that's what i understand congratulations on your confirmation i know that after getting back to washington and seeing the traffic your same thought that i have we're not in kansas anymore as secretary of health and human services you have  r health care and social services remain excellent and indeed improve like a physician your philosophy should be first do no harm the softness hard for the government for meddling in access and choice that government does in fact do harm i'm interested in hearing how you will balance the desire to improve access to health care and human services while not interfering in the quality of the systems themselves one of the biggest concerns with government interference in health care delivery system that i have and i'm sure you have health care reform will be a large part of our discussion today is that we will limit the innovation to choice and the access to this process are going to be trying to involve more government in the process the three areas of concern that i have with the administration's proposals are the utilization of comparative effectiveness to ration health care the elimination of the conscious protection and the overall concept of moving people from the private health insurance to public health insurance i believe three policies will negatively impact the quality and america's access to health care first regarding comparative effectiveness in the stimulus bill including money that not only was for comparative effectiveness but also language directing your department research to make decisions about what treatments the government will and won't approve the government will fund research to decide which medicine or medical treatment works best for most people then and only then will they pay for that one option in other words affect is just another way to say ration health care who's going to be affected by this policy and unfortunately i funding that would she had medication that would allow her to fight off the common cold in the flu when she visited my office she had was suffering from the flu and was afraid she had left to live where she was completely able to function she could play with the grandchildren she could shop she could be productive unfortunately when she switched to medicare the government would not fund her therapy or medication so she was forced to take a new medication which provided her with headaches and back es and it did not protect her from diseases such as a common cold when she came to my office she was considering were in a mask and very worried about the h one n one virus it was all because of the interference in the decision but that  was between her physician and herself personalized medicine is a new frontier and developing applications to meet medical needs of individuals as individuals as our own university of kansas is developing the technologies that can not only detect and analyze and individuals unique physiological response to such as cancer but also tailor the optimum treatment for that person growth nomics research personalized medicine has already success and is realized as the direction which medicine should be moving in the early as early february announced the creation of a new position to focus on the new personalized medical methods came about one of those on one hand the government promotes this personalized medical research and on the other hand i mean the progress through comparative effectiveness policy comparative effectiveness will directly affect a doctor's ability to make the best decision for his patients the federal government a large customer and health care industry once it no longer pay medicines or treatments it becomes financially unsound for manufacturers to be able to recoup their costs from research and development and thus limit their development of new products similarly innovative research on gene therapy and other personalized medicine options will be threatened second i believe that the removal of the conscious protection will threaten our nation's health care access as americans we believe that no one should be forced to act in a way that violates his morals or his or her morals or religious beliefs there are many excellent health care professionals and health care facilities that do not believe abortion is the right is a right is right or not and do not provide that procedure now the administration wants to remove their right to refuse and provide a service that violates their moral principles and or religion besides the civil rights aspect of this policy there would be a severe impact on access to health care catholic hospitals clinics and medical professionals are the bedrock of our health care delivery system in most parts of the nation in kansas is forty percent of our hospitals are not as not for profit hospitals they take care and all that comes to their doors they provide excellent care but if they are forced to close their doors or stop many americans in kansas and we left without a place for medical treatment i'm interested in hearing how the administration plans to ensure that our health care system doesn't come to a grinding halt if they stop reimbursing medical centers for freedom of choice filing in this area in which i know you are intimately familiar as former insurance commissioner of the state of kansas i would like to hear about your rationale for moving people from private health insurance to the public system not only will this exponentially the cost to the taxpayer but it will also further ration health care the ministration has expressed a desire for public insurance a public insurance plan that will directly compete with private health insurance plans employers will see this as a cost avoidance and move their employees and their cost from their own pocket book and bank account to the taxpayers we've seen this already in s chip how will we pay for this as a nation have you accounted for the vast in rome and beyond just today's uninsured further current public insurance accounts for about  forty percent of the health care coverage while private insurance covers about sixty percent of it we all know that the reimbursement rates are much lower than the actual cost when it comes to the public portion in kansas they're experiencing from twenty five percent to seventy percent below cost on the reimbursement rates and it's not one loan it's hospitals clinics and physicians they try to make ends meet by shifting costs from the private insurance payments to cover the shortfalls in the public funding insurance today in kansas one third of the physicians will not take any new medicare or medicaid patients because of this it cannot find a way to meet the seniors health care cost and then how will they be able to pay for the entire populace under government run health care the only way this would be feasible would be rationed health care system similar to what we find in other countries like canada united kingdom norway anywhere else on the face of the earth that has some a program and i believe this is completely unacceptable more important i'm concerned that will be the downfall of the american health care quality and indeed the world as we know it as a standard bearer and health care secretary sebelius is going to have you here today i look forward to