[Congressional Record Volume 160, Number 87 (Thursday, June 5, 2014)]
[Senate]
[Pages S3449-S3454]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           BURWELL NOMINATION

  Mr. NELSON. Mr. President, I want to speak on behalf of Sylvia 
Mathews Burwell. We have had a lot of commentary out here that she has 
shown her capability in her time as the head of the Office of 
Management and Budget, OMB, and she is going to have a similar success 
now in the Department of Health and Human Services. We are going to be 
voting on her just before 2:00 this afternoon, and I am certainly 
looking forward to what is going to be a resounding vote. I think it is 
because most people feel she has done an excellent job at OMB.
  In this Senator's experience with her, discussing with her one of the 
smaller agencies of government, where this Senator felt as though OMB 
had targeted that little agency, instead of allowing the experts who 
were driving that agency--and specifically I am talking about NASA--
purely from a finance and budgetary standpoint, instead of what we 
wanted to accomplish in the Nation's space program, Ms. Burwell 
understood that, and she tried to help out from an agency that is more 
concerned just with budgetary aspects of government, and she understood 
you have got to get into what you want the agency to accomplish instead 
of just looking at the budgetary aspects. I appreciated that very 
much. I think we are going to have a similar kind of experience at HHS 
with Ms. Burwell.

  Now, goodness gracious, she takes over an agency that certainly has 
its hands full, as we are, for example, just trying to continue to 
expand Medicaid and expand it to all of the people in the States that 
have denied the expansion of Medicaid. So what we asked during the 
confirmation hearings is that she consider working with the States to 
find some types of compromises on a way to do that--to expand 
Medicaid--when the States are balking. Twenty-four States have not 
taken the Federal Government up on the offer to pay the full cost of 
expansion for the first 3 years, and then after the year 2020 the 
Federal Government will pay 90 percent of the cost of expansion.
  I offer an example in my own State of Florida. The State of Florida, 
ostensibly because they did not want to incur the 10-percent cost of 
Medicaid expansion after the year 2020--that was the reason they gave, 
but it really wasn't the real reason they didn't want to expand; they 
just didn't want to have anything to do with the Affordable Care Act. 
Many of them labeled it ``ObamaCare.'' As a result, what they have done 
in Florida is denied a population of over 1 million people--
specifically 1.2 million people in Florida--the availability of health 
care by expanding the eligibility for all Medicaid up to the level of 
138 percent of poverty. That level is for a family of four--$32,500 a 
year.
  A person thinks of a million people--over a million who otherwise 
could get health care--and they are making $32,000 or less, we can't 
expect them to buy health insurance if they are only bringing in 
$32,000 for a family of four. That is not reasonable. That is why we 
expanded Medicaid in the Affordable Care Act. But politics has a way of 
getting in the way, and there are 24 States that did not expand.

[[Page S3450]]

