[House Hearing, 114 Congress]
[From the U.S. Government Publishing Office]
REVIEWING THE POLICIES AND
PRIORITIES OF THE U.S.
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
=======================================================================
HEARING
before the
COMMITTEE ON EDUCATION
AND THE WORKFORCE
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED FOURTEENTH CONGRESS
FIRST SESSION
__________
HEARING HELD IN WASHINGTON, DC, JULY 28, 2015
__________
Serial No. 114-24
__________
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COMMITTEE ON EDUCATION AND THE WORKFORCE
JOHN KLINE, Minnesota, Chairman
Joe Wilson, South Carolina Robert C. ``Bobby'' Scott,
Virginia Foxx, North Carolina Virginia
Duncan Hunter, California Ranking Member
David P. Roe, Tennessee Ruben Hinojosa, Texas
Glenn Thompson, Pennsylvania Susan A. Davis, California
Tim Walberg, Michigan Raul M. Grijalva, Arizona
Matt Salmon, Arizona Joe Courtney, Connecticut
Brett Guthrie, Kentucky Marcia L. Fudge, Ohio
Todd Rokita, Indiana Jared Polis, Colorado
Lou Barletta, Pennsylvania Gregorio Kilili Camacho Sablan,
Joseph J. Heck, Nevada Northern Mariana Islands
Luke Messer, Indiana Frederica S. Wilson, Florida
Bradley Byrne, Alabama Suzanne Bonamici, Oregon
David Brat, Virginia Mark Pocan, Wisconsin
Buddy Carter, Georgia Mark Takano, California
Michael D. Bishop, Michigan Hakeem S. Jeffries, New York
Glenn Grothman, Wisconsin Katherine M. Clark, Massachusetts
Steve Russell, Oklahoma Alma S. Adams, North Carolina
Carlos Curbelo, Florida Mark DeSaulnier, California
Elise Stefanik, New York
Rick Allen, Georgia
Juliane Sullivan, Staff Director
Denise Forte, Minority Staff Director
C O N T E N T S
----------
Page
Hearing held on July 28, 2015.................................... 1
Statement of Members:
Kline, Hon. John, Chairman, Committee on Education and the
Workforce.................................................. 1
Prepared statement of.................................... 3
Scott, Hon. Robert C., Ranking Member, Committee on Education
and the Workforce.......................................... 4
Prepared statement of.................................... 6
Statement of Witnesses:
Burwell, Hon. Sylvia Matthews, Secretary, U.S. Department of
Health and Human Services, Washington, DC.................. 8
Prepared statement of.................................... 10
Additional Submissions:
Davis, Hon. Susan A., a Representative in Congress from the
State of California:
CBO Budgetary and Economic Effects of Repealing the
Affordable Care Act.................................... 55
Guthrie, Hon. Brett, a Representative in Congress from the
State of Kentucky:
Letter dated April 3, 2015............................... 88
Chairman Kline:
Letter dated June 16, 2015 from Annette Guarisco Fildes,
President and CEO, The ERISA Industry Committee........ 32
Letter dated June 22, 2015 from The National Coalition on
Benefits............................................... 44
Letter dated June 17, 2015 from Kathryn Wilber, American
Benefits Council....................................... 39
Letter dated June 18, 2015 from Annette Guarisco Fildes,
President and CEO, The ERISA Industry Committee........ 30
Wilson, Hon. Frederica S., a Representative in Congress from
the State of Florida:
ASPE Issue Brief dated July 16, 2015..................... 102
Questions submitted for the record by:
Allen, Hon. Rick, a Representative in Congress from the
State of Georgia....................................... 124
Barletta, Hon. Lou, a Representative in Congress from the
State of Pennsylvania.................................. 124
Foxx, Hon. Virginia, a Representative in Congress from
the State of North Carolina............................ 123
Fudge, Hon. Marcia L., a Representative in Congress from
the State of Ohio...................................... 126
Mr. Kline................................................ 122
Polis, Hon. Jared, a Representative in Congress from the
State of Colorado...................................... 127
Roe, Hon. David P., a Representative in Congress from the
State of Tennessee..................................... 123
Mr. Scott................................................ 125
Secretary Burwell's response to questions submitted for the
record 129
REVIEWING THE POLICIES AND PRIORITIES
OF THE U.S. DEPARTMENT OF HEALTH
AND HUMAN SERVICES
----------
Tuesday, July 28, 2015
House of Representatives,
Committee on Education and the Workforce,
Washington, D.C.
----------
The committee met, pursuant to call, at 10:02 a.m., in Room
2175, Rayburn House Office Building, Hon. John Kline [chairman
of the committee] presiding.
Present: Representatives Kline, Foxx, Roe, Thompson,
Walberg, Salmon, Guthrie, Barletta, Messer, Brat, Carter,
Bishop, Grothman, Russell, Curbelo, Stefanik, Allen, Scott,
Hinojosa, Davis, Grijalva, Courtney, Polis, Wilson of Florida,
Bonamici, Pocan, Takano, Jeffries, Clark, Adams, and
DeSaulnier.
Staff Present: Lauren Aronson, Press Secretary; Andrew
Banducci, Professional Staff Member; Janelle Belland,
Coalitions and Members Services Coordinator; Kathlyn Ehl,
Professional Staff Member; James Forester, Professional Staff
Member; Ed Gilroy, Director of Workforce Policy; Callie Harman,
Staff Assistant; Christine Herman, Professional Staff Member;
Tyler Hernandez, Press Secretary; Nancy Locke, Chief Clerk;
Zachary McHenry, Legislative Assistant; Michelle Neblett,
Professional Staff Member; Brian Newell, Communications
Director; Krisann Pearce, General Counsel; Jenny Prescott,
Professional Staff Member; Lauren Reddington, Deputy Press
Secretary; Alissa Strawcutter, Deputy Clerk; Juliane Sullivan,
Staff Director; Alexa Turner, Legislative Assistant; Joseph
Wheeler, Professional Staff Member; Tylease Alli, Minority
Clerk/Intern and Fellow Coordinator; Austin Barbera, Minority
Staff Assistant; Jacque Chevalier, Minority Senior Education
Policy Advisor; Denise Forte, Minority Staff Director;
Christine Godinez, Minority Staff Assistant; Ashlyn Holeyfield,
Minority Education Policy Fellow; Carolyn Hughes, Minority
Senior Labor Policy Advisor; Brian Kennedy, Minority General
Counsel; Veronique Pluviose, Minority Civil Rights Counsel;
Dillon Taylor, Minority Labor Policy Fellow; and Arika Trim,
Minority Press Secretary.
Chairman Kline. A quorum being present, the Committee on
Education and the Workforce will come to order.
Good morning, Secretary Burwell.
Secretary Burwell. Good morning.
Chairman Kline. Thank you for joining us to review the
policies and priorities of the Department of Health and Human
Services. As is often the case when a Cabinet Secretary appears
before the committee, we have a lot of ground to cover in a
short period of time. That is especially true for a Department
as big, powerful, and costly as the Department of Health and
Human Services.
Now, the end of the current fiscal year, HHS is expected to
spend approximately $1 trillion administering numerous programs
affecting millions of Americans including child care, welfare,
healthcare, and early childhood development. At a time when
families are being squeezed by a weak economy and record debt,
we have an urgent responsibility to make sure the Federal
Government is operating efficiently and effectively. It is a
responsibility we take seriously, which is why this hearing is
important, and why we intend to raise a number of key issues.
For example, we are interested to learn about the
Department's progress implementing recent changes to the Child
Care and Development Block Grant Program. Last year, the
committee helped champion bipartisan reform of the program to
strengthen health and safety protections, empower parents, and
improve the quality of care. This vital program has helped
countless moms and dads provide for their families, and we hope
the Department is on track to implement these changes quickly
and in line with congressional intent.
Another vital program for many low-income families is Head
Start. Earlier this year, the committee outlined a number of
key principles for strengthening the program such as reducing
regulatory burdens as well as encouraging local innovation and
better engagement with parents. The committee then solicited
the public feedback that would help turn these principles into
a legislative proposal.
It was in the midst of this effort to reform the law that
the Department decided to launch a regulatory restructuring of
the program. Some of the Department's proposed changes will
help improve the program. However, the sheer scope and cost of
the rulemaking raises concerns and has led to some uncertainty
among providers who serve these vulnerable children.
Strengthening the law is a better approach than transforming a
program through regulatory fiat, and we urge the administration
to join us in that effort.
These two areas alone could fill up most of our time this
morning, and I haven't even mentioned services provided under
the 1996 Welfare Reform Law and the Older Americans Act. Of
course, as you might expect, Secretary Burwell, on the minds of
most members are the challenges the country continues to face
because of the President's healthcare law. Families, workers,
employers are learning more and more about the harmful
consequences of this flawed law.
For example, patients have access to fewer doctors, to
control costs. It is estimated that insurance plans on the
health exchanges have 34 percent fewer providers than non-
exchange plans, including 32 percent fewer primary care doctors
and 42 percent fewer oncologists and cardiologists. The law is
plagued by waste and abuse.
In 2014, investigators with the nonpartisan Government
Accountability Office used fake identities to enroll 12
individuals into subsidized coverage on a healthcare exchange.
Just this month, GAO announced 11 of the 12 fake individuals
are still enrolled and receiving taxpayer subsidies. More than
7 million individuals paid a penalty for failing to purchase
government approved health insurance, roughly 25 percent more
than the administration expected in the worst-case scenario.
According to the Associated Press, at least 4.7 million
individuals were notified that their insurance plans were
canceled because they did not abide by the rigid mandates
established under the healthcare law.
The nonpartisan Congressional Budget Office estimates the
law will result in 2.5 million fewer full-time jobs. This
reflects what we've heard over and over again from employers
who have no choice but to cut hours or delay hiring because of
the law's burdensome mandates. Healthcare costs continue to
skyrocket. According to the New York Times, health insurance
companies are seeking rate increases of ``20 percent to 40
percent or more,'' suggesting markets are still adjusting to
the, ``shock waves set out by the Affordable Care Act.''
Finally, after all the mandates, fraud, loss of coverage,
fewer jobs, higher costs, and nearly $2 trillion in new
government spending, it is estimated more than 25 million
individuals will still lack basic healthcare coverage.
And yet, just last month, President Obama said the law
``worked out better than some of us anticipated.'' Of course,
for those who oppose this government takeover of healthcare,
this is precisely what we anticipated and is precisely why the
American people deserve a better approach.
In closing, Madam Secretary, I want to thank you again for
joining us this morning. It is our responsibility to hold you
and the administration accountable when we believe the country
is moving in the wrong direction. However, there are areas
where I believe we can find common ground and advance positive
solutions on behalf of the American people. Today's hearing is
an important part of those efforts, and I look forward to our
discussion.
With that, I will now yield to Ranking Member Bobby Scott
for his opening remarks.
[The statement of Chairman Kline follows:]
Prepared Statement of Hon. John Kline, Chairman, Committee on Education
and the Workforce
Good morning, Secretary Burwell. Thank you for joining us to review
the policies and priorities of the Department of Health and Human
Services. As is often the case when an agency secretary appears before
the committee, we have a lot of ground to cover in a short period of
time. That is especially true for an agency as big, powerful, and
costly as the Department of Health and Human Services.
By the end of the current fiscal year, HHS is expected to spend
approximately $1 trillion administering numerous programs affecting
millions of Americans, including child care, welfare, healthcare, and
early childhood development. At a time when families are being squeezed
by a weak economy and record debt, we have an urgent responsibility to
make sure the federal government is operating efficiently and
effectively. It is a responsibility we take seriously, which is why
this hearing is important and why we intend to raise a number of key
issues.
For example, we are interested to learn about the department's
progress implementing recent changes to the Child Care and Development
Block Grant program. Last year, the committee helped champion
bipartisan reforms of the program to strengthen health and safety
protections, empower parents, and improve the quality of care. This
vital program has helped countless moms and dads provide for their
families, and we hope the department is on track to implement these
changes quickly and in line with congressional intent.
Another vital program for many low-income families is Head Start.
Earlier this year, the committee outlined a number of key principles
for strengthening the program, such as reducing regulatory burdens, as
well as encouraging local innovation and better engagement with
parents. The committee then solicited public feedback that would help
turn these principles into a legislative proposal.
It was in the midst of this effort to reform the law that the
department decided to launch a regulatory restructuring of the program.
Some of the department's proposed changes will help improve the
program; however, the sheer scope and cost of the rulemaking raises
concerns and has led to some uncertainty among providers who serve
these vulnerable children. Strengthening the law is a better approach
than transforming a program through regulatory fiat, and we urge the
administration to join us in that effort.
These two areas alone could fill up most of our time this morning,
and I haven't even mentioned services provided under the 1996 welfare
reform law and the Older Americans Act. Of course, as you might expect,
Secretary Burwell, on the minds of most members are the challenges the
country continues to face because of the president's healthcare law.
Families, workers, and employers are learning more and more about the
harmful consequences of this flawed law. For example:
* Patients have access to fewer doctors. To control costs, it is
estimated that insurance plans on the healthcare exchanges have 34
percent fewer providers than non-exchange plans, including 32 percent
fewer primary care doctors and 42 percent fewer oncologists and
cardiologists.
* The law is plagued by waste and abuse. In 2014, investigators
with the nonpartisan Government Accountability Office used fake
identities to enroll 12 individuals into subsidized coverage on a
healthcare exchange. Just this month, GAO announced 11 of the 12 fake
individuals are still enrolled and receiving taxpayer subsidies.
* More than seven million individuals paid a penalty for failing to
purchase government-approved health insurance, roughly 25 percent more
than the administration expected under the worst case scenario.
* According to the Associated Press, at least 4.7 million
individuals were notified that their insurance plans were cancelled
because they did not abide by the rigid mandates established under the
healthcare law.
* The nonpartisan Congressional Budget Office estimates the law
will result in 2.5 million fewer full-time jobs. This reflects what
we've heard over and over again from employers who have no choice but
to cut hours or delay hiring because of the law's burdensome mandates.
* Healthcare costs continue to skyrocket. According to the New York
Times, health insurance companies are seeking rate increases of ``20
percent to 40 percent or more,'' suggesting markets are still adjusting
to the ``shock waves set off by the Affordable Care Act.''
Finally, after all the mandates, fraud, loss of coverage, fewer
jobs, higher costs, and nearly $2 trillion in new government spending,
it's estimated more than 25 million individuals will still lack basic
healthcare coverage. And yet, just last month, President Obama said the
law ``worked out better than some of us anticipated.'' Of course, for
those who opposed this government takeover of healthcare, this is
precisely what we anticipated and it is precisely why the American
people deserve a better approach.