working with you to ensure that every american has the ability to pursue his or her dreams including access to the best health care and wellness programs in the world thank for over thirty four percent of our gross domestic product without reform that change in action now the federal deficit will continue to rise and americans who receive insurance from their employers will be up about twenty six hundred dollars by two thousand and twenty and ten thousand dollars more in two thousand and thirty but only if we make health reform a reality of the message is clear health reform can give us a broken the budget we're considering to invest in key priority areas and puts us on the path to health reform bills on the investments already made in a twenty first century health system that you all made in the american recovery and reinvestment it sends a clear message we can't afford to wait any longer if we want to get health care costs under control and prove our fiscal out cost our nation billions of dollars associated infections as well as support for prevention and wellness programs that can keep americans out of the hospital in the first place two thousand and ten budget builds on these investments the budget includes critical support for patients research that will give patients access to better information and treatment as well as quality incentive payments to hospitals and physician groups who have better r eadmission three hundred fifty four million dollars to combat health disparities improve the health of racial and ethnic minorities and low income and disadvantaged populations and the budget recognizes that if we want to ensure that millions of americans lack insurance good quality affordable care we need to increase the number of health providers in this country are responding to the challenge by including over a billion dollars within the health resources and services administration to support a wide range of programs to strengthen our nation's health care workforce the funding enhances the capacity of nursing schools increases access world health care targets minority virus and get americans the information and resources they needed early in the outbreak but we still don't know what's coming later this fall and winter exactly will happen this summer in the  president obama has committed to creating a healthier and more prosperous america and this budget will help our department achieve those goals and invest in reform will improve the quality  funding for cancer to the exclusion of almost every other disease i don't think there's anybody on this panel who is in love with cancer or ought to i think all of us have a long record  priority having said that there are also in the recovery act and again on the two thousand and ten budget is a significant investment in research and the president also fully supports a living  science research so i think that's a balancing act and i will share your concerns with them it's my understanding that the budget resolution unlike the initial budget proposal has  prices were not as high as they had been in previous years but i understand your program that we share that commitment it's an essential program for really what's lifesaving services for seniors  around the country and then finally in terms of long term care there is already an investment in interest in rebalancing a lot of our long term care issues and finding more of a continuity of care and funding that kind of part of the workforce funding speaks to the fact that i think for many americans care in their home   as a methodology to do exactly what you've just described identify not only best practices and effective outcomes but really helpful drive that in some transparent way inform but also medicaid in the public health insurance plan currently today sixty percent of health care is privately funded public funded in every hospital clinic in every in america today the shortfall of public funded health care costs plan is being debated and really constructed in congress i think that having a fair payment having shared responsibility and making sure that all americans have access to more affordable but more effective health care  you we've had a chance to work together with regard to what was happening in rural america and your focus in that area but also in this job is how with your leadership in the president's leadership we'll be able to provide affordable health care for every american has been a long time in coming and we didn't succeed in one thousand nine hundred and the problems have only gotten worse we cannot fail this time around and i believe the president believes that as do you i want  first associate myself with the comment on health care that the chairman pointed out on the verge strong proponent of a public plan part of the options and that we provide to people today that helps us to level the playing field and it does provide real choice there i'd also would remark on the issue of this committee and on a bipartisan basis i think what we've tried to do is to not pick and choose the various diseases or you will you're marking up autism and of cancer i think we're best if we're not picking and choosing i'm going to go to another question hopefully in a second round i'll come back to health care but i want to just  talk about early childhood and head start if i might and the on the recovery program did provide funding for head start and as part of a safety net but the dollars as you know don't increase the base the of the really the two thousand and ten budget which only included a slight increase for the block grant program and what i want to do is to check in with you about your plans for working to ensure that that increase recovery act is sustained in two thousand and eleven and beyond with regard to early childhood and health care and how in fact you plan to work with the secretary secretary duncan to look at the coordination of services for children who are under under five well thank you congresswoman i as you just said the twenty ten budget does include an increase in funding for head start and early head start that would start with a platform that was put in place by enormous investment in the recovery act money and i think that's that's so essential i've had the opportunity to do a lot of work in early childhood education and i take very seriously the notion that this is probably the best single investment we could make in america and the research on brain development is pretty clear that between birth and five and three years old particularly is an enormous growth period we have already  secretary duncan and i have already had several preliminary conversations in fact i had the first one when i was still governor of kansas and he was already the secretary about how the work we were doing in kansas could be expanded with some early education money and i've circled back around now as the new secretary to talk about ways that we can have a very collaborative and coordinated strategy i think it's important to have all the early childhood providers at the table to have a mutual goal about where this money is best directed based on the science and evidence based research and also to recognize that all children don't thrive in identical programs that we need a variety