  In Florida's case, this means over this period of time there is $51 
billion of Floridians' Federal taxpayer money that would be brought to 
Florida to pay for those additional 1.2 million people who would get 
health care. Well, first of all, it is an issue of quality of life. Why 
don't we want people to have health care who can't afford it? That is 
the whole idea of increasing the percentage of the poverty level in 
order to make people eligible for Medicaid.
  But aside from that, if the Federal money is available for providing 
that health care--in this case, $51 billion--why wouldn't we want to 
take the Federal money to pay for the health care of the people--and 
``the people'' being a substantial number of people--over 1 million.
  In addition, if we care about the creation of jobs, we are talking 
about 125,000 jobs additionally created because of this expansion of 
providing health care.
  So all the way around, it is a win-win-win. It provides jobs, it 
certainly provides quality of life by providing health care, and the 
Federal money is already dedicated.
  Again, politics gets in the way, and politics got in the way in the 
State of Florida and 23 other States.
  Now, what to do about it. OK. The stated reason was that we don't 
want our State to have the obligation of additional spending--10 
percent--after the year 2020. What we have shown is a program that is 
already in place in State law to provide for poor people's health care 
through the low-income pool and other assistance to hospitals that 
serve that poor population, a tax base that already pays for that, 
taxes at the local level.
  We suggested this: We don't have to raise any new taxes to pay the 
State's share of the 10 percent. Those taxes are already being paid. We 
shift the money that is there because we are going to expand Medicaid 
and take care of all the poor people--some of whom are being taken care 
of now--and just use that tax base in place of the State of Florida 
share of 10 percent.
  The Legislature of Florida would not buy it in the closing days and 
weeks of the session. It is my hope they will in the future. But that 
is the kind of example that the new Secretary of HHS will be dealing 
with, as the previous Secretary of HHS has already dealt with in 
iterations of how to cover additional Medicaid populations. States such 
as Arkansas and Michigan have worked with HHS to find ways, some of 
them using the private marketplace to expand coverage.
  So it is my hope that with the new Secretary, with the obvious need 
of additional health care for people who cannot afford it in the 
private insurance market, we will see this turned around in the next 
session of the legislature; otherwise, every day the State of Florida 
loses $7 million that would be coming to the State for health care for 
people of low income.
  I want to say I am very proud of our State. During the open 
enrollment period, nearly 1 million people in Florida signed up for 
health insurance coverage in the State exchange that is run under the 
Federal rules. Of the 8 million people nationwide who signed up on the 
State exchanges, almost 1 million of that 8 million were in our State 
of Florida. So it shows us the hunger of folks there, knowing that if 
they can get health insurance or health care through Medicaid, they 
certainly want that very much. I hope that under the leadership of Ms. 
Burwell, we are going to be able to make that a reality in the coming 
year. I know she is going to do a great job as Secretary of HHS.
  Mr. President, I yield the floor, and I note the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The assistant bill clerk proceeded to call the roll.
  Mr. HATCH. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Ms. Hirono). Without objection, it is so 
ordered.
  Mr. HATCH. Madam President, today the Senate is expected to vote on 
the nomination of Sylvia Mathews Burwell to be the next Secretary of 
the Department of Health and Human Services. I expect her to be 
confirmed, and I expect she will receive a fair number of votes from 
both sides of the aisle. I, for one, plan to vote in favor of 
confirming Ms. Burwell. I believe she is well qualified and well suited 
for this position.
  But let's be clear. If Ms. Burwell is confirmed, she will have a 
difficult job ahead of her, particularly when it comes to 
implementation of the so-called Affordable Care Act.
  While I support Ms. Burwell's nomination, no one should mistake that 
to mean that I have somehow softened in my resolve against ObamaCare. 
Indeed, I am as committed as ever to repealing and replacing this 
horribly misguided law.
  I hold this position not due to politics or partisanship but due to 
the real--very real--problems this law is causing for our citizens, for 
our government, and for our Nation's health care system.
  I would like to take a few minutes today to talk about some of the 
specific problems we are seeing with ObamaCare and what some of my 
colleagues and I are doing to address them.
  As we all know, under the Affordable Care Act, States are required to 
have an online exchange where citizens can go to purchase health 
insurance. The law gives the States the option of creating their own 
exchange, using the exchange provided by the Federal Government or 
using a hybrid of the two.
  The Department of Health and Human Services gave every State $1 
million to fund research and analysis to determine what type of an 
exchange they would use. Additional grants were given in two stages--
two stages--for those States that chose to build all or part of their 
own exchanges.
  On top of that, HHS awarded seven early innovator grants to States 
that decided early on to build their own exchanges in order to help 
support the development and early implementation of the necessary 
information technology systems.
  All told, States received $4.7 billion from HHS to assist them in 
building their exchanges.
  The problem we are seeing now is that, apparently, this money was 
just handed out with little or no accountability.
  At least seven States--seven States--have failed to build a 
successful Web site and exchange, even though they received and 
accepted Federal taxpayer dollars specifically for that purpose. Now 
these States are scrambling to either rebuild their entire systems or 
to transition to the Federal exchange.
  These seven States received roughly $1.3 billion from HHS to build 
their exchanges. That is $1.3 billion--with a ``B''--to just seven 
States in the Union. That is more than one-quarter of the total amount 
HHS provided to States for the purpose of building their own State 
health care exchanges. And apparently these States have little or 
nothing to show for it. In fact, at least three of them are looking to 
drop their own exchanges entirely and use the Federal exchange instead 
now.
  You heard that right, three States--that between them received 
hundreds of millions of dollars from the Federal Government to build 
their exchanges--now want to abandon the prospect entirely and join the 
Federal exchange.
  Let's keep in mind that adding them to the Federal exchange will not 
be simple, nor will it be cheap. More millions will be spent to 
transition these States--along with any other States that may choose 
the same course in the future--into the Federal exchange.
  This is simply preposterous. Where is the accountability? Where is 
the outrage from HHS over those lost and misspent funds? There does not 
seem to be any.
  For her part, the President's nominee to run HHS, Ms. Burwell has at 
least acknowledged that there is a problem here.
  During her confirmation hearing in the Finance Committee, I asked her 
whether States that have negligently mismanaged their exchange funds 
should be required to reimburse the taxpayers for those losses and for 
their failures? Her answer was somewhat encouraging. She said that if 
she was confirmed she would want to get to the bottom of this problem 
and ``use the full extent of the law to get those funds back for the 
taxpayers.''
  Unfortunately, in answer to my followup question--whether she would 
commit to withholding additional exchange-related funds from those 
failing States--she was not quite so definitive. Still, I was glad to 
hear her at least acknowledge the problem and make a