In closing, Secretary Burwell, I want to thank you again for
joining us this morning. It is our responsibility to hold you and the
administration accountable when we believe the country is moving in the
wrong direction. However, there are areas where I believe we can find
common ground and advance positive solutions on behalf of the American
people. Today's hearing is an important part of those efforts, and I
look forward to our discussion.
With that, I will now yield to Ranking Member Bobby Scott for his
opening remarks.
______
Mr. Scott. Thank you, Chairman Kline.
And welcome, Secretary Burwell, and thank you for being
with us today. I look forward to your testimony.
Today we'll hear about the President's Fiscal Year 2016
Health and Human Services budget proposals and the Department's
budget priorities. While the budget was released months ago,
I'm pleased to see that the word ``priority'' is included in
the title of today's hearing. Budgeting requires making tough
choices, and a budget is in fact a reflection of priorities. As
legislators, we decide what our priorities are and how best to
invest in our country.
I was pleased that the President's budget request was
reflective of many important priorities such as protecting
access to healthcare insurance for all Americans, giving all
children a chance to succeed, and reducing inequality around
the country.
In many areas, I believe that we've made great progress on
these 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 has
also helped slow the growth in healthcare costs, closed the
doughnut holes for seniors, and encouraged and improved access
to mental health services and preventive care.
Just weeks ago the Supreme Court decided in another case
pertaining to the Affordable Care Act, in King v. Burwell. The
legality of subsidies for those obtaining health insurance
through the Federal marketplace instead of a Statewide
marketplace was upheld. The Affordable Care Act was structured
and designed to improve healthcare insurance coverage and
access across the entire country, and it has, and now those
living in Virginia have enjoyed access to insurance subsidies
just 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 her efforts and her
Department's hard work in implementing the ACA. I recognize the
challenge that your agency faces in implementing the law with
limited resources and unlimited attacks, but despite these
challenges, the ACA is working.
I was also pleased to see that the President's budget
request 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 childcare programs.
The Republican budget adopted by the House earlier this
year is not reflective of these shared national priorities,
despite research showing for every dollar spent on early
education, there is a return of $7 in reduced costs in other
parts of the budget. We must invest in quality early learning
programs because all children deserve being in kindergarten
with the building blocks to success.
Now, decades of research has shown that properly nurturing
children in the first five years of life is instrumental in
supporting enhanced brain development, cognitive functioning,
and emotional and physical health. But all too often low-income
working families lack access to high-quality affordable child
care and early childhood education, and these children tend to
fall far behind. In addition to this achievement gap, children
who don't participate in high-quality early learning programs
are more likely to have weaker educational outcomes, lower
earnings, increased involvement in the criminal justice system,
and increased teen pregnancy.
Affordable high-quality child care is not just critical for
children, it is also critical for working parents, because
child care is a two-generational program. Parents of young
children need child care to go to work or go to school. And 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 America's
children and to help grow our economy. Just two programs
throughout the bulk of the Federal role in early education, the
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 10 eligible children have access to Head Start and only one
out of six federally eligible families receive child care
subsidies. We have decades of evidence that investing in
programs like Head Start and the Child Care Development Block
Grant work, and the time is to invest in these programs and
ensure that we're giving all children the chance to succeed.
Lastly, it's past time for Congress to raise the sequester-
level discretionary spending caps that are stunting the
progress that we can make as a Nation in important areas like
health and education. These caps threaten nearly every program
under the jurisdiction of this committee from low income home
energy assistance program to the Older Americans Act and
others. The sequester has led to woefully inadequate investment
in critical National needs and puts us on a path to another
government shutdown.
In coming back to the idea of priorities, investing in our
Nation's future should be Congress' number one priority, not
corporate tax breaks or lowering the estate tax. Our focus
should remain on restoring investments that strengthen our
Nation's middle class and help hard working American families
get ahead.
So thank you, Mr. Chairman, and thank you Secretary Burwell
for being here today.
Chairman Kline. I thank the gentleman.
[The statement of Mr. Scott follows:]
Prepared Statement of Hon. Robert C. ``Bobby'' Scott, Ranking Member,
Committee on Education and the Workforce
Thank you Chairman Kline, and welcome Secretary Burwell. Thank you,
Secretary, for being with us and I look forward to your testimony.
Today we will hear about the President's Fiscal Year 2016 Health
and Human Services Budget proposal and the Department's policy
priorities. While the budget was released months ago, I was pleased to
see the word ``priority'' included in the title of today's hearing.
Budgeting requires making tough choices, and a budget is in fact a
reflection of priorities. As legislators, we decide what our priorities
are and how to best invest in our country. I was pleased that the
President's budget request was reflective of the priorities that are
important to the success of families and communities across the country
- protecting access to health insurance for all Americans, giving all
children a chance to succeed, and reducing inequality in this country.
In many areas, I believe we have made great progress in these
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 has helped to slow the growth in
healthcare costs, closed the donut hole for seniors, and has encouraged
and improved access to mental health services and preventive care.
Just a few weeks ago, the Supreme Court decided another case
pertaining to the Affordable Care Act. In King v. Burwell, the legality
of subsidies for those obtaining insurance through a federal
Marketplace instead of a state-run Marketplace was upheld. The
Affordable Care Act was structured and designed to improve health
insurance coverage and access across the entire country. And it has.
Those living in Virginia have enjoyed access to insurance subsidies,
just like someone in Minnesota, and will continue to do so.
I want to thank Secretary Burwell for her efforts and her
Department's hard work implementing the ACA. I recognize the challenge
your agency faces in implementing this law with limited resources and
unlimited attacks. Despite these challenges, the ACA is working.
I was also pleased that the President's budget request placed
priority on giving ALL children a chance to succeed by ensuring robust
funding to increase both access to and the quality of early learning
and childcare programs. The Republican budget adopted in the House
earlier this year is not reflective of these shared, national
priorities despite research showing a return of over $7 for every $1
spent on early education. We must invest in quality early learning
programs because all children deserve to enter kindergarten with the
building blocks to success.
Decades of research has shown that properly nurturing children in
the first five years of life is instrumental to supporting enhanced
brain development, cognitive functioning, and emotional and physical
health. But all too often, low-income working families lack access to
high-quality, affordable child care and early childhood education, and
these children tend to fall behind. Beyond the
achievement gap, children who don't participate in high-quality
early education programs are more likely to have weaker educational
outcomes, lower earnings, and increased involvement in the criminal
justice system. Affordable high-quality child care is not just critical
for children, it is also critical for working parents. Child care is a
two-generation program. Parents of young children need child care to
work or go to school. And 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 America's children and to help grow
our economy.
Just two programs provide for the bulk of the federal role in early
education: the Head Start Program and the Child Care and Development
Block Grant. Unfortunately, because of limited federal funding, too few
young children have access. This unmet need continues to grow - only 4
out of 10 eligible children have access to Head Start and only 1 out of
6 federally-eligible families receive child care subsides. We have
decades of evidence that investing in programs like Head Start and the
Child Care and Development Block Grant works. It is time to invest in
these programs and ensure that we are giving ALL children the chance to
succeed.
Lastly, it is past time for Congress to raise the sequester-level
discretionary spending caps that are stunting the progress we can make
as a nation in important areas, like health and education. These caps
threaten nearly every program under the jurisdiction of this Committee,
from the Low Income Home Energy Assistance Program to the Older
Americans Act supportive programs. The sequester has led to woefully
inadequate investment in critical national needs and put us on a path
to another government shutdown. And coming back to the idea of
priorities, investing in our country's future should be Congress'
number one priority - not corporate tax breaks, or lowering the estate
tax. Our focus should remain on restoring investments that strengthen
our nation's middle class and help hardworking families get ahead.
Thank you and Secretary Burwell, I look forward to hearing from you
today.
______
Chairman Kline. Pursuant to Committee Rule 7(c), all
members will be permitted to submit written statements to be
included in the permanent hearing record. Without objection,
the hearing record will remain open for 14 days to allow such
statements and other extraneous material referenced during the
hearing to be submitted for the official hearing record.
It is now my pleasure to introduce our distinguished
witness. The Honorable Sylvia Matthews Burwell is the Secretary
of Health and Human Services. Prior to joining HHS in June of
2014, Secretary Burwell served as a director of the Office of
Management and Budget, where she oversaw the development of
President Obama's second term management agenda. During the
Clinton administration, Secretary Burwell served as deputy
director of OMB, deputy chief of staff to the President, chief
of staff to the Secretary of the Treasury, and staff director
of the National Economic Council.
Welcome, Madam Secretary. I will now ask the Secretary to
stand and raise your right hand.
Thank you.
[Witness sworn.]
Chairman Kline. Let the record reflect the witness answered
in the affirmative.
Now, before I recognize you to provide your testimony, let
me briefly remind you or, more importantly, my colleagues of
our lighting system. We typically allow five minutes for each
witness to present, although I will be flexible on this
timeline, given you are our only witness and you are a Cabinet
Secretary. I would ask you, though, to try to limit your
remarks, because we have a lot of members who want to get to
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. We will honor that, and I would ask my
colleagues to be patient.
Again, on the lights, when you start, and we'll put the
timer on, but you can effectively ignore it if you'd like, it
will be green and then turn yellow when you have a minute to go
and then red when the five-minute mark is over. And that
applies only to the Secretary. To my colleagues, when five
minutes is up, five minutes is up.
Now, you are recognized, Madam Secretary.
TESTIMONY OF THE HONORABLE SYLVIA MATTHEWS BURWELL, SECRETARY,
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, WASHINGTON D.C.
Secretary Burwell. 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 common
ground. We saw the power of common ground in the
reauthorization of the Child Care and Development Block Grant
Program that happened last fall, as well as the bipartisan SGR
repeal earlier this year. And I appreciate all of your all's
work to get that passed.
The President's budget proposes to end sequestration fully,
reversing it through domestic priorities in 2016, matched by
equal dollar increases for the Department of Defense. Without
further congressional action, sequestration will return in full
in 2016, bringing discretionary funding to its lowest level in
a decade adjusted for inflation. We need a whole of government
solution, and I hope that both parties can work together to
achieve a balanced and commonsense approach.
The budget before you makes critical investments in
healthcare, science, innovation, public health, and human
services. It maintains our responsible 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
discretionary budget authority. This 4.8 billion 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, which in tandem with
accompanying legislative proposals, could save taxpayers a net
estimated $250 billion. The budget is projected to continue
slowing the growth in Medicare by securing $423 billion in
savings as we build a better, smarter, healthier delivery
system.
In terms of providing all Americans with access to
affordable quality healthcare, the budget builds on our
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, spends 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 Nation's
healthcare workforce, 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 also invests in precision medicine, a new cross
department effort focused on development treatments,
diagnostics, and prevention strategies tailored to the
individual genetic characteristics of a patient. To further our
common interests 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 this Congress last fall to create a continuum of
early learning opportunities from birth through age five. This
change would provide high-quality preschool for every child,
guaranteed quality child care for working families, grow the
supply of early learning opportunities for young children, and
expand investments in voluntary evidence-based home visiting
programs.
To keep Americans safe and healthy, the budget strengthens
health and public infrastructure with $975 million for domestic
and international preparedness. It also invests in behavioral
health services including more than $99 million in new funding
to combat prescription opioid and heroin abuse.
Finally, as we look to leave the Department stronger, the
budget invests in our shared priorities of addressing waste,
fraud, and abuse--initiatives that are projected to yield $22
billion in gross savings.
The budget addresses the Department's Medicare appeals
backlog with a coordinated approach. The budget also makes a
significant investment in the security of the Department's
information technology and cybersecurity.
I want to conclude by taking a moment to say how proud I am
of the HHS team and the employees that work on Ebola, their
work every day and their commitment every day. I want to assure
you I am personally committed to a responsive and open dialogue
with members of this committee as well as with your colleagues.
I look forward to working closely with you, and I welcome
your questions. Thank you.
Chairman Kline. Thank you, Madam Secretary. The light
didn't even turn red. I'm unprepared now. I'm at a loss.
[The statement of Secretary Burwell follows:]
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Chairman Kline. Seriously, I want to thank you, Madam
Secretary, for your ongoing efforts to keep us informed about
the Department's progress in implementing the Child Care and
Development Block Grant Act of 2014, as well as the opportunity
for committee staff to communicate directly with your staff.
Can you update us, briefly, on the timeline for the release
of guidance in the proposed rules in accordance with the Act?
Secretary Burwell. I think, our staff has had an
opportunity to go back and forth, and I think that's helpful as
we're producing the guidelines. And I'm hopeful--I'm not sure
which particular piece you're referring to, and so I want to
make sure, and we can follow up on that. But overall, we are
making progress and hope to get them out.
One piece that I would like to recognize with regard to the
implementation of the authorities that you all gave us, there's
an important piece of the budget that is related to the
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 aren't being served, such as parents that work in
different hours.
And so there's funding in the budget that we are talking
about today on the discretionary side that I think it is
important to do that, and I do want to raise that as a part of
this conversation. That as part of doing the implementation,
there is some funding to do that.
Chairman Kline. Okay. I'm not sure that's exactly what I
was getting at, but that's good. Thank you very much.
Secretary Burwell. And I will get back on the specifics of
the timing of the guidelines.
Chairman Kline. Just trying to get a better feel for the
timeline.
Secretary Burwell. I'm happy to get back on exactly the
timetable.
Chairman Kline. And again, I very much appreciate the
exchange between staffs, very, very helpful.
I want to take the remainder of my time, no doubt, and I'll
try to be brief, but there is an issue having to do with the
Patient Protection and Affordable Care Act that's just sitting
out there that really, really needs to be addressed, and that's
the maximum amount of out-of-pocket limits for cost sharing
that I'm sure that you've heard about. I've heard from several
employers recently about this unilateral change the Department
made to cost sharing, maximum out-of-pocket limits under PPACA.
We can't seem to determine where this is coming from. The
statute is pretty clear. There are two separate and distinct
types of coverage, self-only and other than self-only coverage,
each with respective out-of-pocket limits. Before this new
rule, any combination of family member's out-of-pocket costs
has counted towards the maximum of these out-of-pocket family
coverage limits. Now, the Department has declared that 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
percent of the out-of-pocket costs sooner.
I understand that you're aware; I have been led to believe
that you're aware of these concerns. I'm sure that employers
have raised this issue directly with you and your staff
probably many times. They certainly have with us.
We'd like to understand under what statutory authority you
did that? And then I'd like to enter into the record letters
from the ERISA Industry Committee, the American Benefits
Council, and the National Coalition on Benefits, conveying
their grave concerns to the Department's new embedded maximum
out-of-pocket limit rule.