of programs for parents and children to succeed but i can assure you those conversations are very much underway and it's a passion that both of us share the three hundred million dollars early learning challenge grant you have any  for a program that is based on what we know works in the long run what gets children ready to go to school we did an alarming study in kansas a couple of years ago conducted by the board of education that hung out there long enough essentially the people got a chance to understand what was in it and they didn't want it very much and they sent messages back to us that were very clear and rather direct for that which the chairman suggested and i believe your statement suggested that people want to be able to keep what they have and then above and beyond that they want to ensure that they maintain choice as we go forward with such a package i don't do not know what a government single pay system might lead us to but a lot could be learned by also not just at the hillary clinton commission but some of that which john maynard keynes may have taught us about what socialized process to deliver in the final analysis that there were all of that will be a part of discussions ahead of us will be a healthy one and an important one the chairman and i have spent some energy attempting to figure out what we do with a thing called pandemic flu i want to commend the department for taking on h one n one virus seriously and going forward with a program that will attempt to make sure that we're ready and we w benefit from that which we've learned so far as a result of work by people like julie gerberding and the like i know that within your budget there's a request to include three hundred fifty four  million dollars for public health and social service emergency funds at the same time i'm concerned that there are plans to move bioshield money from flu vaccine for f vaccine production with the in that mix it's awfully important that we make sure we're not stealing from peter to pay paul that we we have enough money to ensure that we are protecting the public and  and if you agree that there are conflicts that could lead to funding difficulties and i don't think there's any question that the investment made over the past five years this congress and the previous administration and preparation and planning and beginning to work on the new vaccines that potentially are needed for a variety of deadly diseases have been critically important and i know this committee and chairman i'll be and others have been a real leadership role on pushing that ahead i think that as a governor i was able to see some of the results of that because we were able to do planning and put a pandemic plan together do cross state  preparation bring private industry and do a whole series of initiatives to really get ready for an outbreak which would not have been possible with state only funds so i've seen it both at the  federal level but also experienced what those investments have done i know that currently we are in the process of evaluating steps forward with h one n one at the same time recognizing that  we need to keep the planning stages in place with bioshield for whatever eventuality my might hit next so i think that the budget reflects and the current actions ministration to ask for supplemental funding to deal specifically with h one n one reflect a notion that safety and security is first we know what's facing us right now with a whole series of uncertainties with h one n one we know we have a new virus we know we have a need to take a look at the potential vaccine program but we also know that there are a series of other outbreak potentials and terrorists that still are low and we need  have within the stimulus package increased funding significantly billion dollars adjustment in that baseline as we go forward i know that your department is making a request it's a pretty modest i have i am aware that there is a significant investment in the recovery act which i think is very appropriate and and will pay enormous dividends and i can assure you that we are going to begin to work and look forward to working with this committee and the committees in the senate side about the future about a multi year planning strategy because i think everyone is aware that there  significant investment is basically out there but the worst of all worlds is to i think a number of new initiatives and then actually take a huge step back so i do look forward to your subcommittee for their constituents that drove us to seek an appointment to the committee in the first place from cancer to mental health to meditation and other forms of health related practices that can improve the nation  there is a constant battle on this committee for the years that i've been on to try and find an appropriate the necessary resources to address each of our individual and collective concerns one of my central projects  disparities the language charge top scientists doctors around the country at the institute of medicine to come up with an approach a scientific approach that would justify spending on this committee for addressing some of the profound gaps that exist in treatment scientists named the report the treatment for as long as i've been on the committee since the report was released this committee has basically attempted to follow the roadmap laid out as office of minority health and the national center for minority health and health disparities we further focus on reducing health disparities by supporting many of these programs that contribute to diversity in the health care workforce if you could understand that the budget lays out continues to be pretty grim in terms of the appropriate treatment by ethnicity is very disparate and around the country and i think that's one effort that can actually enhance the transparency about what is going on i don't think there's any question that the debate that's currently underway about health reform will have an impact on health disparities because unfortunately what we know is that by income and by minority group the likelihood of an insurance i mean lacking insurance and under insurance is a predominant case and i think having an opportunity health ongoing treatment protocol for every american is is a step in the right direction certainly some of the steps to address also workforce issues again not one that we necessarily automatically think is part of health disparities but there is  workforce money that looks particularly for minority students and combines that with under served area because i think cultural competency an issue with health care delivery and whether or not folks feel comfortable about seeking out health information and follow it is often due to whether or not they feel a relationship with the health provider so i  think in addition to the funding that you've just for specific programs i think there are another range of investments workforce issues on health reform that will also help close the gap of disparities that we continue to  don't know if that's the lack of knowledge about where people can sound but the question is how now as we look at the potential of compulsory insurance what happens how do we make it work in louisiana we still have one hundred thousand