[[Page S3451]]

commitment to recouping taxpayer funds lost in these debacles. If she 
is confirmed, I hope with all my heart she will live up to this 
commitment, and I expect her to do so.
  That said, it is clear that, if we are going to make the taxpayers 
whole on this matter, we are going to need to do something besides 
waiting around for HHS to address the problem. Indeed, if our 
experience has taught us anything, it is that commitments made in the 
context of a confirmation hearing often fall by the wayside. I do not 
intend to have this one fall by the wayside.
  That has been particularly true, though, with this administration, 
especially when the commitments deal with ObamaCare. That is why I have 
joined with the ranking member of the Senate Judiciary Committee, 
Senator Grassley, in an investigation into this matter. Congress needs 
to exercise proper oversight on this issue. We need to get answers. We 
need to get them now. One way or another we are going to get them.
  Last month Senator Grassley and I sent a letter to CMS Administrator 
Tavenner asking for information about CMS's communications with the 
States with regard to the difficulties they have had setting up 
exchanges and their use of Federal funds. As I said, all told, these 
failures amount to over $1 billion in lost funds. The American people 
deserve to know where the money went and why it was so horribly 
misused.
  That is not all the American people deserve. They also deserve to be 
paid back for these losses. That is why I have joined with Senator 
Barrasso in introducing the State Exchange Accountability Act, a bill 
to require the States to pay back these wasted funds. Every Senator 
here, Democrat or Republican, ought to be willing to back that bill.
  Specifically, if enacted, our bill would require those States that 
operated a State exchange in 2014 and subsequently chose to use the 
Federal exchange to repay all of their establishment and early 
innovator exchange grants. The bill would give them a 10-year timeframe 
to do so. States would have to enter into an agreement with HHS to 
repay at a minimum 10 percent of the total grant money they received 
every year. States that fall under these requirements but fail to enter 
into such an agreement would see their Federal assistance medical 
percentages, or FMAP, reduced by HHS. The FMAP reduction would be 
uniform and take place over a 10-year period and would be equal to the 
amount of exchange grant money the State received.
  Under the bill, HHS would be explicitly prohibited from reducing the 
amount of reimbursement that States owe to the Federal Government. I 
expect some would deem this approach to be too punitive, but they 
should not. I do not think anyone can reasonably dispute there is a 
problem that needs to be dealt with. Our solution is reasonable and 
achievable. All we ask is the States that have wasted taxpayer funds 
repay them within a reasonable period of time. We give these States 10 
years to pay the money back. This is not punitive; it is necessary. 
More than anything, the failures we are seeing with the State health 
care exchanges demonstrate that the Affordable Care Act has been flawed 
from the beginning. Indeed, it was the law itself that included an 
open-ended appropriation to help States build their exchanges without 
any mechanism to make States accountable for wasting those funds. Given 
these fundamental problems, I expect we will see more States take this 
route, especially if there are no steps taken to make them accountable.
  Congressional oversight into these failings is vital. I hope the 
administration will cooperate in our effort to resolve these problems. 
Our legislation is no less important. It is the only way to guarantee 
the American taxpayers get their money back. But that is not all we 
need to do. Make no mistake, ObamaCare is doing serious damage to our 
Nation's health care system and our Nation's fiscal future.
  When it comes to his health law, the President's favorite argument is 
that Republicans have not produced an alternative of their own. 
However, this is simply untrue. I suspect the President knows that. 
Earlier this year two of my colleagues and I unveiled a legislative 