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Chairman Kline. The letters also convey that compliance
will not be possible by 2016 given that employers' plans are
already set for next year. It wasn't until May, when additional
guidance was issued, that most large employers knew this change
applied to them. So there's real confusion out there, Madam
Secretary. And, again, I'm fairly confident that you are
hearing some of this directly, but I want to make sure you
heard from me.
Can you commit to at least delay the impact of this,
really, significant rule change for at least a year, and if
not, why not?
Secretary Burwell. So with regard to the issue of the
question of delay, we are now hearing and receiving feedback.
We want to take and incorporate that and determine what we
should do to move forward. I think it's important to note why
the change was put in place. And the change was actually put in
place about the consumer and the fact that when one consumer in
a family hits that individual limit and the question of should
they hit that family limit and whether you should aggregate or
the individual. Because, I think actually when consumers
purchase and how the consumer thinks about this issue, I hear
and understand, and we are hearing from the companies in terms
of how they think about the question of the maximum out-of-
pocket limit.
But if you are an individual in a family, do you think that
limit is your individual limit, and then there's a broader
family limit for all. And so once you've hit your individual
limit, what would happen is you would keep going. And so you
would not have those things paid for, and you signed up in a
place where you thought your individual limit was your
individual limit and your family limit was for all members of
the family. And so that's how the consumer has tended to think
about it and at least what we've heard from the consumer side
of it.
And so that is why we have gone forward. We are hearing
comments and want to incorporate those comments and understand
if it is implementable.
Chairman Kline. Well, I understand the point of view of the
consumer here, and I'm not making light of that. But the
statute we think is pretty clear. And because there is so much
confusion out there, and there is the uncertainty and arguably
the inability to comply, we are hopeful that you will commit
sooner rather than later to a delay of this rule change.
And I'm going to try to--it's already too late. The light
has turned red for me.
But, Mr. Scott, you're recognized.
Mr. Scott. Thank you, Mr. Chairman.
Thank you, Secretary Burwell, for being with us today. I
wanted to ask you a few questions about the Affordable Care
Act, but, first, I want to thank you for your Department's
outreach efforts, particularly Joanne Grossi, who is the
regional director in my area has just been outstanding in
outreach into the community, making sure that people know about
it, and during the signup period was all over my district. So
I'm sure she was all over the region.
Can you say a word about what the Affordable Care Act does
for people with insurance in terms of preexisting conditions
and job lock?
Secretary Burwell. So two different things that I think it
does. With regard to preexisting conditions, it creates a
situation where anyone with a preexisting condition is able to
get insurance. And so whether it's the people that I've met as
I traveled across the country that are concerned for their
children as their children get older, if it's child that has
asthma or other conditions or someone who has actually gotten
cancer and is now well and their ability to know that they
won't be locked out. So preexisting conditions are something
that are no longer something that creates both health and
financial worry for people in the system.
And with regard to the question of lock out and job lock,
there are many people who wouldn't make changes because of
their fear of losing coverage. And that is a part of the
numbers that the chairman stated in terms of the changes that
occur. Because with regard to the employer-based market, we
have not, in the two years that the Affordable Care Act has
been up, seen that shift from employer-based coverage in terms
of the reduction and percentage of employees that are in
employer-based coverage. We haven't seen that shift.
And some of the estimates are about people, though, who
will choose to make a decision to go do something
entrepreneurial if they want to start a business or make other
changes in their lives. And so the lock that was created
because they were fearful of losing coverage doesn't exist
because they have an option, and that option is through the
marketplace.
Mr. Scott. And what has happened to the growth in
healthcare costs since the passage of ACA?
Secretary Burwell. With regard to the growth of healthcare
costs, thinking about it in terms of we've had some of the
lowest price growth per capita that we have seen in 50 years in
terms of slowing of that growth. I think when discussing the
question of growth and cost growth, while it's a hard thing to
do and recognize, one needs to look at historical growth and
then what growth is.
And so if we look at what was released recently in the
Medicare trustee's report, which is let's reflect on the public
sector costs of this growth, what we saw is growth of 1.2
percent over the period of the last four years. What we saw in
that period before then was 3.6 percent growth. And so what
we've seen is a slowing in a lot of different places, both the
public and the private, of that growth.
Mr. Scott. And the programs under your jurisdiction, can
you say a word about the effect of the sequestration if we
don't do something about the sequestration?
Secretary Burwell. So as we look at this issue of being
funded at the lowest level in a decade when one accounts for
inflation, it is across the entire Department, and whether
that's an issue of Head Start or child care that we'll focus on
in this committee, it also is in places like the NIH and our
research or the CDC, who has been so active this year in so
many ways, whether that's Ebola or measles, and also in places
like the FDA, who are doing things like making sure our food is
safe and that we are watching and taking care and that our
drugs and diagnostics are safe.
So it's across the entire Department. Another place that
this particular committee is interested in, I know, is the
older Americans and the programs that we have there to support
those older Americans around food and transportation as well as
elder justice.
Mr. Scott. Thank you. Head Start is not in the Department
of Education. It's in the Department of Health and Human
Services. Can you explain why it's important--what the services
to low-income children get remaining in Health and Human
Services that it would not be available in just an educational
program and why Head Start is so important?
Secretary Burwell. So I think that the program of Head
Start, we have it as part of our continuum at HHS that starts
with home visiting. And thank you to all of you all who
supported the sustainable growth rate bill that had the
extension of the home visiting an evidence -based program that
starts with that care in the home, visiting the home, and
helping start children on the right track. And we believe that
continuum as well as the changes in the authorizations in Head
Start that you all have done to push to improve quality that is
all part of a continuum, and the continuum is related to the
issues that we work on broadly at HHS.
And whether that's starting the mother on the right
trajectory with regard to her maternal health so the child is
born in a certain environment that has been taken care for 9
months and then continuing that early care, starting that
learning early and that brain development. The science that we
know, and having a 5 and 7-year-old, of how quickly that
neurodevelopment is occurring and how fast they are learning,
sometimes it surprises me.
But it is what we believe is a continuum of both health and
the building block of healthy productive lives that we use at
HHS.
Mr. Scott. Thank you, Mr. Chairman.
Chairman Kline. I thank the gentleman.
Dr. Foxx.
Ms. Foxx. Thank you, Mr. Chairman.
And Madam Secretary, welcome to our hearing. Madam
Secretary, I appreciate you bringing up the Older Americans
Act. We're looking at--the Committee is looking at ways to
promote best practices to combat elder abuse. And I wonder if
you could talk a little bit about how the Department is working
with other agencies to protect vulnerable elders?
Secretary Burwell. So working across the Department and
obviously, the Department of Justice is a partner with some of
the work we do. But most recently, whether it's with our
Departments and States, as well as other stakeholders.
The White House Conference on Aging, we took an approach
this year, where we actually went out to communities across the
country, and this was one of the pillars and issues that we
focused on and used that as an opportunity to bring in the
engagement and involvement of both ideas as well as how we can
implement better as a Department in terms of the issue of elder
abuse. So we're seeking that input to improve what we are doing
both within the U.S. Government, but also with a number of the
players that implement and those are stakeholders on the ground
and States. Because many of the programs are actually delivered
and implemented at that level.
Ms. Foxx. And would you discuss a little bit those delivery
models of the Older Americans Act and what makes them work
well? Working with other agencies, I'm sure, is the right thing
to be doing, but are there ways to implement these similar
delivery models across other programs across the country, and
how is the Department providing leadership to do that?
Secretary Burwell. So I think two--there are many things,
but I'll just focus in a short time on two things that I think
are important in this space.
One is actually the awareness of the issue. Elder abuse is
something that is not an issue that many focus on and whether
these providers and the organizations in the community are a
part of recognizing the issue. It is a little like the issue
with victims in trafficking, creating a greater awareness of it
is an important thing to do.
I think the other thing that we think is important to do,
is that when these acts occur that justice is served, so people
know that when they are taking advantage of the elderly, and
that's a place where we need to continue to work with State and
local officials on that as well as Federal.
And I think one very specific example of that is the recent
takedown that was done on Medicare. You all probably know that
our most recent takedown, which was a joint effort with us,
DOJ, the FBI, HHS, OIG, and CMS. It was over $700 million in
false billing. And many of those examples were around elder
justice issues where patients were being told they were being
treated for dementia and were simply being moved from one
location to another being charged for that and Medicare was
therefore charged. So I think it is the combination of those
kinds of things that we trying to bring together.
Ms. Foxx. Thank you very much for that.
Congressman Scott brought up Head Start performance
standards. We know that Head Start is the largest program we
have working with young children. But we're concerned about the
impact of the new regulations that you're putting out there.
Our reauthorization in 2007 required you to have regulatory
revisions not result in the elimination of or reduction in
quality and scope of services, but you are talking about a
reduction of 126,000 children's slots, elimination of 10,000
teachers' jobs. How can you ensure that the revisions that you
are proposing are in compliance with the 2007 law?
Secretary Burwell. We have done three issuances of
regulations with regard to implement the law, and this is the
third of those. One of the things we did was make sure they are
serving low-income communities, the other was making sure that
there were reviews and people had to reapply for the money, the
grantees. And so we set standards there, this is the third
part. And in this part, we are using evidence-based studies to
improve the quality and safety, which we believe that the
authorization is what it told us to do.
One of the things that the Chairman mentioned, that I think
is important to mention, is we got rid of one-third of the
guidelines in terms of simplifying and making it easier. With
regard to some of the things that you are referring to, I think
you are referring to the extension of the day and the year. And
the evidence that we have seen, all the scientific evidence
shows, that moving from three and a half hours to six hours is
an important effort to provide the quality that we need to
provide and the summers, having two children right now going
through their summer, what they lose if they do not have that
kind of continued education.
We propose the amount of money that it would take in our
budget. We're hopeful that we can move forward on that. And the
other thing is if grantees can't meet that and have reason not
to, there is waiver ability.
Ms. Foxx. Thank you.
Chairman Kline. The gentlelady's time has expired.
Mr. Hinojosa.
Mr. Hinojosa. Thank you, Chairman Kline and Ranking Member
Scott. I strongly support the Health and Human Services budget
request and ask that we work together to forge a consensus on
how to ensure that our families continue to have access to
quality healthcare coverage and adequate funding for Head
Start.
We can invest in our preschool programs today or in
juvenile detention tomorrow. We have heard Pope Francis deliver
a very strong message all over the world urging leaders like
us. The Pope says, we must make the right amount of investments
to address poverty found in older senior persons and children
in low-income families.
Madam Secretary, thank you for your testimony on the
Department's enormous progress we have made since the enactment
of ACA. It's a pleasure to have you testify before this
committee.
Today, in my congressional district, because of the
Affordable Care Act there are over 100,000 individuals who now
have health insurance and 88,000 seniors who are now eligible
for Medicare preventive services without paying any copays, co-
insurance, or deductible. We know that another program, Head
Start, is a crucial developmental program in my congressional
district known as the lower Rio Grande Valley. This program
serves between 15,000 to 20,000 children and families. Head
Start has made a significant impact on improving the
opportunities for eligible children, especially our Nation's
Latino and African American youth. Thank you for your strong
budget support for this program.
My first question, what is at stake for our Nation if we
ignore the ever-growing body of research, and we fail to
sufficiently invest in quality early learning for our Nation's
minority children?
Secretary Burwell. So I think this is why this area in our
budget, and we discussed the Head Start portion of it, but
there's also the child care proposal. And part of the child
care proposal on the discretionary side comes to part of the
chairman's question in terms of implementing the authorization.
That's on the discretionary side. The broader proposal that we
have, which is a larger mandatory proposal, is about making
sure that there's access on this continuum.
And so what we do is we take care of that child from the
moment of that home visiting and the pregnancy through those
early years of education, and that we do that both for those at
the lowest level of income, and Head Start is focused on that.
But child care, and that's a part of what we're proposing is
child care for working families, that there is supplement so
that they can afford that, up through that school age. And so
what we are trying to do is create a continuum, which we think
was a part of the authorization and some of the concepts of the
authorization.
This budget funds it fully. We think it's one of the most
important priorities. And as we reviewed the budget and put it
together, it is a place where we made choices that we would
prioritize and put a lot of our dollars because we think it is
so important to the long-term health of those children and the
well-being of our society.
Mr. Hinojosa. I agree with you, and I recommend that you
consider adding more emphasis on early reading and writing for
children from cradle through the fourth year so that they can
love books and improve their vocabulary and be able to stay at
grade level and do well.
In my district, the majority of the uninsured population
falls under the Medicare--excuse me, falls under the Medicaid
coverage gap and does not qualify for assistance in healthcare
marketplace. According to the Kaiser Family Foundation, up to
950,000 uninsured people would gain healthcare coverage if the
State of Texas decided to expand Medicaid. What justifications,
if any, have you heard or received, and how has HHS responded
to discussions that you've had with the governors like Abbott
in Texas?
Secretary Burwell. So with regard to the conversations with
governors, I spent the weekend at the National Governors
Association, and the year before that I did as well. In terms
of any concerns that governors have, what I want them to know
is we want to expand the program, we want to expand the program
in a way that implements the statute, which is about expanding
access and doing it for low income populations so it's
affordable. But we want to do that in ways that works for
States.
And so I think in terms of answering concerns and
questions, whether it's the negotiations that we did with
Governor Pence, and I personally participated in a number of
other governors so that we can make sure that we do this in a
way that serves the citizens, the States, that may have
different needs. And so that's, in terms of one of the issues
that comes up. I want to clearly articulate - I want to work
with governors and their states.
Mr. Hinojosa. Thank you. I yield back.
Chairman Kline. The gentleman yields back.
I'm going to yield to Dr. Roe, but I want to give members a
heads-up here. We're looking at a clock and time. I'll be
recognizing Dr. Roe for five minutes and probably Ms. Davis,
maybe Mr. Walberg and Mr. Grijalva. After that we are going to
have to start dropping down. So just start tailoring your
questions we are going to go to four minutes and see if that
will make it. I am trying not to go to three or two, but I want
to give everybody a chance to be involved in this conversation.
Dr. Roe.
Mr. Roe. Thank you, Mr. Chairman.
Thank you, Madam Secretary, for being here. Just some QFRs,
some questions I want to bring up to begin with and then we'll
get to the questions. These are things I want your shop to
answer.