children who are eligible for this you or let you know that are not signed up so how do we encourage how do we engage people  assist in spreading those throughout the country because there are states that have done pretty creative work and had great success at enrollment and there are others who have not and i think that is one of the ways that our department and that's a key building block for health reform is actually getting folks to enroll engage in programs that they are currently eligible for and providing that coverage which  where some states still rather than relying on fairly easy technology are relying on face to face visits which often are complicated for families that are working and juggling opportunities so there are i think a bunch of strategies that we can engage in the departments of medicare and medicaid to make it easier and more seamless for families to actually and role their children in programs that they qualify for but i think that as we move forward having discussion and debate about everything from auto enrollment which is i know one of the strategies that some members of congress are taking a look at to presumptive enrollment to how you how you make it easier for people who are eager to find affordable health coverage to actually sign up and become engaged is one of the i think discussions that's underway with the committees that are looking at this because it's now the last thing we want is to make you know fordable health care have another huge barrier and that some enroll meant that becomes terribly complicated and sets up its  own restriction along the way but we know what has worked in many areas we know what has worked for employer care and for other care and i think we can take those lessons learned and help spread that bill closing the disparity and you would you know the problem with knowledge but i'm wondering in the overall health care debate now that's taken place we don't hear much in the debate about this being a critical element of the health care reform package whatever package we come out so i wanted to raise that with you because i raise this with the white house several times and just know that you know in this debate this has got to be front and center for many of us because our communities of course of the ones who are you know the unfortunate you know in a busy areas of the terrible benefits years of these disparities secondly with regard to single payer i know the realities of single payer as it relates to what ultimately will be the the type of health care package that we come up with but i hope that single payer is on the table for discussion i don't think we need a health care reform debate without looking at all of the options that exist and so single payer is an option that needs to be considered on the table as part of our efforts third y i just want to commend you for and the president for your proposing to end the ineffective and discredited abstinence only education programs for many years now senator lautenberg and myself have worked on ntil this morning she couldn't be back in time but she wanted you to know that she'd be submitting questions for the record and to extend her welcome to you madam secretary thank you so much  i definitely think as you know the health reform debate and discussion is firmly here at the capitol under way in both the house and the senate three committees in the house and two committees in the senate and lots of you have been intimately involved whether it's single payer health disparities that information that you have the expertise about and the data that you know so well needs to be some principles that he believed in with health care moving forward and he did feel very strongly that we needed to start with a promise that we build on the current system and not dismantle the employer based health coverage but i know there are a number of strong advocates for the single pair system particularly here in the house and i assume that will be part of the options that you look at as you move along thank you i have a little more time let me just ask you to make a point with regard to that yes we are going to make sure that here in the house that is laid on the table and that's included as part of the debate single payer and health care disparities but i would hope that we hear from the administration the i bent over a proposed rule but it's taken a long time do you have an idea of when we're going to be able to finally lift the ban as it relates to hiv positive people coming into the united states my understanding is that's very much on the radar sure is the president's position on health care now that it would be mandatory that everybody participate that's somewhat of a shift from the campaign so as he made that decision yet and he has not congressman  as you know in that in the campaign he supported a mandate with regard to parents with children he did not support a individual mandate i think what he has said pretty consistently though is that he is open to  engaging in that conversation with congress he knows that a number of members of congress are very committed to an individual mandate as have been some of the stakeholders at the table so i think at this point he is not made and so that's that's going to be discussion we have second question because the single payer government plan option is a big impediment for a lot of us and i actually think it makes a bipartisan compromise much more difficult have you thought about anything modeled after something like medicare part d which actually has worked pretty well it came in a lot less than estimated in terms of the cost it has a high satisfaction rate the premiums are comparatively low lower than we estimated cvo estimated at the time it's an all private system but obviously you have a government framework to operate and you know while it was a matter of a great deal of contention when we dealt with it to me that almost nobody wanted to go back and undo it it's actually work table i would suggest that it is not accurate to describe the public option as part of the healthy as a single payer plan i don't think that is a accurate description and what i think is in vision is a health exchange where private plans side by side compete with public plans as they do now in many states in the country in state employee health plans as they do in many  country with the children's insurance program because absent a public option in many parts of the country you would not have choice and you wouldn't have competition because one private insurer has a monopoly competitive goal and frankly i think that having a plan potentially that has you know miserable benefits and low provider rates is not likely to attract many americans to choose that plan if they have a choice of another plan so i think the notion of a public plan is to have a health exchange where you actually provide choice and competition to meet two great driving features and  give a number of americans who right now don't have a choice and there's nobody compete with some cost competition suggest a lot of this year mr two yards concerned that that's going to move toward a lot of private employers pulling out and effectively shifting i've got very on let me ask you one last question here you and