proposal that would undo the damage ObamaCare has inflicted on the 
American people. Unlike the Affordable Care Act, our proposal would 
actually reduce costs and shore up our entitlements. It would do so 
without all of the harmful distortive mandates and regulations we see 
under ObamaCare. Once again, in the immediate future, we need to solve 
this problem with the failed State exchanges. But we also need to keep 
our eyes focused on the long-term goal of repealing ObamaCare once and 
for all and replacing it with something that will actually work for the 
American people.
  I hope that as time wears on, more of my colleagues, particularly 
those on the other side of the aisle, will recognize this is what we 
really need to do.
  As I said, I intend to vote today in favor of Ms. Burwell's 
nomination to lead HHS. I have helped that process to go smoothly. I 
want it to go smoothly. I believe she is a good choice for this job. I 
am hoping with all my heart that she will be that good choice she has 
indicated she is, and I have deduced she is. But I still have a number 
of concerns about the direction the agency is headed. During the course 
of her confirmation hearing, Ms. Burwell made two very important 
commitments to me. The first commitment she made was to respond 
promptly, within 30 days, to questions and inquiries submitted to HHS 
from Members of Congress.
  This is an important commitment, one I hope she lives up to. Under 
this administration HHS has been one of the least transparent of all 
Federal agencies. Letters and inquiries oftentimes have been ignored 
entirely. When we do receive letters in return from HHS, they are 
almost in every case unresponsive. Ms. Burwell is committed to changing 
that practice. I respect her for it. It is part of the reason I led the 
charge to have her confirmed. Once again, I surely hope she does help 
change that practice.
  I mentioned the other major commitment she made to me earlier in 
dealing with the failed State exchanges. Ms. Burwell committed to doing 
everything in her power to retrieve the wasted taxpayer funds. This 
commitment is also important, because thus far HHS has refused to 
acknowledge many of the problems they faced in implementing the 
Affordable Care Act. The fact that she made this commitment to me 
demonstrates she is at least willing to admit there are some major 
problems with the program.
  I support Ms. Burwell's nomination in large part because of these 
commitments she has made. I hope she lives up to them. I think she has 
the ability to live up to them. I have high hopes of that. No one 
should misread my vote today as an acknowledgement that all is now 
right in the world of ObamaCare and at HHS, because nothing can be 
further from the truth. But Ms. Burwell has, for her part, acknowledged 
that problems exist and has committed to doing what she can to fix 
those problems. Under this administration, that is probably the best we 
can hope for.
  This is an important nomination. She is a very qualified woman, in my 
opinion. She has had some significant experience in the Federal 
Government. I have high hopes that she will turn out to be a wonderful 
Administrator at HHS. It is almost an uncontrollable, unadministratable 
agency. I am going to give her all the help I possibly can to help get 
that agency under control and get it right again.
  This is important. I feel deeply about it. People in the bureaucracy 
know if they work with me I will move heaven and Earth to try to help 
them. It is time our government is more responsive to its citizens, 
more responsive to what people believed when they were confirmed, and 
more responsive in solving those problems that are so significant, so 
costly, and so important to the American people.
  Ms. MIKULSKI. Madam President, I wish to speak in strong support of 
Sylvia Mathews Burwell, who has been nominated to serve as Secretary of 
the Department of Health and Human Services, HHS.
  HHS is a $1 trillion agency responsible for, among other things, 
managing Medicare, Medicaid, and implementation of the Affordable Care 
Act, ACA. HHS needs a strong leader. I believe Sylvia Burwell is up to 
the job.
  President Obama could not have selected a better person to lead HHS 
into