One is the Medicare wage index or area wage indexes. If you
look at those around the country, it was never intended to be
like that. The 20 of the highest are in California and
Massachusetts, and 14 of the lowest are in Alabama and
Tennessee. For instance, what you get paid in Santa Cruz,
California, is 1.7 with the Medicare area wage index and it is
0.73 where I live. It's putting us out of business. And that
needs to desperately be looked at.
The second thing I want to bring up, and I want to know
what your solution for that is, the second thing I want to know
are the RAC audits. The RAC audits, certainly, we are all
against fraud and abuse. But in my State, the Medicare comes
in, does these audits, withholds the payments, and we win 72
percent of them. And now, the backlog is so long, you can't get
in front of anybody to get your money back that you've earned,
and that's unfair. And I think you absolutely need to redo the
RAC audits.
And thirdly, this is a much deeper one, and it may take
some time, but Medicare is on an unsustainable course, as you
well know. Last year, in 2014, Medicare spent $613 billion, and
we took in $304 billion in premiums. That's unsustainable. And
since its inception, $3.6 trillion, negative, of premiums over
what we spent on the program. I'd like to know what your
recommendations are to put this on a more sustainable course.
Yes, through our reform we did save $2.9 trillion over the
budget window. That's a start. But I would like to know what
those other issues are.
And regrettably, I've got to ask some questions now that I
don't like asking, but I think are extremely important to ask.
And also one last thing, question was for the QFR on IPAB. Do
you think one person, that would be you now currently, sitting
in that seat, should have the power to determine how Medicare
dollars are spent if it goes over this formula? I'd like to
know that, because there's nobody on that 15-panel board right
now.
Recently, we've seen two videos that showed Planned
Parenthood physicians basically having wine and eating a salad
bargaining over the harvesting and sale of dismembered baby
parts. I found this incredibly offensive to me as a physician
and as an obstetrician. Have you seen those videos?
Secretary Burwell. I have not seen the videos. I've read
the articles about them.
Mr. Roe. Well, last week in the Wall Street Journal, it
reported that you couldn't comment because you haven't seen it,
but you need to see those, Secretary Burwell, as quickly as you
can. And it's only eight or ten minutes, but you need to look
at those videos to see what the rest of us have looked at.
And given Planned Parenthood's, which I think is horrific
conduct, Americans may be troubled to realize that Planned
Parenthood gets over $500 million a year, much of it through
your shop, through Medicaid and Title X funding. Having said
that with a significant financial relationship, could you tell
us what you've done to investigate these activities?
Secretary Burwell. So, first, because it's so related to
the budget issues we're discussing today, the RAC issues and
the backlogs, we have put together a strategy that includes, it
is just because it is such an important issue and appeal, so I
just want to make sure there is a budget issue in terms of
extending the number of people that we can have to review the
appeals because there are legal judges that we have to bring
in.
Second, there are statutory changes. And on the Senate side
a bill is moving to make changes that will help us, and third,
administrative actions, including settlement. So, I just want
to raise that because it is important.
I want to go on to the broader issue that you've raised.
With regard to the issue, I want to start by saying this is an
important issue that people have passion deeply on both sides
of the issue and whether that's the issues of research that are
important for eyes, degenerative diseases, Down's syndrome,
Autism, or the issue of belief. And I want to start there. With
regard to the question of--
Mr. Roe. Let me stop you, because my time is about up. Have
you had any contact with Planned Parenthood yet? On this issue.
Secretary Burwell. I'm sorry?
Mr. Roe. With regard to this issue, this sale of the . . .
Secretary Burwell. No. Planned Parenthood's funding, the
$500 million, I think you mention I think is a number that is a
State number. And with regard to Medicaid and States those are
issues where--
Mr. Roe. 41 percent of their funding comes through the
Federal taxpayers. And let me just say before my time runs out,
because we are limited in time. I found it absolutely amazing
that Planned Parenthood could complain about a woman having an
ultrasound before she terminates her pregnancy, and then uses
an ultrasound so they can harvest body parts to be sold for
fetal tissue. I found that absolutely astonishing.
Mr. Chairman, I yield back.
Chairman Kline. The gentleman yields back.
Ms. Davis, you are recognized.
Mrs. Davis. Thank you, Mr. Chairman. And I'm sure there
will be plenty of investigations on that by my colleagues.
But I wanted to go on and just ask Mr. Chairman for
unanimous consent that the CBO's score showing that a repeal of
the Affordable Care Act, which would add $137 billion to the
deficit in the next decade, that this report be entered into
the record.
Chairman Kline. Without objection.
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Mrs. Davis. Thank you, Mr. Chairman.
Thank you very much, Madam Secretary, for being here, for
your service, and for joining us today.
You mentioned NIH earlier. I know that you care deeply that
we continue to fund this at higher rates. We absolutely cannot
fall behind the global community in how we address science and
innovation. And so I think that's very, very important. And I'm
pleased that the President has increased that funding.
But I also wanted to talk about not just the innovation
piece of it, but really the access piece and affordability, and
particularly focus on the changes that you have recommended in
reforming Medicare Part D.
And specifically in ways that you call for in the budget
request in terms of reducing Medicare costs both for the
government and the consumer and looking at the question of
giving authority to you and to the Department to negotiate drug
prices in Medicare Part D. So can you talk a little bit about
that and why that is part of the budget and why you think that
this is so important?
Secretary Burwell. I think that we believe that the
ability, as we look and address the issue, one of the issues
that was brought up--the question of the long-term health of
Medicare and how we work on that, is that we look at some of
the issues that will be driving costs in the out year. We
believe that drug costs are a part of that, and we see that
happening. We see that both in terms of the numbers we see now,
but in the out-year projections we also hear it from the
private sector.
So the belief is, and, you know, having come from the
private sector and actually having come from a company that is
known for its negotiating on price, Wal-Mart, the idea that we
use market mechanisms to try and put downward pressure on price
is something that we think is important. And so that's why
we've asked for those authorities so that we can try and work
with the pharmaceuticals and negotiate to keep downward
pressure on that price. That's what we hope we can do, and we
see it as part of the overall issues that we're being asked
about, how we transform the system for the long term. We
believe there are things that we need to do and pressure we
need to put.
Mrs. Davis. What do you see as some of the key problems
that you're going to be having as you try to move forward with
this?
Secretary Burwell. So I think with regard to this
particular issue, it's not one, you know, it is a legislative
and a statutory issue. And so it will take a statutory change
to grant the authorities to be able to negotiate. That's not
something that administratively we can do. So it is something
where the action will sit with the Congress.
Mrs. Davis. Uh-huh, yeah. Well, thank you for working on
that. I know it's not a simple way of moving forward, but it
does seem to make a difference. And there have been so many
stories lately about how the high costs have, really, not just
bankrupted families, but made it very difficult for people to
access important lifesaving drugs.
I wanted to just for a moment also talk about the
increasing access for folks here at home. And we know that the
ACA really has been a huge success in helping to reduce the
number of the uninsured. I actually have a constituent in my
district who was going regularly down to Tijuana to get the
medications that she needs, and this now means, as a result of
her being insured, that she doesn't have to do that any longer,
and it has been a big difference in her life.
So I wondered if you could just talk a little bit about how
dramatic the increase in the uninsured population has been
since the implementation of the ACA and what this additional
coverage has meant in terms of increasing patient outcomes.
Secretary Burwell. So with regard to that, I will try and
be brief, and just in terms of numerically the number I think
you know is over 16 million is the number of reduction in the
insured. With regard, I think what tells the story better are
the individuals, and whether that's Anne Ha, a woman who was
26, uninsured, her mother told her to sign up; she needed
insurance, she didn't, but in the end she listened to her mom.
A month later she discovered she has stomach cancer and had the
coverage that she needed. And that coverage both helped her for
her health and actually, recently married, and in addition to
that, though, the financial security in terms of her business
and her availability to continue on in that way as well.
So I think it's the individual stories combined with the
numbers in terms of what we're seeing of what the extended
coverage means.
Mrs. Davis. Right, yeah. I particularly have heard about
that when it comes to type 2 diabetes and the prevention that's
made a real difference for those folks. So thank you very much
for your service.
Thank you, Mr. Chairman.
Chairman Kline. The gentlelady's time has expired.
Mr. Walberg, you are recognized for five minutes.
Mr. Walberg. Thank you, Mr. Chairman.
And thank you, Madam Secretary, for being here. Thank you
for reaching out to us before this as well.
I want to ask you the first question, how many fictitious
claims have been paid since enactment of ObamaCare, and how
much has been lost due to this fraud? But to just bring it into
context here, earlier this month, GAO released a report that
investigated Healthcare.gov through various undercover tests
performed throughout the 2014 coverage year. The report
revealed some stunning things, that the marketplace approved
subsidized coverage for 11 out of 12 fictitious applicants
created by GAO resulting in a payment, they state, of about
$30,000 to insurers on behalf of these fake enrollees.
For seven of the 11 successful fictitious applicants, GAO
intentionally did not submit all the required verification
documents to the marketplace, and the marketplace even then did
not cancel subsidized coverage for these applicants despite the
inconsistent and incomplete information.
And so subsequent to that, how many fictitious claims have
been paid since the enactment of ObamaCare, and how much has
been lost due to the fraud?
Secretary Burwell. So with regard to the example, we take
very seriously the issue of program integrity and want to
continue to improve it. We look forward to the GAO's
recommendations out of that study. We haven't seen those yet.
We look forward to understanding what they are, because we
welcome the opportunity.
With regard to the question of answering the number,
because GAO didn't find actually that there were fictitious
claims, they did, when they had individuals who came through
the system--first, they came to Healthcare.gov, the marketplace
in terms of electronically, couldn't get through. Then they
actually came through, through the phones, and that's where
they got through. At that point, because they are GAO, they
were able to do things that for everyone else would be perjury;
that would have up to a $250,000 fine affiliated with it.
Mr. Walberg. And they were successful?
Secretary Burwell. And were successful in breaking the law
in terms of what they were doing to go through.
With regard to the next step, and there are a number of
gates. There's the gate at Healthcare.gov, in terms of that was
where it was caught. Got through at the point, you know the
question of confirmation of information. Then because they did
not file taxes, what will happen to these individuals is in
this year, as per statute, they will no longer be able to get
subsidies in the next year, because at that point the IRS will
let us know that they have not filed taxes.
Mr. Walberg. So, we don't know how many fictitious
complaints may have been filed already other than GAO?
Secretary Burwell. No, we don't. We know of the 11 examples
of GAO--
Mr. Walberg. We know that.
Secretary Burwell.--with regard to those that have
committed--
Mr. Walberg. Twelve examples, 11 got through.
Secretary Burwell. With regard to those are the only
examples we know of because as GAO said in the report, they
didn't know of other examples other than those that they had
created.
Mr. Walberg. They don't, yes. But you don't know either?
Secretary Burwell. So, with regard to the things we have in
place, what we do know is we have a number of steps in place.
And within 90 to 95 days, we go through data matching. And this
year already, 117,000 people who have not--we don't know that
they are fictitious, we know that they have not provided the
right documentation--and the first quarter of this year,
117,000 people came off.
Several other hundred thousand people, over close to
200,000 people, received information saying we did not have
enough justification for their income and, therefore, their
APTC, their tax credit, would be adjusted downward.
Mr. Walberg. What--
Secretary Burwell. So we are on a constant path of making
sure we have the information that aligns with what we have been
told, and if not, we are taking action.
Mr. Walberg. Without getting into specifics of these cases
that were successful, again, which shows that there should be
concern, can you explain to the committee what process has
likely failed to allow these fictitious applicants to gain
subsidies?
Secretary Burwell. So, there are a series of processes that
occur. And in terms of the gates, when people have lied about
their information - it's something that can happen in the
system. It can happen in all of our systems. The way we catch
that is in the data matching and information. So it depends on
whether they've lied about which part and that could have to do
with--
Mr. Walberg. But which ones failed?
Secretary Burwell. Pardon me?
Mr. Walberg. Do we know which ones failed that allowed.
Secretary Burwell. No, because we have not seen the GAO
examples. One of the things that would be very helpful to us is
to actually see the example. Because all we know is what you've
said. And if we have the information, then we can find where
the system may not be working. Right now in terms of the
system, as the examples I gave you--
Mr. Walberg. What's keeping you from getting the examples,
then, if that's the case? This came out earlier in July.
Secretary Burwell. At this point, the GAO has neither given
us recommendations or--
Mr. Walberg. Have you asked for it?
Secretary Burwell. We have asked the GAO in terms of can we
understand how you did this. They believe they are protecting
their sources and methods.
Chairman Kline. The gentleman's time has expired.
Mr. Grijalva, you are recognized for five minutes.
Mr. Grijalva. Thank you.
Thank you, Mr. Chairman, and thank you, Madam Secretary.
With regard to the GAO question you just received, the gaming
of the system and the process, is this such a rampant
phenomenon that it is undercutting the very pinning's of the
Affordable Care Act or are we dealing with an issue in which as
you get more information, you deal with it?
Secretary Burwell. At this point, there are a number of
gates and efforts on program integrity in place, and that's the
initial information gathering, which we check at the hub at
that point, when that goes through, we also--when we don't have
data matching, as I said, within 90 to 95 days, we review those
cases, we take action.
At the point of the filing of taxes and in the examples
that we are given, folks didn't file their taxes, that is the
next place where that would occur, and the next gate will occur
in terms of that people choose not to file their taxes for some
reason, that is the point at which subsidies will go away.
We have a number of gates in place. We are implementing
those. If we can understand places where people think those
aren't working, we do want to understand that so that we can
work to improve. We have improved the timetable.
Mr. Grijalva. But GAO shares the methodology with you and
those examples. We are waiting--you are waiting for that,
correct?
Secretary Burwell. We are looking forward to GAO coming out
with recommendations, which is the part that has not yet
occurred.
Mr. Grijalva. Thank you. The President's commitment to
early childhood education, it is reflected in the budget
proposal, $1.5 billion extra for early head start and for head
start itself. Briefly, if you could tell us, you know, the
budget levels of spending caps established by the majority,
what is that going to do to the fact that you are trying to
build capacity, you are trying to stress quality and
accountability for providers for these children, and what does
that do to capacity?
Secretary Burwell. So with regard to the levels, I think
that if you are going to meet those levels and you want to
fully fund head start, what it will mean are dramatic cuts to
things like NIH or CDC in terms of other places. I think we
believe we put together a budget that is a budget that as I
mention, you know, there is savings in terms of deficit
reduction that comes from the HHS budget as a whole, that we
put together a plan and an approach that affords us the
opportunity to fund all of those things.
But at the current cap levels, you would not be able to do
that, and so you would not be able to implement the changes in
head start or you would have to make dramatic choices in other
places. One of the largest budget areas for HHS is NIH.