the chairman in the dialogue and i think probably expressed concerns about long term care it's obviously a huge problem for the country in terms of how you fund it there's a lot of folks obviously that clearly started moving assets early if you thought about or are considering any kind of expansion of health care savings accounts again with the idea that over a lifetime you can build up a certain amount of capital and use that to defray long  term health care costs i'm not saying it's lucian for everybody but the more people you pull out of the system that way or did allow them to operate that way the last public cost you might have i have not been engaged in that particular discussion i was engaged for a number of years and i know it's been a proposal before congress for years looked at everything from tax credits to incentives for individuals to do more purchasing of long private long term care policies i think that the balance always was that a number of the private long term care policies did not include very robust consumer protections and in fact many of  them had cost escalators that had people paying in for a decade and then the policy became so expensive that they dropped it and ended up with nothing so but i think we need to look at variety of strategies because as you well know if you are you know meeting the income guidelines then you become eligible for long term care benefits at basically the state level and if you don't meet the income guidelines ministration the idea was to address the whole panoply of needs of the individual and they didn't use the term holistic in those days but that's really what they meant we haven't achieved that objective  that large part the congress has as much to fall does anyone because we as the chairman suggested identify particular needs fund them and as a result we have this vast array of different the various needs of the individual problem is it's the same individual and if we really wanted to achieve the most savings but even more importantly perhaps most effectively address the needs of that single person we would start combining and finding overlapping jurisdictions and find ways that we could better integrate the services that we're trying to offer  your budget alone even after we take out education that's got to be hundreds of programs and some individuals are eligible for half of one of the things that has been done around the the level of teenage pregnancy and thus abortions we found any number of case of cancer that adolescents never would have had a checkup and identified that in early stage mental health problems lored cabinet members to really come together on strategies leveraging assets and opportunities in departments we've had some rob childhood obesity on certainly the look at the new drug administration combines strategies the early my first few days and washington or cabinet wide approaches on h one n one and it was a great illustration of how various members of the cabinet and various departments needed to collaborate and cooperate not just in terms of that kind of an emergency but i think on a regular basis so i really look forward to not only figure out within our own agency how to break down some of those silos and put people at the table and cross cutting issues but then with colleagues and cabinet agencies because of all of us are approaching the same problem but from different lenses and taxpayer dollars will go a lot further the programs will be a lot more beneficial if we can actually approach them as as you say in a holistic approach thanks very much  the president requested over six hundred billion dollars was kind of a sort of seed money for the health reform proposal although half of that was dependent upon generating revenue by reducing the tax deductibility of charitable contributions it looks like the senate has rejected that so we're probably at about three hundred billion terms of revenue that would pay for health insurance overhaul and yet the cost over ten years is one point two trillion the i should have said the six hundred billion dollars over ten year period the cost is one point two trillion over ten year period most people so we are really short about ninety billion dollars a year nine hundred billion dollars over the decade there are other ideas that the administration may propose two ways and means and finance particularly those two means of financing this gap or even on the revenue side and i find that as members engage in the work of trying to identify where money is available they're likely to be back  table for starters we have been asked in our agency as have other agencies to identify additional opportunities and we're in the process of doing that right now within the department of health and human services i also think that there are opportunities for various savings that frankly haven't been scored and whether or not they will end up being scored remains to be seen but  in the prevention and wellness area at least in the out years that may have significant payoffs we know that we're now spending seventy five percent of our health costs on  chronic disease and some efforts to better manage better control better better outcomes with chronic disease management have significant payoffs down the road so we're currently underway working on that i think that there's a great belief that the investment in health technology and will pay huge dividends not just in helping to drive appropriate protocol but a lowering medical errors again not quite in the system yet so there is some work to be done in terms of identifying i think some of those at your savings that most people agree are very much there but just haven't been part i join my colleagues and welcome you madam secretary madam secretary many of us were shocked and saddened by the horrific murder of dr george tiller over the weekend and for years the bush administration went out of its way to protect doctors from being forced to provide services they found objectionable yet did nothing to shield physicians providing legal and life protecting medical care to women from ongoing harassment threats and violence this is unconscionable and must change in my judgment the federal government must send a message that acts of violence against health care providers will not be tolerated i was pleased to learn that attorney general holder has indicated that the u s marshal service will begin protecting certain abortion clinics and doctors and this is a good first step today the new york times also called on attorney general holder to revitalize the national task force on violence against health care providers that was originally established in the one nine hundred ninety s now i realize this task force would be under the jurisdiction of the department of justice not h h s i want to know number one would you support its revitalization and how does intend to work with the department of justice to ensure that these acts of violence are eliminated and do you agree that this type of violence could discourage medical schools from teaching doctors how to perform abortions interest in making sure that health services are delivered within the law and that providers surely are protected for their activities and the attorney general was  quick to reach