[[Page S3452]]

future. I first got to know Sylvia during the Clinton administration, 
but I also worked with her when she was at Bill and Melinda Gates 
Foundation and the Walmart Foundation. I really got to know Sylvia more 
recently as she ran the Office of Management and Budget, OMB. She 
played a pivotal role in helping Congress come to agreement on a budget 
deal last December.
  Her work at OMB has prepared her to step up to challenge of leading 
HHS. She is a problem solver who knows how to work with Congress. She 
is also a mom with kids. I am confident that Sylvia will be an 
outstanding HHS Secretary.
  It is my hope that she is confirmed quickly. It is important that HHS 
has a leader in place. It is important that Congress has a point person 
in place as we work to pass the fiscal year 2015 Labor-HHS 
appropriations bill. And it is important for the country to have a 
Secretary of HHS confirmed so we can move forward with implementation 
of healthcare reform.
  I would like to take a moment to express my deep appreciation to Ms. 
Kathleen Sebelius--our current HHS Secretary. Whether it was as 
Secretary of HHS or Governor of Kansas, Ms. Sebelius has always been a 
bright, hard-working, and devoted public servant. Despite constant and 
relentless opposition, she fought every day in every way to make health 
insurance a reality for millions of Americans. She was a phenomenal 
partner and tireless advocate in efforts to improve women's health, 
expand mental health benefits and services, fight childhood obesity, 
and protect people from dangerous influenza strains. She was a fierce 
advocate for those most in need and she will be missed. I wish her and 
her family well in all future endeavors.
  As I mentioned earlier, HHS is a $1 trillion agency. Every single 
person worldwide benefits from work done at HHS. For instance, HHS 
oversees the National Institutes of Health, NIH--our Federal agency 
responsible for finding cures and treatments for the illnesses and 
diseases that impact our families. HHS also oversees the Centers for 
Disease Control and Prevention, CDC--our Federal agency responsible for 
protecting the public health by preventing, tracking, and managing the 
spread of disease. HHS also oversees the Food and Drug Administration, 
FDA--our Federal agency responsible for protecting our Nation's food 
and drug supply. HHS oversees the Administration on Children and 
Families, ACF--our Federal agency responsible for running the Head 
Start Program and helping lower income families afford childcare. In 
addition, HHS is responsible for overseeing the Centers for Medicare 
and Medicaid Services, CMS--our Federal agency responsible for managing 
Medicare for our Nation's seniors and Medicaid for those in need. These 
are only a few examples of how we rely on HHS agencies.
  We also rely on HHS for implementation of Affordable Care Act. 
Unfortunately, healthcare reform remains a divisive issue, despite 
passing the House and Senate, being signed into law by the President, 
and being upheld by the Supreme Court of the United States. It also 
remains divisive despite all the benefits we have seen so far: More 
than 8 million Americans have obtained health insurance thanks to 
healthcare reform. More than 3 million young adults have been able to 
stay on their parents' health insurance plans. More than 3 million 
people have been newly enrolled in Medicaid and the Children's Health 
Insurance Program, CHIP. Thanks to healthcare reform, being a woman is 
no longer a preexisting condition and people can no longer be denied 
coverage or charged more for preexisting conditions. And thanks to 
healthcare reform's provisions to close the dreaded doughnut hole, more 
than 7 million seniors have saved $9 billion in prescription drug 
costs.
  Despite the many successes of healthcare reform, there is still much 
to be done, and we need a Secretary in place to get that job done. We 
need a Secretary focused on ensuring smooth open enrollment periods 
that are glitch-free. We need a Secretary who is willing and able to 
work with States who are not yet where they need to be. We need a 
Secretary focused on protecting people's privation information in an 
ever-dangerous cyber climate, and we need a Secretary focused on 