Mr. Grijalva. Yeah. And I think the last point, community
health centers, that was mentioned briefly in your testimony.
At least in my community, it is an essential network for health
delivery, an essential part of the Affordable Care Act delivery
system. If you could talk to the committee as to that role and
how the budget that you are talking about is reflecting an--
continuing that commitment that the President made to the
health centers at the inception of the Affordable Care Act
discussion?
Secretary Burwell. And we appreciate the work that was done
also in the sustainable growth rate bill in terms of these
issues. The community health centers serve approximately one in
15 Americans actually are served by community health centers.
We think they are an integral part of care. They are an
integral part of primary care, a very important part of making
sure as we expand access that we have an ability to serve.
That is a part of why they were extended as part of the
original Affordable Care Act and are extended now, as we have
seen in the number of uninsured drops so that there are places
for people to go as part of that. We believe they are a
successful part of coverage, especially in communities that
don't always have as much, and whether that is rural, minority,
or other communities, that these are an important part of that.
They are also an important part of integrating behavioral
health and primary health together so that we can get to the
place where that type of coverage is one.
Mr. Grijalva. Thank you. I yield back, Mr. Chairman.
Chairman Kline. The gentleman yields back.
We are going to move members to four minutes because we are
watching the clock. I can't seem to get it to slow down, so Mr.
Guthrie, you are recognized for four minutes.
Mr. Guthrie. Thank you.
Thank you, Madam Secretary. Thank you for being here again,
and I appreciate it. I want to talk about the employers'
sponsored health insurance, the small market group definition.
The Affordable Care Act in Section 1304 expands the small
market group definition to 100 employees, so of particular
concern are employers from 51 to 100, because if you are below
50, you are not mandated to provide.
Once you are, maybe 100, 102, I don't know what the number
is, but once you start growing, then you are able to self-
insure when you get a bigger pool because a lot of bigger
businesses aren't having the same issues.
So the trap seems to be, and I have heard from a lot of
employers' insurers and actually, a lot of colleagues on both
sides of the aisle have been working to try to fix this
problem. And I have seen estimates of a 30 percent increase
from different studies. But the issue is, you know, employers
from 51 to 100, if they go into this small market group
definition, will have expensive mandated benefits, and there is
a big concern, as I said. It is bipartisan over here in the
Capitol, and so I just wondered if you have looked at this
issue and what actions are you looking at taking?
Secretary Burwell. So looking at the issue right now, one
of the things I would ask, if we could follow up with you and
your staff to make sure that we are getting the comments that
you are hearing directly from either employers or other groups.
It would be very helpful. There is, you know, another side in
terms of expanding the other market that people argue, but we
would love to hear directly if you have those comments--
Mr. Guthrie. Absolutely.
Secretary Burwell.--as we are reviewing that. It would very
helpful to hear the specifics of why people assume it will work
the way that you described it working. There are others that
argue the other side of this issue, so it would be helpful if
you could follow up on that evidence.
And so, I want to understand in terms of a policy
perspective and then the question is would we have authorities,
and so those are the two questions we are examining right now.
It is a timely conversation, so if I could ask that we follow
up with your team or you directly to--
Mr. Guthrie. Absolutely.
Secretary Burwell.--make sure we have those comments. I
would appreciate having the facts from the field to inform our
conversation.
Mr. Guthrie. Okay. We will make sure that happens. There is
a bill, it is H.R. 1624, and it has 158 cosponsors and is
bipartisan. It is not just--I mean, it is a very bipartisan,
look at what is going on, and having said that, Mr. Chairman, I
have a letter actually--and I do have a letter, we will share
it with you, from 19 employer groups regarding this, and I
would like to enter into the record, unanimous consent to enter
into the record.
Chairman Kline. Without objection.
[The information follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Guthrie. Thank you, Madam Secretary, and I yield back.
Chairman Kline. The gentleman yields back.
Mr. Courtney, you recognized for four minutes.
Mr. Courtney. Thank you, Mr. Chairman, and thank you, Madam
Secretary, again for your accessibility since taking over, and
it's much appreciated. For the record, I just want to note we
had a great conversation to talk about the observation coding
issue, which still is a very, I think, widespread problem out
there for folks who are discharging from hospital, and
unbeknownst to them, find themselves in this sort of coverage
gap for Medicare to cover medically prescribed services.
Since we spoke about the two-day midnight rule, I have
already got a sheath of input from folks who, again, I will
share with you about why that by itself is just not a solution
to this problem. So but we will move on.
The chairman mentioned earlier about the insurance rate
increases that were reported a while ago in the press. I would
just point out, coming from Connecticut, a State which embraced
this law, is now in year three of its exchange.
Just a couple of days ago, some of the insurers who
participate in the exchange revised downward their initial rate
request, so for example, Anthem came in at 6.7. They revised
downward to 4.7. This is prior to insurance department rate
review. The Co-op, which last year cut its rates by 8 percent,
came in with a 13 percent rate increase. They revised downward
to 3.4 percent. And the largest insurer on the exchange,
ConnectiCare, which is a private health insurance company, they
came in with a whopping two percent increase earlier. They have
now revised downward to .7 percent.
And I point this out because this is a cohort that actually
has claims experience under its belt now, so that the fear
amongst the actuaries, that the walking wounded, in the
exchanges were going to spike up, you know, in the initial
years. I mean, we are actually seeing incredible stability in
terms of the rates.
We also are seeing new insurers come into the marketplace.
Harvard Pilgrim is now knocking on the door and is coming in to
sell their product in Connecticut. So again, your Department
has been boosting the insurance department rate review piece of
this, and I am just wondering, you know, if you could share,
you know, from a global standpoint, you know, whether or not
some of these fears are really overstated?
Secretary Burwell. So with regard to the rate issue, it
is--I think what you were pointing to is one of the things
about the Act that is important is about adding transparency
and the light of day to things in the marketplace to make a
market work so that individuals have information and that there
is pressure in the market to make it work, and that was one of
the ideas.
And so when people saw the rates, the rates that were
reported are only the rates really, in most States, that are
above 10 percent because that is required. If a company is
going to raise the rates above 10 percent, part of the law is
they have to--it has to be posted. We have to report it while
the State insurance commissioners review it. That is the other
part of this, is that it needs to be reviewed. It doesn't just
happen that they propose it.
If they are going to propose above 10 percent, they need to
justify it, and so that is a part of the process at work. And
what you see in terms of Connecticut and what just happened is,
that creates downward pressure, both in terms of the public
pressure and the requirement that you have to justify any rate
increases.
And so we think, overall, what we have seen last year is
that the rates come in here and then that there is downward
pressure. We also see in States like Connecticut and actually
California just came through yesterday, and their rates were at
4 percent, which is lower than their increase of last year.
And so that is what we will continue to watch and monitor.
The reason we recently had a conversation with the State
insurers to make sure they know and are using that tool of rate
review, to put that downward pressure, which we believe is an
important thing to do, making the market work.
Mr. Courtney. I mean, as a former small employer who double
digit requests were--you know, or increases were just a matter
of course, I mean, to see a 2 percent or .7 percent, or--really
that is eye popping in terms of--
Secretary Burwell. The difference.
Mr. Courtney.--the stability.
I yield back, Mr. Chairman.
Chairman Kline. The gentleman yields back.
Mr. Barletta, you are recognized for four minutes.
Mr. Barletta. Thank you, Mr. Chairman.
Secretary Burwell, my district is home to a number of small
family run businesses that sell premium cigars to adult
consumers. These job creators have expressed to me concerns
about the impact of an expansion of FDA's regulatory authority
under the Tobacco Control Act on their businesses.
Their shops serve a distinctly adult clientele, and I do
not believe this category was the intent of Congress in 2009
when the law was passed. Can you tell the committee what steps
you are taking to ensure that such businesses, which are a
staple of Main Street America, are not regulated out of
existence?
Secretary Burwell. With regard to right now, as we are in
the middle of a rulemaking process, I think you probably know
that we actually proposed two different alternatives as part of
the rule. To gather the evidence and information with regard to
the question of premium cigars and how they are or are not sold
to children, you know, that was a part of what we are trying to
do, and we are reviewing that and we are in the middle of that
process now.
Having said that, as we are in that process, a part of your
question was the recognition of small employers, and that is
something that will be taken into consideration, no matter
where the rule ends. It is something, I think, is very
important that we do as we think about implementation, and so
wherever the rulemaking comes out, as we are in the process,
but I do want to recognize the point that you have made, which
is making implementation for small employers and small
institutions possible, whatever it is.
It is something we consider a real priority and something
we believe, no matter where you are we can work on as part of
implementation.
Mr. Barletta. The proposed deeming rule has been under
consideration for more than a year. Regulatory uncertainty is
exceptionally challenging for small businesses, who are trying
to plan for the future, as you know, open new stores, hire more
workers, and serve their customers. When do you anticipate this
rulemaking to be finalized?
Secretary Burwell. I am hopeful that we will do it as
quickly as possible. I think the issue you have raised is one
of many complex issues that we received, I think you know, a
number of comments on. We are trying to work through how we get
to a balanced answer is what we are doing and trying to do that
as quickly as possible. We appreciate the point that you made
about uncertainty, again, in terms of recognition of what this
means for the business community, especially small players.
Mr. Barletta. Okay. Thank you. I yield back, Mr. Chairman.
Chairman Kline. The gentleman yields back.
Ms. Bonamici, you are recognized for four minutes.
Ms. Bonamici. Thank you, Mr. Chairman, and thank you,
Secretary Burwell, for your testimony, and thanks to you and
the Department for all your work on so many issues, healthcare,
precision medicine, I am interested in that, mental health
services, thank you for your work on early childhood education,
community and family support programs.
I want to spend my short time talking about the Older
Americans Act, which recently celebrated its 50th anniversary,
and I want to thank Chairman Kline and Ranking Member Scott, I
know they are committed to working together with my colleagues
and me to successfully reauthorize the OAA. Thank you to Dr.
Foxx for calling out the issue of elder abuse, and I want to
emphasize that elder abuse includes both physical abuse, but
also financial abuse.
So I have three questions, and I think what I will do is
tell you what the three are to save time. First, as we know,
the population of older Americans is changing rapidly, so can
you talk about what steps you are taking to modernize the
administration for community living programs, as our older
population is becoming increasingly diverse.
Secondly, when I talk to people about the Older Americans
Act, they know about the nutrition programs, especially
programs like Meals on Wheels. We know that the population of
seniors is expected to double by about 2050, so we all support
investments that will yield greater efficiency. So can you talk
about how the Department is promoting evidence-based practices
among nutrition providers and how you plan to spur innovation
in those essential nutrition services? We know that oftentimes
that is the only social contact seniors have as well is with
that meal.
And then my third question has to do with the family
caregiving. Seventy-seven percent of caregivers say that family
caregiver support services make it possible for them to
continue to care for their loved ones, it keeps seniors at
home, but of course, it is hard work, and training in respite
care services for caregivers are very important. Many of these
caregivers are in the sandwich generation where they are taking
care of parents and children at the same time. So what is the
Department doing to prepare and support a large diverse
community of caregivers?
Secretary Burwell. So we will quickly try and work through
each of these. In terms of the modernization, a part of the
modernization, as I discussed, how we actually went about doing
the White House conference on aging.
Ms. Bonamici. Right, right.
Secretary Burwell. And getting that input because it was a
very different approach in terms of being out in the community,
using technology, including the fact that the White House
Conference on Aging, actually people could participate through
technological approaches, and so changing the way we think
about our work in terms of technology and the fundamental idea
of people's engagement in our programs and their feedback,
being more customer friendly and doing it in ways that use
technology are two things in terms of the modernization.
In terms of the evidence-based practices around nutrition
and meals, and I think that is part of a broader category of
what I would consider prevention and preventative care and
making sure that we are doing that correctly. And that, I
think, is actually centered a little less than ACL and a little
more with CMS, and it is also a part of the Affordable Care Act
in terms of people knowing that they can do preventative and
wellness visits without copays.
Those numbers are increasing. We need to increase them
more, so the people accessing those services are not at the
level--they are improving, but it is a place where we need to
send more time. Nutrition and wellness comes into that as well
in terms of how it fits into this broader thing that I think
changes that but changes a larger piece.
The last piece is the family caregiving and encouraging
that staying in community at home. And you probably have seen
our most recent rulemaking at CMS, which is an important part
of reforming the overall system of delivery of our healthcare
and paying in ways that encourage that kind of care at home.
And so the rulemaking and the demonstration we are doing there
are probably our most effective tools because those are the
ones that scale broadly and because payment is an important
part of how people are making these decisions about staying in
a community versus making a change.
Ms. Bonamici. Thank you so much. I see my time has expired.
Thank you, Mr. Chairman.
Chairman Kline. Thank the gentlelady.
Mr. Carter, you are recognized for three minutes.
Mr. Carter. Thank you, Mr. Chairman.
Ms. Burwell, earlier this year you received a letter, along
with Secretary Lew, from a group of employers with workforces
who have variable hours, and it was specifically to address the
employer notice and appeals process, because it is very
important for employers to get notification about employees who
have received subsidies; otherwise, those employees are going
to be facing tax penalties if they declined a more affordable
employer plan and accepted the subsidies, so this is very
important.
It is my understanding that, as of yet, none of those
employers have received anything from HHS. Can you give me an
idea, just a date of when you expect to give notification to
employers?
Secretary Burwell. Mr. Carter, this issue is one I am not
specifically familiar with, but my understanding of what you
are talking about is it is a Treasury issue because what you
are talking about is tax information on the individuals in
terms of they received an APTC, and that is a matter of--
Mr. Carter. Okay. Can you just get back with me and let me
know a date when we can expect for that to be resolved and
start--
Secretary Burwell. I am happy to raise with Secretary Lew
the question that you have raised.
Mr. Carter. Fair enough. Fair enough. Okay. Notification to
the employers. You would agree that those employers who have
multistate locations, it would be better if they got one
notification as opposed from every State? That is also
something I am very concerned about, and I hope you look into
at that as well.
You do agree, obviously, that it is a burden on these
employees when they have a tax penalty at the end because they
didn't accept the employer's more affordable plan. So that is
what we are trying to get at now, right?
Secretary Burwell. What we want to do is make sure that
where employers should cover, as appropriately, that they are
providing coverage, and if the employee makes a choice to not
accept the coverage by an employer, that they don't receive
subsidies they shouldn't in terms of--
Mr. Carter. Right, right, but it would have helped if the
employers had gotten notification, so that is what we are
trying to achieve here.