out and make it very clear that acts of violence would not be tolerated that he would use the assets of the justice department to provide protection and i think to send a very strong message about action in the future that would be prosecuted i am not familiar with the with the task force that you've described but we'll look forward deliver health services to men and women across this country is essential i thank you and following up on a nother issue given your experience as the kansas state insurance commissioner you  threat to quality unfordable care opposed by the insurance industry when multiple insurance companies merger have record profits at the expense of health providers and consumers in fact from two thousand and one to two thousand for health plans in new york state made more than five billion dollars in profits while it's hospitals lost six hundred million dollars and i think it's interesting that the westchester county association which is run by many of the businesses in westchester county in many of the discussions and sessions with us so first of all do you agree that the relationship between private payers and the financial viability of the health care system needs to be examined and if you could share with us your experiences battling the insurance industry in kansas and how that impacted consumers i'd like to know is there a lessons from this experience that can be applied across the country and included in health care reform legislation well congresswoman i share your concern about oversight and my colleagues who are serving as insurance commissioners across the country have jurisdiction to review everything from loss ratios to appropriate rate setting and some are  aggressive and others frankly have very little choice because often there is a dominant carrier and a single provider so the opportunity to  have regulatory oversight is fairly limited we did have a situation in kansas when i was commissioner of a proposed takeover of the blue cross blue shield plan out of kansas by an out of state company and i ended up ruling against that takeover alternately because after reviewing all the testimony after having a series of hearings after having providers and hospitals come before us it became clear that the only way really to produce the profit statements to the shareholders which the company had promised was to either reduce benefits or reduce payments to providers all of which would not have been good for cancer consumers i do think there's an appropriate oversight role i think it's certainly one that in the proposal of the public plan i think is the president's  congress call that regulatory oversight or competition within a marketplace works very well and that's part of the real goal of the public plan option thank you need for the services of which millions of americans depend upon you have a big job and i know you'll do well and as you know as a congresswoman pointed out on saturday an assassination took place in your home state of kansas a position was murdered it was an act of terrorism and it was in his church this act of an anti abortion inspires fear and terror for not only health care providers but for women who need the services the murder doctor had previously been shot in the clinic in which work has been previously bombed abortion in this nation is a legal health care procedure and i support a woman's right to make her own health care choices the work  the courageous health care providers women's needs daily and they should do so without fearing loss of life what america witnessed on sunday with the taliban tactic to prevent abortion by murdering a doctor this is terrorism and i hope this is ministration as you pointed out will continue to extend protection to women's clinics all across this country and i know that  planned parenthood in minnesota there was an article in the paper has been targeted in the past they have received protection thank you so much and the women in the area that receives the service also thank you and th holder i support comprehensive sex education based on science comprehensive family planning and reproductive health care for all women in counseling to ensure women have the best information to make good choices about ages comprehensive information and reproductive health services thank you and you can count on my support to do everything to get that passed but i do have a question as we take on the challenges of health reform i firmly believe that every american has a right to health care and specially true for every single one of our children as a former health care system we need to remember that no population stands to gain more from coverage should not vary by location in this country the question is how does the federal government insure that its most important investment the investment in the health of its children the standard in terms of uniform to have a chance to work with on that critical issue as you know there are some mandated benefits for young children in the medicaid packages which all states must follow but beyond that you've correctly identified that eligibility rates vary from state to state particularly the chip program and  very in terms of at the very earliest prenatal care so the likelihood of having reducing low birth weight babies and bringing people into the system again very so i think it is a huge challenge so forth and i know that the president supports the notion that we desist i'm starts with a focus on children i think that's why he was so enthusiastic during the course of the campaign about a mandate applying to families with children felt that we need to start universal coverage with children so working with you on making sure that all children have access to the benefits you've described is something i thank you mr chairman welcome can i ask you in terms of health insurance reform the most basic tenet of health insurance reform is community rating that means that insurance companies can no longer cherry pick who they cover based upon who is healthy and who is sick and they make their money not by how there for excluding people and only covering the healthy people is the administration going to commit itself to community rating as an essential part of health care reform plan of the preexisting condition discussion you've accurately described i think the market as it often exists where either health condition eliminates entirely or at least put an end on affordable now know that insurance companies roughly thirty cents on the dollar for administration versus medicare and medicaid which is three cents on the dollar for the straight of oversight what is th going to do to go into and do a forensic audit of these insurance companies to ensure that they're not going to be able to pass along nor miss administrative costs they have betted in the current administration of their plans that they pass on to consumers i mean this is part i think of something that as you already ink that that is one of the essential elements of having some competition in the new marketplace so health insurance would combine private plan options with a public plan option and they would compete for benefits and for cost and i think that part of the competition is a way to get regulatory oversight over the overhead