getting young people enrolled in health insurance plans and focused on 
keeping premiums low for individuals and small businesses.
  Running HHS is a big job. Ms. Burwell is the right woman for the job. 
I urge my colleagues to join me in support of her confirmation to serve 
as Secretary of HHS.
  Mr. HARKIN. Madam President, today we consider the nomination of 
Sylvia Mathews Burwell to be the next Secretary of the Department of 
Health and Human Services. Ms. Burwell currently serves as Director of 
the Office of Management and Budget, a position to which she was 
confirmed by a vote of 96-0 in April 2013. Through a dynamic career in 
both public service and private sector leadership, she has proven 
herself as an effective manager with experience and skill in leading a 
wide range of organizations. During her confirmation hearing in the 
HELP Committee last month, she garnered strong support from Members on 
both sides of the aisle. Clearly, I am not alone in concluding that she 
is a deeply impressive nominee and is eminently qualified to serve as 
the next Secretary of Health and Human Services.
  The United States faces serious public health challenges, many of 
which require urgent answers. Very often, the entire world looks to HHS 
for leadership. Just last month, this country confronted the first ever 
incident of MERS, Middle East Respiratory Syndrome, within our borders. 
HHS responded quickly to educate the public, investigate the situation, 
and develop a path forward.
  We will count on our next Secretary for exactly that kind of 
informed, decisive action in the face of future challenges and crises, 
and to provide a steady hand overseeing an incredible range of 
activities across the Department.
  For example, she will be responsible for research efforts at the 
National Institutes of Health, among other agencies. This federally 
sponsored research has made the United States the world leader in 
biomedical innovation, and has resulted in countless discoveries and 
breakthroughs, from the extraordinary application of genomics to 
cutting-edge pharmaceuticals to an unprecedented understanding of the 
human brain.
  As Secretary, Ms. Burwell will also be in charge of another long-time 
priority of mine, disease prevention. She will lead our Nation's 
efforts to transform our health care system from a ``sick care system'' 
into one that focuses on wellness and prevention, not just at the 
doctor's office but also in our schools, workplaces, and communities.
  Ms. Burwell will oversee the Food and Drug Administration--a 
critically important agency that protects and promotes public health by 
helping to keep our Nation's food and medical product supplies safe, 
among other things. In fact, FDA now oversees items that account for 25 
cents out of every dollar spent by Americans.
  The Department also ensures that we can meet the health care and 
education needs of our most vulnerable citizens through programs like 
the community health centers, Ryan White HIV programs, and the Head 
Start program.
  The Secretary is also charged with oversight of programs that support 
millions of Americans with disabilities. Medicaid makes it possible for 
many with chronic disabilities to remain in their homes, to go to work 
or school, and to be active members of society. In tandem, the 
Administration for Community Living implements policies that help 
people with disabilities to stay in their homes, neighborhoods and 
places of work, with the result that people are healthier, happier, and 
have better quality of life.
  And of course Ms. Burwell will have the critical role of overseeing 
implementation of the Affordable Care Act. We can be proud that thanks 
to the Affordable Care Act we have seen over 6 million new Medicaid 
enrollees, and more than 8 million more Americans have signed up for 
health insurance in the marketplaces. But there is more work to be done 
to continue successfully implementing the law and reforming our health 
care system.
  The list goes on and on, but I have made my point that as Secretary, 
Ms. Burwell will shoulder incredibly important responsibilities that 
matter deeply to the health and wellness of the American people. I have 
no doubt that Ms. Burwell is up for the challenge.
  Since her nomination Ms. Burwell has met with numerous members of