Also, right now you are using a paper system. Do you have
any idea when you will be going to a computer system?
Secretary Burwell. A paper system, I am not sure with
regard to what you are referring to. I am sorry.
Mr. Carter. Okay. Well, I will get clarification on that
and send you a letter later.
Secretary Burwell. Okay. Okay.
Mr. Carter. In your opening statement, you said that over
$100 million would be given to states and used for prescription
drug abuse.
Secretary Burwell, I am a pharmacist, the only pharmacist
currently serving in Congress. I have witnessed firsthand
people's careers, people's lives, people's families being
ruined, and people actually losing their life as a result of
prescription drug abuse. And one of the limitations on that for
pharmacists is that Medicare limits pharmacists as to what they
can do with this in the way of compensation.
There is a bill, H.R. 592. I hope that you will look at
that closely. This is something that needs to be addressed.
This is an epidemic. This is one of the biggest drug problems
that we have in this country, prescription drug abuse, one that
has really gotten out of control. As a member of the State
Senate in Georgia, I sponsored the prescription drug monitoring
program that is now law. This is something that we really need
to work on, and we can help you in our profession, and we want
to help you, but please look at that bill, H.R. 592.
And Mr. Chairman, I yield back.
Chairman Kline. The gentleman yields back.
Mr. Pocan, you are recognized for three minutes.
Mr. Pocan. Three minutes. Thank you, Mr. Chairman. I will
go really quick. Thank you for being here, Secretary Burwell.
First, I am glad to see that NIH increase in the budget.
The funding, as you know, with the sequester, it has been
especially hard. I have the University of Wisconsin in my
district, which has a lot of research going on. One of the
things that we have noticed because of this cutback of funding
is that now the age of the average first time grant recipient
is 42, and it used to be 36 in 1980. A lot of young researchers
are looking at a lot of other areas to go into, and we want to
keep the talent there.
Senator Baldwin and myself and others have introduced a
bill called the Next Generation Research Act trying to address
some of those concerns. I am just wondering if you could very
briefly just address how we can try to help those younger
researchers as we move forward in NIH funding.
Secretary Burwell. I think it is about creating a certainty
in terms of the years that we have been through recently with
regard to everything from sequester to shutdown, the ability to
create the certainty. It is just like the certainty we need to
create for those small businesses that were referred to.
People having certainty in knowing how things are going to
run in regular order and assurance of the funding is how people
are going to make their decisions. If you are making a decision
to get a Ph.D. in a particular area, that is a long period of
time you are making a financial commitment, and you want to
know there is certainty at the other end.
So I think the thing that we can do is create certainty
around funding streams, that the funding for this type of
research, basic research and other research that NIH does, is
going to be there, and so that is one of the things we want to
work to do, which is why we have in this budget a billion
dollar increase.
Mr. Pocan. If you could take a look at that Next Generation
Research Act, too, working with a lot of those younger
scientists, we have had some ideas, too, we would like to
propose, at least while the sequester is still out there.
Secondly, and I am going to piggyback a little bit on
Representative Hinojosa's question around the States that
haven't done the Medicaid expansion. Unfortunately, States like
my State, Wisconsin, where Governor Walker is, you know, in the
increasingly smaller number of States that hasn't done this, we
would save about $400 million over the next two years in our
State. Almost 85,000 people would have additional healthcare.
You know, as you look in--and I am glad you just met with
governors about this, but you know, as a Member of Congress,
this is very frustrating. I actually do everything I can to get
resources back to my State, and then I see something like this.
You know, what can we do for the States like Wisconsin that are
just really caught in this bad spot because we have governors
that refuse to expand this?
Secretary Burwell. So with regard to, you know, that is
where the decision, as know, sits with the governors and State
legislatures, not all States. Some States, it is just the
governor, and so continuing to work. But I think one of the
most important things is articulation of the benefit, both the
economic, job creation, and what it means in terms of State
budgets as well as the individual. Obviously, that is the place
where we focus our most attention.
Mr. Pocan. I am just going to wrap this thing. If you also
need names of people who have told us they benefitted from the
Affordable Care Act, you know, I go into little towns in my
district, Spring Green in rural Wisconsin, small business, you
know, they come and they grab their husband from upstairs, the
wife had to tell me this is the first time they have had
healthcare. I have had caregivers stop me in the grocery store
crying because it is the first time in her adult life she has
been able to have healthcare. If you also want those kind of
things, we are more than glad to share those through our
office.
Secretary Burwell. Thank you.
Chairman Kline. The gentleman's time has expired.
Mr. Russell, you are recognized.
Mr. Russell. Thank you, Mr. Chairman.
I would like to thank you, Madam Secretary, for your
distinguished service both to the Nation and also, to your
charitable work.
As a small business owner that has a small workforce well
under the 50 threshold, I have seen a 68 percent increase in
health insurance that I provide my employees over a two-year
period. Do you believe increasing the cost of insurance will
encourage or discourage small businesses providing insurance?
Secretary Burwell. With regard to the 68 percent increase,
is it people taking it up, or is it the cost itself?
Mr. Russell. It is the cost itself. We are part of a pool,
being a light manufacturer, and so, you know, we can't do the
groups on our own, but we can pool with others. And we have
seen a 68 percent increase in two years.
Secretary Burwell. Is it particularly incident-driven,
having, you know, worked as a small employer at one point in
time, when we would have, you know, we had a couple of very
large cancer cases or we had a number of pregnancies at one
time, was it those kinds of things? Because what we want to do
is get to the issue.
What you are describing is a case that is not the
experience that we have seen for most, and what I want to do is
understand it.
Mr. Russell. Sure.
Secretary Burwell. So we can understand why--
Mr. Russell. We have not even filed claims. We have been in
business for five years.
And my second question is, in the HHS' 2011 report entitled
``Drug Abuse Warning Network,'' it cited that 455,000 emergency
room visits were directly associated with marijuana use.
Further, supporting documentation shows multiple adverse health
effects.
Do you believe the President's policies in not enforcing
Federal law on illegal marijuana States that violate the law
promote or prohibit HHS' goals on emergency care reduction and
drug abuse prevention?
Secretary Burwell. So, with regard to the HHS role in this
space of marijuana, we are the research, the regulator, the
educator, and the treatment. And with regard to the issue that
you have raised in terms of the question of the health impacts
of this, it is something that we are spending time on. You may
know we recently actually changed a rule that will lead to
increased research that we hope will afford us the opportunity
to do more and better education in the space of the damage.
Mr. Russell. And then my final question and you certainly
don't have to comment on the ongoing investigations that will
be necessary and that sort of thing, but given that HHS
provides significant Title X funding to Planned Parenthood, do
you believe personally that the harvesting of infant body parts
to be moral?
Secretary Burwell. So as I said, this is an issue, an
important issue, that has strong passion and strong beliefs
about the importance of the research and other beliefs, and
what I think is important is that our HHS funding is focused on
the issues of preventative care for women, things like
mammograms and cancer prevention screenings with regard to our
relationship there.
With regard to the other issues, the attorney general, I
think, has right now, is under review to make determinations on
what is the appropriate next step.
Mr. Russell. I yield back my time. Thank you, Mr. Chairman.
Chairman Kline. The gentleman yields back.
Ms. Adams, you are recognized.
Ms. Adams. Thank you, Mr. Chairman. Thank you, Ranking
Member Scott. Madam Secretary, thank you for being here, and
some of my questions have already been answered.
But let me first of all say that I have, over the years,
appreciated Planned Parenthood's good work in promoting
healthcare for men and for women, and I am a little bit
disheartened by all the attacks to undermine the good work that
they do. But having said that, let me move on to Affordable
Care.
My State of North Carolina is one of those 24 that did not
expand Medicaid. We are looking specifically at--with all of
the great benefits, I am still perplexed why our governor and
our legislature decided not to do that, 317,000 more North
Carolinians would have had it. I know you met with the
governors.
My question is when we look at North Carolina having one of
the highest rates of uninsured adults in the country, standing
at 24 percent, it is critical that we take a serious look. And
what are the options? Are there options for folk in my State
and other States that have not expanded Medicaid that--who may
want to consider it in the future, are there options that they
have?
Secretary Burwell. So with regard to the options for the
individuals, I think, you know, that is why community health
centers are going to continue to be extremely important in
terms of ensuring that people who don't have coverage have
care. They are an important part of that.
With regard to the options in terms of States making those
decisions to do that expansion, we want to work with States, we
want to provide them with different options and opportunities.
That is what the 1115 waivers are about. We have done that. We
have done that with Governor Pence in Indiana, and that program
is up and fully running. There are other governors that we're
having those conversations with, and we look forward to the
opportunity to understand what are the core considerations of
the State in terms of moving to reduce that coverage gap that
you describe in North Carolina, which is one of the largest
states in the Nation now.
Ms. Adams. Thank you very much. For somebody in my
position, I did serve in the legislature for 20 years. I am
still at odds with the governor and the State legislature about
it, so can you give me any suggestions about how to kind of
push them along and to get closer to ensuring the low income
people in North Carolina who it will--
Secretary Burwell. I would certainly defer to you on how to
work with your own State governor and legislature.
The only thing I will say is when you look at Kentucky and
the analysis that's been done, in the State of Kentucky--and
this is by, you know, an accounting firm in the University of
Louisville, 40,000 more jobs and 30 billion flowing into the
State by 2021, and so that, from an economic perspective, just
seems to be an anchor of a place to talk about.
Ms. Adams. Yes, ma'am. That makes great economic sense for
us to do it. I'll certainly continue to push those folk in
North Carolina. Thank you, Madam Chair--Mr. Chair. I yield
back.
Chairman Kline. I thank the gentlelady.
Mr. Allen.
Mr. Allen. Yes, thank you.
Thank you, Mr. Chairman, and thank you, Madam Secretary.
You've got a tough job. It's hard to deal with some of the
issues that are coming out of this process, but I can tell you
in Georgia, ObamaCare is not real popular. We are having major
problems down there.
In fact, most physicians I meet with say that nothing's
changed. Emergency rooms: people show up still without health
insurance. They see very few patients. You might check with
some of the hospitals. You know, their elective surgeries are
off something like 80 percent because of the high deductibles,
so just, you know, one problem after the other. But what I want
to zero in on is this Planned Parenthood thing.
And I would like some commitment from you here today on
when your Department will conduct an investigation on this
very, very serious matter. Not only is it unconscionable, but
they are breaking the law, and it's a big issue with the people
of this country. I mean, it's what I hear about every day, what
are we going to do about this? Can you tell me when we going to
do something about that?
Secretary Burwell. I do want to--just one moment on your
Affordable Care Act--
Mr. Allen. Yeah.
Secretary Burwell.--and that issue. And the question of
expansion in a State like yours, and what we see in Arkansas is
we've seen as a percentage drop the number of uninsured that
are coming in emergency rooms, we've seen actually a dramatic
drop, and so, as a part of the issue there and how we think
about rural hospitals, which I know are an important issue in
your State as they are in my home State.
With regard to the Planned Parenthood issue, as I've said,
this is an important issue and one that there is passion and
emotion and belief on many sides of the issue, and I want to
respect that.
With regard to our funding, I think you know we do not fund
abortions as the Federal Government except for the Hyde
exceptions, which have been in place for many years. Our
funding for Planned Parenthood is in another issue space. With
regard to the issue you raised, which is a question of whether
it's a legal issue, and there are laws and there are statutes
that guide the use of fetal tissue that are in place and should
be enforced.
With regard to investigating or looking into those issues,
as I said, because it is a statutory legal issue, the
Department of Justice and the attorney general has said she has
taken those issues under review and will determine what the
appropriate next step is.
Mr. Allen. And that would include your investigation? I
mean, it should be like all hands on deck on this thing.
Secretary Burwell. With regard to the question of a legal
matter, and you know, I defer to our colleagues at the Justice
Department, we will support them in anything they need or want
from us, and we always do that, but with regard to making those
decisions of the question of an investigation of a legal
matter--
Mr. Allen. So you don't have personnel that can look into
this?
Secretary Burwell. With regard to what we do we have at the
Department of HHS is, this is not an issue in terms of us
funding this specific issue. When we do have issue--
Mr. Allen. You deal with Medicare fraud.
Chairman Kline. The gentleman's time has expired.
Mr. DeSaulnier.
Mr. DeSaulnier. Thank you, Mr. Chairman. Thank you, Madam
Secretary. Briefly, on the issue of Planned Parenthood, as I
understand it, there are multiple investigations in California.
The State attorney general is investigating the issues,
including if the people who actually took the film violated the
law.
But I have two areas for questions for you. One is your
work on prescription drug abuse. As my colleague from Georgia
mentioned, it's a very large issue, 45 Americans die a day,
according to the Center for Disease Control. The U.S. has less
than 5 percent of the world's population, but we consume over
80 percent of the opioids in the world. It's a huge cost issue
both financially and from the human side.
So in California, we are switching to an electronic
monitoring system. It's been getting up, and even people who
question it are starting to support it. So my question is, what
are things that you might think--and I'll ask both questions
and let you go, given the time constraints, that we might be
able to do on a Federal level to help States like California,
New York, and Georgia.
And then secondarily, coming from a high cost State where
we're very proud of the ACA in California, sort of the opposite
side of what one of my colleagues brought up being from the Bay
area, provider rates and attracting primary care physicians, so
if you could address those two things quickly, I would
appreciate it.
Secretary Burwell. I'm sorry, the second issue?
Mr. DeSaulnier. The second question was the opposite side
of high cost States and reimbursements rates, and then because
of that, we're having a difficult time attracting primary care
physicians in California, particularly young people to go into
that field.
Secretary Burwell. On the primary care, let's just start
there, in terms of how we are structuring our graduate medical
education proposal in this budget, it is actually to focus
funding for GME on places like primary care and rural districts
where we have shortages and other specialties. So what we're
trying to do is use our tools at hand to encourage people to go
into those specialties and create more of a pipeline to go to
places.
With regard to the issue of prescription drug abuse, 250
million prescriptions in one year in the United States. That is
enough for every adult in the country. This is an acute
problem. One, prescribing it. I think that number itself tells
you something about we got to go after prescribing. The
congressman's comments about PDMPs, prescription drug
monitoring program, essential, get those up, get those working
in the States.
That's a lot of what I'm spending my time in conversations
with governors, whether Governor Baker in Massachusetts or
Hickenlooper, in Colorado, been to visit both.
Second is access to Naloxone. Naloxone is the drug that
when someone is in overdose, actually saves their life, and so
the question of how that's accessed is a very important thing
in creating in a State-by-State basis.
