes of this morning the question of the investigation into potential conflicts of interest. We will talk more about that in the future for purposes of this morning, what does hhs plan to do to ensure that opiods