[[Page S3453]]

this body to discuss their individual priorities and her personal 
vision for the Department. I urge my colleagues to vote in support of 
Ms. Burwell and confirm her as our next HHS Secretary so she can begin 
the important work of advancing our Nation's health.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. WYDEN. I ask unanimous consent that the order for the quorum call 
be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WYDEN. To close for our side, I would like to strongly urge my 
colleagues in a few minutes to support the nomination of Sylvia Mathews 
Burwell to be the next Secretary of the Department of Health and Human 
Services.
  I want to start with a simple fact. Sylvia Mathews Burwell's 
nomination has a breadth of bipartisan support because she is really 
that good, she is really that capable, and she is really that 
qualified.
  I am going to say to colleagues, nobody has to take my word for it. 
We all know that our colleague on the other side of the aisle, Senator 
Coburn, is a man of strong views. He says what he means, and he means 
what he says. As a ranking member of the Homeland Security and 
Governmental Affairs Committee, Senator Coburn has had many 
opportunities to work closely with Ms. Burwell during her service as 
the OMB Director.
  For example, he emphasized the nominee's competence, saying: The fact 
is when you have somebody who is confident, competent, and also has 
strong character, you find a way to get past your differences to try to 
solve problems.
  He emphasized she is a good listener and that she is communicative.
  He said:

       Responsiveness is key for the Congress, and I have to tell 
     you I found her remarkably responsive. The fact is she is 
     going to be committed to do the right thing and to keep 
     Congress involved.

  Finally, in a quote that I thought was particularly striking, Senator 
Coburn said:

       Even when she has made up her mind, which sometimes 
     happens, she will listen to another point of view to get 
     information she might not have.

  Senator Coburn also said:

       That is a characteristic too often that we don't see, as 
     Members of Congress, and in members of the administration, 
     whether they are Republican or a Democrat.

  Senator Coburn is not the only one who is part of this we could call 
it choir of bipartisan support for Sylvia Mathews Burwell.
  When she went before the HELP Committee, our Republican colleague 
from North Carolina, Senator Burr, said:

       I support her nomination. I will vote for her in the 
     Finance Committee, and it is for one primary reason, it is 
     because she doesn't come with a single experience that would 
     make her a good Secretary. She comes with a portfolio of 
     experience that would make her a tremendous asset at 
     addressing some of the challenges the agency specifically and 
     uniquely has.

  Senator Burr continued:

       I look forward to her confirmation being quick and our 
     ability to then work together to be every bit as quick.