The third is medicated assisted treatment, and for all
those who are addicted, trying to get that transition. I met a
woman in Colorado who has been clean four years, and her
journey there from having her wisdom teeth taken out, becoming
addicted and going to heroin is a journey we don't want people
to travel, and so getting that medicated assisted treatment and
those other things in place are three specific evidence-based
approaches.
Mr. DeSaulnier. Thank you, Madam Secretary. Thank you, Mr.
Chairman.
Chairman Kline. I thank the gentleman.
Mr. Bishop, you're recognized.
Mr. Bishop. Thank you, Mr. Chairman.
Thank you, Madam Secretary, for being here today. I
appreciate your testimony and the discussion. I know there are
a dozen windows that are opened up right now, but I'd like to
talk to you specifically about the exchange enrollment issues
that I'm seeing in my office.
It's an ongoing concern I'm hearing from constituents, and
I want to make sure while I have your attention, that I address
the concern.
The Government Accountability Office recently put out an
alarming report highlighting various shortcomings of
Healthcare.gov, which resulted in numerous fictitious enrollees
gaining access to coverage and subsidies paid by the American
taxpayers. In the meantime, as I said, I've heard from any of
the number of my constituents, one anecdote after the next,
very frustrated with regard to how this is working, purchased
or tried to purchase on the Web site insurance, only to have
their coverage canceled because of a minor mistake they made on
their application.
And by the time they get to me, they are furious, and I
can't say that I blame them. As a parent, who has a family and
is expected to provide for my family, my heart goes out to
them, but it becomes me being the reason why.
They also have problems getting the issue corrected and
lackluster communication with the Department, how we can
correct the issue, long wait times, there is just so many
issues with regard to this. And GAO's information suggests that
significant fraud is being--is being rewarded, while at the
same time some of these minor mistakes are being punished. I'm
wondering what we can do to address that if you've had this
same communication from other members, if we're addressing
them, and if you could just quickly comment on that.
Secretary Burwell. So first of all, with regard to the
communication coming into your office, please reach out, reach
out to me directly, let's work on those individuals and work
through those individual issues, so please make sure, just
reach out to us, our office, we will work on those.
Mr. Bishop. Okay.
Secretary Burwell. With regard to, though, actually it's
both sides of the coin because the GAO, we don't actually know.
We don't know when they falsified, whether they falsified a
Social Security or what, the small issues. What we're trying to
do is program integrity, and that's what your folks are getting
caught in because they have done that, and we're doing it in a
strict way. That's what people are feeling is because we are
trying, if you do not provide the data that's required to say
your income is X or to say that you are of a certain status,
that you know, that's what's happening to the examples.
And so actually, we don't exactly know because the GAO
hasn't told us what those examples are. Those are actually two
very related things in terms of us doing the program integrity
that we're being asked for. We don't know that the examples of
the GAO are more than the examples that you're talking about.
When we get to recommendations, we may know that, but at
this point, we don't, and so right now, what we're doing is
trying to do program integrity, but we want to make sure that
if there are individuals--because many of the people are like
you said, we don't have the right information but they still
may be eligible, so please let us know about those examples.
Mr. Bishop. Thank you, Madam Secretary. I yield back.
Chairman Kline. Thank you. The gentlewoman, Ms. Wilson.
Ms. Wilson of Florida. Thank you, Mr. Chair. I ask
unanimous consent that the Office of the Assistant Secretary
for Planning and Evaluations' research brief showing that
increases in cost sharing can discourage low income individuals
from accessing necessary medical care which can have negative
health consequences be entered into the record.
Chairman Kline. Without objection.
[The information follows:]
[Additional Submissions by Ms. Wilson follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. Wilson of Florida. Secretary Burwell, thank you so much
for being here today and for working with Florida, especially,
and our head start and elder care and all of the other things
that you do. I appreciate your testimony on how ObamaCare is
working for the American people, and I call it ObamaCares,
because I believe that Obama cares about the people of this
Nation, and that's why we have this healthcare law.
It's here to stay. It's the law of the land. The people of
Florida are much better off because of this. We have led the
Nation in new enrollments through the Federal exchange. My
district Florida--in my District 24 has the third highest
number of people in the Nation who benefit from subsidies.
Unfortunately, we have not expanded Medicaid, but I thank you
for your commitment to working with the Florida legislature and
the governor to expand Medicaid, and consider me as a partner
in this pursuit and hopefully for a better outcome in the
future. I also want to thank you for helping securing low
income pool funding for Florida. That was very special to us.
I want to thank you for your testimony on the importance of
investment in high quality early learning, so I commend you and
the President for your commitment to expanding and investing in
early education. I have several questions. I want to try to
combine them in one.
The President's budget includes an additional $1.5 billion
to improve quality head start. Why is this crucial? What is
head start doing to ensure that all head start children and
early childcare are eligible, have access to high quality early
learning? What is at stake if our Nation ignores the ever
growing body of research? And can you describe how the revised
program performance standards will help, and can you please
speak to the negative impact of spending caps?
Secretary Burwell. So I will try and get through as many of
those as I can with our time. One is with regard to the
changes, there are a number of changes that are part of the
proposal, and they are about using the evidence with regard to
extending the day and the question of extending the year, but
there are other important changes in terms of what curriculum
should be used in terms of the teachers and those
participating.
There are also a number or safety issues, making sure that
the grantees and others that are doing the services do it in a
safe way. We also try to reduce the bureaucracy to make it
easier for people to come in and apply and be a part of that
system. So we put the money in the budget to match the changes
that we have proposed as we go forward.
With regard to the ramifications--
Chairman Kline. I'm sorry; the gentlelady's time has
expired.
Mr. Messer.
Mr. Messer. Thank you, Mr. Chairman. Thank you, Secretary
Burwell, for being here. I'd like to talk a little bit about
the 49'er phenomena under the Affordable Care Act, the idea
that the Affordable Care Act only applies to businesses of 50
or larger, and so there's has been questions about some
businesses staying at that 49 threshold, not being willing to
hire that 50th person because they would make themselves
subject to all the mandates and requirements of the President's
healthcare law.
The administration has helped ease that burden somewhat by
delaying that 50 figure by making it up to 100 so that
businesses that were 100 and less wouldn't be forced to --
wouldn't be required to comply with the law.
Could you talk a little bit about the rationale of lifting
that to 100? Why was it businesses 100 and less that the
administration said wouldn't be subject to the law up until
2016?
Secretary Burwell. So I think there are also two different
issues in terms of application proportions of the law.
Mr. Messer. Yeah.
Secretary Burwell. And some of those have to do with what
benefits but also what category, and so I'm not sure if
you're--
Mr. Messer. Like the employer mandate example. You're not--
Secretary Burwell. If it's a question of the category in
terms of--
Mr. Messer. You're not subject to the employer mandate
under your delay until--for businesses of 100 or less until
2016. I'm just trying to get at what was it that made you
decide to lift it to 100 from the 50.
Secretary Burwell. So with regard to that issue, it is
that, you know, 96--you know, as we look at the number of
employers, and even when we go to those higher levels, I think
we believe that employers at that level should be providing
that type of care and can do that, and we can do that in a way
that you can do it if there are pooled markets in affordable
ways, and that's what we believe that can be done because we
want to make sure that small businesses that have this--
Mr. Messer. But to the precise question of why you lifted
it from 50 to 100, why was it that you guys said businesses 100
and less could be delayed until 2016? Because the law says 50
and less.
Secretary Burwell. So, just want to make sure you're
referring to which piece, because we've already had a
conversation earlier, I think you heard about a particular
question of the provision, of whether or not 50 to 100 applies
to whether those small businesses, which market they will be,
and those are two different things.
Mr. Messer. Again, I'm reclaiming my time because I only
have so much time. I think it's clear that you guys have
acknowledged that businesses of 100 and less are small
businesses that make it difficult to comply with all the
elements of this law. I've actually introduced legislation,
H.R. 2881, the Small Business Job Protection Act of 2015 that
would make that level of 100--businesses of 100 employees and
less--the permanent standard under the law, just essentially
continuing the delay that you guys moved in to 2016.
It's not really a trick question. I think that the reality
is, is that there are a lot of very small businesses of that 50
or less employees, and the mandates and requirement of this law
are difficult to comply with. I think businesses of 100 and
less--while I'd like to see the mandate go away entirely--
they're at least a different kind of business than a business
of 50 and less. Appreciate your testimony.
Secretary Burwell. Thank you.
Chairman Kline. The gentleman's time is expired.
Mr. Polis.
Mr. Polis. Thank you, Madam Secretary. Back in April I had
the opportunity to visit the head start program at the
Wilderness Early Learning Center in Boulder, and I've seen
firsthand the benefits head start can provide for kids and
communities.
As you know, head start's grants are given to nonprofits,
community centers, and often traditional public schools, but to
my knowledge, no charter schools have ever received head start
grants and very few have applied. Can you talk about what your
agency is doing to clarify guidance so that charter schools,
which are public schools that have the autonomy to offer unique
curriculum for students, know that they're eligible to apply
for head start grants and understand how to meet head start
requirements?
Secretary Burwell. This is an issue I'm not familiar with
in terms of charters and application for head start, so one
we'll have to get back to you.
Mr. Polis. Great. We'd be happy to hear from you about a
specific plan to make sure that charter schools are aware of
the opportunity to apply and what they need to do.
Earlier this year, as you know, the FDA published revised
recommendations pertaining to blood donations by gay men. The
policy change eliminated the lifetime ban and replaced it with
a one year deferral policy, which on the margins can save a few
more lives.
While it's a positive step forward, I'm hoping you can
speak about your opinion of whether the new policy truly
reflects the most up-to-date science on the issue. As you know,
the large majority of gay men don't engage in risky behavior
and are not at higher risk of contracting HIV than the general
population. In fact, the FDA's own blood drive survey found
that the prevalence of HIV in gay male blood donors, was just
.25 percent, actually lower than the overall prevalence of HIV
in the total U.S. population, which is .38 percent.
Would the FDA consider a policy that screens for specific
risky behavior rather than grouping all gay men into one black
blanket high risk category?
Secretary Burwell. With regard to the policy that we have
announced, we've tried to move the policy forward based on the
scientific evidence that we have in front of us, both with
regard to issues of self-reported monogamy as well as the
penetration of HIV in particular populations. We always welcome
the additional--
Mr. Polis. I believe it's self-reported abstinence, not
self-reported monogamy; is that correct?
Secretary Burwell. I will have to check exactly what is the
self-reported--my indication.
Mr. Polis. I think if we could move for it, would you be
supportive of moving to self-supported monogamy?
Secretary Burwell. What we are always open to is reviewing
evidence in terms of the decisions that we're making in this
space. We believe that the decisions that we've made at this
point are evidence based. If there's additional evidence that
we should know about, we always welcome it.
Mr. Polis. Well, I'm looking forward to your implementation
of the self-reported monogamy recommendation, which I am
certainly in strong support of, as an indication of risky
behavior, certainly in those who are in monogamous or married
relationships would be at much lower risk than those who are
not, and I yield back.
Chairman Kline. The gentleman yields back.
Ms. Stefanik.
Ms. Stefanik. Thank you, Mr. Chairman, and thank you, Madam
Secretary, for your testimony today.
The President's healthcare law mandates certain employers
provide healthcare coverage to their employees and will soon
tax employers if that coverage is too generous. And Section
1511 of the healthcare law requires employers to automatically
enroll new employees and continue enrolling current employees
into their healthcare coverage, giving employees only a very
small window to choose to opt out.
This mandate takes away the ability for employees to choose
coverage that best meets their needs, and it could result in a
loss of take-home pay to cover possibly more expensive health
insurance than they otherwise would not have chosen.
I've introduced H.R. 3112, the BE OPEN Act to eliminate
this harmful and unnecessary provision. But could you
specifically discuss whether mandatory auto-enrollment can
trigger individual mandate penalties for employees receiving
subsidized exchange coverage?
Secretary Burwell. With regard to the specific of that
implementation issue, that is an issue that I would defer to my
colleagues at Treasury. The implementation of the tax portion
that I think is within the context of what you're referring to
is a Treasury issue. I think, as you probably know, we have
guidance out for comment right now, and so with regard to the
specifics of that, that's a place where I would defer to my
colleagues with Treasury, and we can take that question and
give it to them.
Ms. Stefanik. Let me ask this question a different way.
What about those employees who become enrolled in double
coverage because of this mandate and they miss the 90-day
window in which to opt out? Should those employees, in your
opinion, be penalized by paying multiple premiums because of a
requirement imposed on by employers in the ACA?
Secretary Burwell. With regard to the specifics of this
question in terms of the detail of how it would be implemented,
I would want to know and understand what the implementation is
that the Treasury is thinking with regard to this issue, so I'd
want to coordinate with my colleagues at Treasury.
Ms. Stefanik. Sure. I look forward to getting a response
from the Department of Treasury, but I also believe that this
is duplicative and it's an unnecessary mandate requiring
employers to automatically enroll employees into health plans
where they have little choice and sometimes they don't have
knowledge of that.
So I understand you want to defer to the Department of
Treasury, but I think it's an important broken aspect of the
ACA where I'd like HHS' feedback on. I yield back.
Chairman Kline. The gentlelady yields back.
Mr. Jeffries.
Mr. Jeffries. I thank you, Mr. Chair, and thank you, Madam
Secretary, for your testimony here today as well as for your
tremendous leadership.
I want to begin by asking a question about sort of
providing care to some of the most disenfranchised,
economically isolated individuals, in this particular case,
many of the constituents that I represent. Over the last
several years, we've had a crisis throughout Brooklyn with the
closure of several safety-net hospitals, and in other
instances, significant financial distress that many of these
safety-net hospitals have experienced, largely as a result of
perhaps the overutilization of certain aspects of the hospital,
the emergency room for issues that can be taken care of in a
primary care context.
And for instance, the fact that, traditionally, in many
socioeconomically disadvantaged communities, you've got a mix
of individuals who are either on Medicaid or totally indigent
and uninsured, the access to private insurance traditionally
has not been a healthy mix, and it's created a situation where
many of these safety-net hospitals are under severe financial
distress.
That's beginning to change given the onset of the
Affordable Care Act, which is tremendous, but there's still, I
think, is an effort to begin to direct individuals more into
the primary care context and away from the overutilization of
these safety-net hospitals. Could you speak more about that,
what the administration is doing and where you think we need to
go?
Secretary Burwell. So one of the things that the
administration is doing is part of the overall effort. There
are many new people who are newly insured, and the actual
employee-insured based population has many new--access to many
new services in terms of prevention.