costs thirty cents on the dollar may be high but i don't think there's any dispute that it's somewhere in the fifteen twenty twenty five depending on if you're talking about a large employer plan or a smaller plan and the those are not only not medical dollars being spent but the estimate is that most americans who have private health insurance currently are paying another ten to fifteen cents on the dollar for the cost of those coming through emergency room doors without insurance you get close to fifty cents on the dollar that's not buying a drop of medicine or a doctor enforce regulatory oversight of the insurance companies whatever happens i think of what happened recently and i think if we're going to put out to bid billions and billions of dollars particular weapon system i can imagine the lobbying that's going to go on up here between health care providers when it comes to health care contracts so don't you think it's important that we have really strong  oversight at the department of justice to make sure that when it comes to the bidding wars for various health contracts that there's government oversight through the department of justice to make sure there regulatory framework make sense but i'm a believer that competition also goes a long way to help regulate cost and that if you have a competitive marketplace you don't need this heavy hand in regulatory issue of unplanned pregnancies and abortions excuse me and the president and i watched with great interest his speech at notre dame and i thought he articulated not only a framework for our public discourse over the next few decades but also way of approaching these controversial issues that we truly want to find some common ground and i know chairman o b and members of this committee have made a large commitment towards reducing on planned pregnancies and therefore reducing the need for abortions and supporting pregnant women and as you may know chairman o b has in the past directed significant funds towards the purpose towards this purpose and congressman de lauro and i have been working for a number of years to introduce legislation in the past several congresses that would help address this issue what is the department doing going to enormous challenge that we face and one that is something i've been working on in my home state of kansas for a number of years and one that i think brings together people providing services to reduce on an pregnancies we therefore it reduce by anybody's count the number of abortions that are performed in this country which is a i think it goal that all of us could support available health care is an important piece of that puzzle there are adoption incentives which which work along the way early childhood education support for women a range of programs for women and girls that really provide an environment where they have options and choices that are so essential to you know reducing situations that produce unintended pregnancies so i think that i was alarmed by the recent c d c study that says we have an increase now in teen pregnancies again having had a decrease for the last number of years that's not good news we know that forty percent of bursts right now are to single parents that's not the hallmark of good news so there is a lot of common ground and a lot of work to be done and i think that a lot of the assets to do that work are in the department of health and human services and i just look forward to working with you and congresswoman de lauro and others because i think this is an area where some real focus collaborative  about health care there's always an issue that we we never really talk about it it's the issue of stress and a lot of us are seeing it now in our congressional districts because of the economic situation that we're dealing with and the issue of stress leads to i think increase we know increased illness and you know these people who are losing their jobs losing their health care it has an effect and i just want to ask what that we had this conversation little bit with  then i h the brain research on being able to regulate yourself and regulate your emotions and reduce your level of stress is significant and so when i was here i asked him specifically about doing more and more research on mindfulness and congressman jackson brought up meditation and mindfulness based stress reduction i've been studying this for thirty years at the university of massachusetts in different places across the country and i to know if you're familiar with this if it is a part of your approach moving forward here you know the physiology of stress the neuro science behind it beginning to this is a very inexpensive way to teach kids how to increase their level of attention their attention span their level of focus how people who are dealing with chronic pain you mentioned earlier and how that you want that to be a significant savings how dealing with chronic pain can be treated with with this method as well so i just wanted to see if you're familiar with this and if there's any approach within the department to try to not only increase the research but increase the programming in the education  know has the potential of paying huge dividends i've seen it used as a violence prevention technique with kids in school you know teaching  various kinds of control methodology and you see violence levels rise with as you say folks becoming unemployed and the stress is related to that so i would just like to have the opportunity we will have a new leader in mental health areas and certainly it overlaps with health reform and that we're national minority aids council so that they can also express themselves for themselves the way the seed issue and i think that those issues will come with them and they'll be able to express that the minority aids issue i would welcome the chance to meet with the council and in preparation for these budget hearings change in procedure was brought to my attention and i must confess i don't know enough about it to tell you if i'm going to change it or not change it but it certainly is on my radar screen and i intend to go back and take a look at how it operated in the past and why the change was made and make inquiries i do think that competition needs to be not only on a level playing field but make sure that we get resources into the hands of folks most likely to reach out to the population needing to be served so i think that's a very appropriate question to ask even though it's not in the jurisdiction on this subcommittee to your latter point about disparities this twenty ten budget does have a significant request for an increase for indian health services and one that i would suggest is long overdue we have a great new leader who has been confirmed by the senate  a native american who is coming in to lead the indian health services and has worked in this area for a long time so i think there is a recognition that we haven't lived up to our commitment for  appropriate health services to that community for generations and that in the whole overview of health disparity that is a community very much off the radar screen  and one that i think not only did the president recognize in in the request in the budget for what amounts to almost a fifteen percent increase