  These are statements that reflect a nominee who is going to be, in my 
view, an active agent of bipartisanship. She is somebody who has 
already shown she can bring Democrats and Republicans together to solve 
big challenges, and I think she is going to show it at the Department 
of Health and Human Services.
  Suffice it to say, we know Health and Human Services will need to 
have strong leadership in the days ahead. We know the debate about the 
Affordable Care Act is going to continue. It is going to continue in 
Hawaii, Oregon, and across the country.
  My hope, as chair of the Finance Committee, is that Sylvia Mathews 
Burwell can help bring together Democrats and Republicans to build on 
the Affordable Care Act, just as many of us did to work with former 
President George W. Bush, to strengthen the Part D Program, the 
Medicare prescription drug program. Many of the first stories about 
Medicare Part D were much like the first stories about the Affordable 
Care Act. Yet Democrats and Republicans came together, were able to 
strengthen Part D to the point where now--enormous support among 
seniors--it has come in at more than 30 percent below the cost 
projected by the Congressional Budget Office.
  So let's all work together with Sylvia Mathews Burwell to do for the 
Affordable Care Act what we did with George W. Bush's program on 
prescription drugs, and that has worked in a bipartisan way.
  One of the reasons I am so enthused about Sylvia Mathews Burwell is 
we have big challenges that both sides, Democrats and Republicans, are 
going to have to team up on to tackle in the days ahead. For example, 
Medicare in 2014 is dramatically different than Medicare when it began 
in 1965. In 1965, for example, if a senior broke their ankle, if he or 
she needed to see a doctor, they went perhaps to an outpatient program, 
Part B of the Medicare Program. If they needed more attention--perhaps 
the ankle needed to be reset--they had to go to the hospital, they 
would get assistance in the hospital under Part A.
  Today that is not primarily what Medicare is all about. Today, well 
over 80 percent of Medicare is tackling chronic disease. We are talking 
about diabetes, we are talking about cancer, we are talking about 
strokes and heart disease. Certainly if you add Alzheimer's on top of 
it, that is 90 percent of the Medicare Program. That broken ankle, when 
the senior has one, of course, has to be taken care of. But most of 
Medicare is about chronic disease.
  What we are going to need is Democrats and Republicans coming 
together to tackle an issue that, frankly, has gotten short shrift in 
Washington, DC. It didn't come up a whole lot in the debate about the 
Affordable Care Act on any side, and yet it is going to be the issue 
that dominates the future of the flagship health care program in this 
country, Medicare; and much of what is done for chronic disease for the 
Medicare population will also be copied for the under-65 population, 
since the trend historically, when Medicare takes bold action, is often 
replicated in the private sector.
  Some of this work has begun, but the fact is we need a strong leader 
with bipartisan support, as I have tried to highlight with Dr. Coburn's 
comments, Senator Burr's comments, and others. I think it was all 
summed up when Dr. Coburn and Senator Rockefeller--the senior 
Democratic Senator from her home State--teamed up that first day and 
set the mood about how this would be a nominee with exceptional ability 
to reach out and tackle the big challenges of our time.
  Medicare, of course, in my view, is the biggest. But the issue of 
family support, the child welfare programs the Department manages, 
these are programs that are critical lifelines for struggling Americans 
across the country. So many of our people are now falling between the 
cracks--falling between the cracks into poverty since the recession. 
The Department of Health and Human Services plays a powerful role 
ensuring that we have a strong safety net.

  I have talked about her credentials before, but her education 
includes a stellar background, a graduate of Harvard and Oxford, where 
she was a Rhodes scholar. She was a staff director of the National 
Economic Council. This is someone who is very savvy on the big economic 
challenges, and she has superb experience. In 1977 she became Deputy 
Chief of Staff to the President and moving the following year to become 
the Deputy Director of the Office of Management and Budget.
  She also has extensive experience in the nonprofit world. At the 
Gates Foundation she led efforts to tackle some of the most pressing 
global health challenges of our time.
  At the Walmart Foundation, where she served in 2011, she offered 
outstanding leadership in the fight against hunger and to improve 
economic opportunity for women.
  As Senators consider this nomination in the last couple of minutes 
before the vote, I only want to remind--perhaps not subtly--the Senate 
confirmed Sylvia Mathews Burwell for the position of Director of Office 
of Management and Budget 96 to 0. I think that is a very rare statement 
of bipartisanship for an extremely important position that not

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only has Sylvia Mathews Burwell discharged very well, she has won 
additional plaudits for her bipartisan work, as I have indicated today.
  She is going to respond to the biggest and the big challenges in a 
way that I believe brings Americans together. That is what Senators 
have said throughout the process, and they have said it whether you 
have a D or an R next to your name. What the country needs, in short, 
is somebody who is a true agent of bipartisanship.
  I conclude my remarks by saying I have gotten to know Sylvia Mathews 
Burwell well in the past few years. She is the right choice for the 
right time, and I strongly urge my colleagues on both sides of the 
aisle to join me this afternoon in supporting her nomination.
  I yield the floor.

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