And so at CMS, one of the things we are working on is
something called, ``Coverage to Care,'' and it's both for those
that are newly insured, but it's also for those that are in the
insurer base market to help people understand how to use that
coverage to access a primary care physician, to get a health
home so that we can start to solve some of these issues and to
do things as simple as some people, and even in the employer-
based market, understanding your bill. Those kinds of things
are often complicated and difficult to do.
So at CMS, we are having a program. We are working on it.
We want to use the resources that are part of the teams that
have helped get people insured to make sure we're moving that
information. It comes back also to that Medicare point I raised
earlier that many people in Medicare don't know that they can
get access to these services without copays. So we want to
focus on greater education to get people into those primary
care settings.
Mr. Jeffries. And is enhanced Medicaid reimbursement for
primary care services also a part of what can be helpful moving
forward?
Secretary Burwell. It is. And as you know, we've proposed
to extend that.
Mr. Jeffries. Thank you. I yield back.
Chairman Kline. The gentleman yields back.
Mr. Brat.
Mr. Brat. Thank you, Mr. Chairman. Thank you for being with
us today. I have two quick questions. I guess I just got dinged
from five minutes down to three, so I'll make it real quick.
On ObamaCare overall: productivity, claims that it's good
for the economy. The basics in 2014, CBO reported they expect
ObamaCare will result in a 2.5 million person job reduction and
full-time equivalent employment by 2024. And so if you do the
math on that, 2.5 million people times 40 hours a week is 100
million hours, and then you do that for the year, and you get
100 million times 50 weeks in a year, and you are at five
billion hours in labor productivity gone due to this single
program, and that's the response I get when you walk door-to-
door, small business to small business, from people on the
street is like we can't hire anybody, this is devastating us,
and so I'll ask for your remarks on that.
The economy is already struggling to keep up with a kind of
a 2 percent rate, if that, and so the claim that the program is
good for the economy, I struggle with. And then secondly, I'll
just ask you a quick one and ask for your response. At the
micro-level, I have constituents who have approached me with
concerns about FDA's proposed rules to regulate premium cigars.
Premium cigars don't have youth access issues, sold in
adult establishments. The specific goal of the Tobacco Control
Act were to limit youth access and prevent negative health
effects from habitually used products, neither of which apply
to premium cigars.
So, shouldn't the FDA leave this category out of
regulations? By the FDA's own estimation again, over half of
premium cigar stores and manufacturers will be shut down if FDA
chooses option one in the proposed regulation. And so on this
level, too, how do you justify the regulation when it's
eliminating so many jobs and will have such a great impact on
my constituents?
Secretary Burwell. With regard to the premium cigar issue,
I think one of the things we asked for was the evidence, the
evidence with regard to child use, and so, that's why we put
out two different proposals. As we review that, it is about the
evidence we receive with regard to the question of premium
cigars and child use, getting to the core part of the statute
that you articulated, and we'll continue to work on that.
With regard to the broader economic issues, I think in that
same CBO report, what we do know is the reflection of what
happens in the out years with the Affordable Care Act in terms
of why there's long-term deficit reduction and it's also both
about productivity as well as cost, and we see large numbers in
terms of those out years, and so as that works through the
system.
I think the other thing is we think about these issues of
jobs and job creation. We know that we have had the longest
stretch of job creation as a Nation in terms of constant
stretch of job creation. And the other thing that we see in
that is we have not seen any rise in the number of people who
are looking for, you know, at that 40-hour level.
Mr. Brat. Let me ask you on that. The generic phrase, ``we
have seen an increase in jobs,'' isn't consistent with the
clear evidence that the workforce participation rate is at its
lowest in history, so yes, I mean, we're gaining jobs, the
population is bigger, but the labor force participation rate is
at it's all time low, can those be squared?
Chairman Kline. I'm sorry; the gentleman's time has
expired. We're jamming up against the clock here.
Mr. Brat. Thank you.
Chairman Kline. Mr. Takano.
Mr. Takano. Thank you, Mr. Chairman.
Madam Secretary, I understand that my colleague from
California, Mr. DeSaulnier asked you about graduate medical
school education. I just want to associate myself with those
remarks. In Riverside County, which I represent, there are
about only 34 primary care physicians for every 100,000 people,
half the number of doctors needed to provided adequate access
to care. And I understand that the GME levels have been frozen
under the Medicare and Medicaid budgets since around 1996, so I
associate myself with the exchange.
I hear from many of my colleagues about rising healthcare
costs, and Mr. Courtney of Connecticut commented on the slow
rates of growth there. In that case, it's a good thing. The
Affordable Care Act is bending the cost curve. Last year,
healthcare spending grew at the slowest rate on record since
1960, and healthcare price inflation is at its lowest rate in
50 years.
Just this week, as you mention in your testimony,
California released its premiums for the 2016 planned year.
Statewide, the average increase in premiums is just 4 percent.
It's even lower than last year and a far cry from the years of
double-digit premium growth we had before the ACA. Covered
California also announced that if consumers shop around, they
can reduce their premium by an average of 4.5 percent. That's
incredible.
Madam Secretary, can you share more about how the ACA is
containing healthcare costs?
Secretary Burwell. I think you've outlined a number of the
places that it is in terms of that downward pressure on
premiums and also what happens in competition, your point that
people can go on the marketplace and shop in the individual
market.
We have also seen some of that downward pressure in overall
price. It's also in the employer-based market. And the only
other piece that I would mention is I think it's important to
reflect that we've had a reduction of $317 billion in the
projected Medicare spending from the period of the passage.
Mr. Takano. Real quick, before my time is up, how many
years has the solvency of the Medicare trust fund been extended
thanks to the ACA?
Secretary Burwell. It is I want to say 17. It's at 2030,
and when we came in, it was in the 2017, 2019 range.
Mr. Takano. So it's increased--with increased--
Secretary Burwell. Thirteen to 17 years.
Mr. Takano. By 17 years.
Secretary Burwell. Thirteen to 17. I want to go back and
check exactly. It is 2030, and I think that previous number--I
just don't know what the previous historical number was.
Mr. Takano. So the cost containment seems to be working,
and I congratulate, you know, all of us for standing by the
law. And I know there's much more that we need to do to fix it.
And I'm going to run out of time, I'm pretty sure, so Mr.
Chairman, I yield back.
Chairman Kline. The gentleman yields back.
Ms. Clark.
Ms. Clark. Thank you, Mr. Chairman, and thank you, Madam
Secretary, for being here today. I appreciate your leadership
in so many areas, especially early childhood education and
access to affordable high quality healthcare for all Americans.
Today I want to focus in my brief time on a topic that has
come up with my colleagues from Georgia and California around
the opioid crisis, and I commend you for your recent
announcement and hope that Congress will support the 100
million that you want to invest in this crisis.
As you know, it doesn't matter when it comes to opioid
abuse, whether you are rich or poor, your level of education
attainment, but an area where we are seeing growth is in women
using heroin, which has more than doubled in the last decade.
I introduced legislation called, Protecting Our Infants
Act, which focuses on care for babies that are being born
dependent to opiates, but it also looks at the effectiveness of
programs specifically aimed at women and helping with substance
abuse disorders.
Can you discuss any efforts that you have made to evaluate
and respond to the circumstances of unique populations,
including young women and others, in addressing this crisis?
Secretary Burwell. With regard to, I think that it is
especially important for young women, especially pregnant young
women, to get into medicated assisted treatment quickly. And,
actually, just a week ago, I was in Colorado visiting a clinic
that did this work. And they do it, obviously, they do
medicated assisted treatment, but they are an integrated
facility so that a woman can come work on these issues at the
same time she gets her prenatal care in a facility that is all
in one place.
And so the emphasis and importance on medicated assisted
treatment is something that we believe is a key part with this
type of population, especially the pregnant women, so that
we're protecting that newborn.
Ms. Clark. Another area, shifting gears, but still talking
about pregnant women and new moms, is the issue of postpartum
depression.
Secretary Burwell. Yes.
Ms. Clark. I just dropped a bill today looking at this,
hoping to expand grants to States. one in seven new moms are
going to experience this depression. Can you talk about your
efforts in this area, and what you think we can do to improve
screening and access to treatment?
Secretary Burwell. We believe that this is an essential
part of prenatal and maternal care. As part of the prenatal
care, making sure people know and understand this issue. We
believe it's part of the full integration of behavioral health,
and that's something that was done through the Affordable Care
Act; it's something that was done in terms of the Mental Health
Clarity Act, and making sure that we bring the--so it's all
about maternal care. It's not about one or the other. This is
an element of maternal care.
And so making sure that we have the right wellness visits
and the right questions being asked as part of those wellness
visits, and that is the integrated care that we believe is part
of delivery system reform across the board.
Ms. Clark. Thank you.
I yield back.
Chairman Kline. I thank the gentlelady.
Mr. Curbelo, you are wrapping up here. You are recognized
for three minutes.
Mr. Curbelo. Thank you very much, Mr. Chairman.
And thank you, Madam Secretary, for your time and for your
testimony here today.
The rising costs of healthcare coverage remains a major
issue for people in my community. I'm talking employers and
employees. And one issue that's starting to come onto people's
radars is the Cadillac tax, the 40 percent tax on so-called
high-cost plans has resulted in many employers already making
changes to their plans to avoid hitting the tax in 2018
because, at the same time, they also have to offer minimum
value coverage to avoid an employer penalty. So, it's a careful
balancing act that a lot of employers are trying to make.
According to Towers Watson, 84 percent of large businesses
surveyed expect to make changes to their full-time employee
health benefits over the next three years. We hear stories now
of how employers are making plan design changes such as
increasing cost sharing and narrowing provider networks.
Miami-Dade County Public Schools, the second largest
employer in the State of Florida, reported to me that they
could see devastating effects as a result of this tax from an
estimated $500,000 impact in 2018 up to a $10 million impact in
later years.
Madam Secretary, if we are concerned about the costs of
coverage, wouldn't it make sense to get rid of this excise tax
because it's forcing the costs of coverage to go up for
employees? Shouldn't the answer be to get rid of it and allow
employers to offer the health benefits their employees are
requesting and willing to pay for?
I really see this as one of those examples where the
government actually ends up hurting the people who most need
the help. When you're talking Miami-Dade County Public Schools,
it's a lot of teachers; it's a lot of low-income earners, and
now they face losing their health insurance or seeing fewer
healthcare benefits as a result of this tax. Could you share
some of your views on this issue?
Secretary Burwell. Yes. One of the things is that for those
populations and for those communities, the types of increases
that we were seeing in terms of the percentage increase in
premiums already existed. Some of the shifts that you're
talking about in terms of how companies are doing cost sharing
and their networks and deductibles, those things were occurring
already.
By having the downward pressure of the excise tax in terms
of the question of people's interests and companies and other
employers' interests in trying to control their healthcare
cost, we believe it's something that actually does put downward
pressure on overall costs. I think the other issue at hand that
we all have to consider with regard to this excise tax is the
Federal deficit and the question of any changes and how it
interrelates with the Federal deficit.
So, those are the two issues that I think come to the
floor. The question of whether or not overall it has downward
pressure on prices and then the second is the fiscal
responsibility.
Mr. Curbelo. But do you have any concern for those low-
income earners who don't make a lot of money but at least for
many years and I can speak as a former board member of Miami-
Dade County schools, they knew that they had a good healthcare
plan that they and their family members could rely on. They may
lose those plans. Is that a concern for you?
Chairman Kline. I'm sorry. The gentleman's time has
expired. We are exceeding the hard stop time.
I'd like to recognize Mr. Scott for any closing remarks
that he has.
Mr. Scott. Thank you, Mr. Chairman.
Could I ask one question--
Chairman Kline. Please.
Mr. Scott. Just a brief question. My distinguished
colleague from Virginia asked about people who might lose their
job because of the Affordable Care Act. Could you make a quick
comment about the effect of job lock and how that creates the
situation you referred to?
Secretary Burwell. Just that the question of job lock and
those numbers have to do with many people are going to make a
choice to start their own business.
I think the other thing in terms of job creation as I said
with the Medicaid numbers, what we see is increased jobs
because of some of the changes.
Mr. Scott. And so when you talk about people leaving the
job, that's because they were only working on the job because
they had a preexisting condition and wouldn't have insurance
before, and they count that as a bad thing that they have
another choice to leave their job I think is not looking at the
positive effect that the Affordable Care Act has.
And so I want to thank you for talking about the
President's priorities, especially healthcare, early childhood
education, the effect of sequester on all of your programs, and
I look forward to working with you as we go forward with the
budget.
Secretary Burwell. Thank you.
Chairman Kline. I thank the gentleman.
Madam Secretary, I just have a quick follow-up to clarify
an earlier question you were asked about Planned Parenthood. I
know that came up a couple of times as you pointed out an issue
that there's a lot of passion. I just want to be clear, is it
your testimony that the Department of Health and Human Services
has no intention of looking into this matter?
Secretary Burwell. What the Department of Health and Human
Services will do, and we didn't discuss it today, is with
regard to the issue of our grantees and the Department of NIH,
part of HHS that does our research, there's funding with regard
to grantees, and some of those grants actually use fetal
tissue. With regard to that, what we are doing is making sure
that what we do have in place, which is clarity around the
issue of the fact that for any of those grantees that are going
to do that research, that as they come through the process and
before we do the grant making, there are terms and conditions
that clearly list what the law is with regard to fetal tissue.
They need to assert and certify that they understand the laws
and that they will abide by that.
And then on an annual basis, with regard to when they re-up
the grants, we ask them to certify, again, that they will obey
the laws and the terms and conditions of which this is a
specific place.
So, with regard to the piece that interacts with the
Department, these are steps that we are taking to make sure
that we have appropriate procedures in place to make sure that
people know the law and certify that they are abiding by it.
Chairman Kline. And so, the activities which have been so
important to so many of us that have been revealed in these
videos that are the actions of Planned Parenthood, you believe
that is solely a matter for the Department of Justice; is that
correct?
Secretary Burwell. With regard to the determination of if
the law has been broken, that is the Department of Justice. If
there are any concerns at all with our grantees, we would want
to refer that to our IG and/or the Department of Justice,
depending on those circumstances.
Chairman Kline. Okay. Thank you.
I really want to thank you. You were very indulgent here.
We have gone over by eight minutes. I appreciate your patience.
We very much appreciate your coming today. And there being no
further business, we're adjourned.
Secretary Burwell. Thank you, Mr. Chairman.
[Questions submitted for the record and their responses
follow:]
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[Secretary Burwell's response to questions submitted for
the record]
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[Whereupon, at 12:08 p.m., the committee was adjourned.]
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