but it is one that i i will personally commit to paying a lot of attention to what closely with the tribes in kansas the first day i was on the job i went to the tribal leaders meeting and told them that i want to stay involved and committed and will continue of approaching the problem in many states including kansas we required everybody who drives to have car insurance the result is as we have a fundamental insurance package for automobile for car insurance we could do the same thing for a basic health care policy that include a certain number of visits to physicians to clinics to hospice hospital days we could have an annual physical which i think would be very good including counseling for a healthy lifestyle which would probably avoid a lot of cost  future we could have an annual dental visit on it which many people need as well and it would provide we could provide tax incentives for everybody to purchase a basic health care policy if they couldn't afford a voucher for example those pa poverty level where they could go out and shop for it it would have a provision that would i think address the need that mr kennedy brought up a very compassionate man knows that there are some people that get denied coverage in the example of auto insurance we have a high risk pool where each provider takes a turn drawing a name from a pool which would cover people who have preexisting conditions it's an alternative that would provide competition it would be lower cost and if you look at the right now health care is about twenty percent of our gross domestic product if we did privatized or take the privatized portion and move it into the public sector it cost at least one point five trillion dollars a year that's almost a fifty percent increase in what our current federal budget is i don't think we can afford that in today's economy so for us to provide insurance plan that would be competitive i would be a good alternative would you can developing a basic health care policy that could be considered as part of  debate congressman those policies really exist across the country and in most cases they're not attractive to either employers or employees and i think that going to  individual market which is really the description that you're giving is not what insurance is about it's about sharing risk so people right now  interested in getting in a pool where they are pooling their own health situations with others driving the market which has been suggested i would say strongly in the last eight years that was the administration's primary suggestion for solving the health crisis is essential having all americans move toward individual coverage and really dismantling the employer coverage that we have right now is not something that i support and i  the piece of legislation to you i think my colleague mr cantor would be interested in this it's called the informed consumer choices in health care act senator rockefeller is interested in the senate congress from shorts and myself has introduced here that would provide consumers with a coverage tax label similar to the nutrition label which would streamline put it would make it consistent as to what would be offered so people could understand what's being offered secondly it creates a federal office of health insurance oversight to deal with oversight and regulation obviously the states have a major portion of that but at the federal level it would be helping to monitor to that to that effort i would love to get your thoughts and taking a look at conceptually whether or not this is something that can fit in with the with the health care debate let me move quickly to food safety and i know you've had just a little bit of time to settle into the department and you do co ch the food safety working group i was wondering what you see is the really the most important goals and objective how do you believe we ought to measure success of final comment there is you know where i stand on the on the issue of food safety functions and taking them out of the f d a in an agency that has its own commissioner and its own agency is this an idea that you would be open to considering well i'm enthusiastic about the  work collaborative work between the department of agriculture and h h s on food safety and certainly appreciate your passion and leadership on this issue over the years i would suggest that we have a new commissioner of the it's got to be a public private partnership whether or not it's a standalone agency or in the food and drug administration i think is almost secondary to what the system needs to look at and i am eager to restore the f d a to its gold standard which it certainly is a long way from right now secretary historically our health insurance programs and systems have been driven by the individual states new york state law used to dominate this whole arena commissioners across the government's role being one of cooperatively working with the individual states trying to react and support their challenges and their solutions or do you see foresee a more centralized federal government system i met  my former colleagues the insurance commissioners who are here dealing with this very issue and i'm coming to lobby some of you i'm sure i am a strong supporter in  particular the consumer protection role that states play in the health insurance area and i was engaged in that myself and i saw firsthand the individuals covered by a risk up land who really had nobody to turn to if those benefits were denied or if the claim wasn't paid or if the company suddenly ceased operating insurance so i  am a strong believer that there is a important consumer protection role and also an important oversight role that states will continue to play in in the future markets are often regional or local and i think having somebody in that role who understands that and not a cookie cutter approach that is nationwide makes very good sense and i would say that nothing i've seen being discussed really runs counter to that at this point chairman madam secretary i've been a long standing supporter of community health centers because in my congressional district health centers provide access to affordable high quality cultural competent care to medically underserved individuals who might otherwise go without i know the president o well acquainted with the central role health centers play as health care as health care in illinois and nationwide indeed the president recently stated and i quote health centers primary care and prevention are at the heart of my plan for an affordable accessible health care system my first question do you agree that we must continue growth in this important program as we undertake comprehensive health reform secondly the epidemic of hiv aids continues to rage in the african american community according to even though blacks account for about thirteen percent of the population they account for about half forty nine percent of people who get hiv and i'm pleased to note that while c d c s budget continues to prioritize prevention testing and treatment of activities among african americans i am concerned that the program in title as you know during the course of the campaign the issue of taxing employer based health coverage was discussed in a fairly robust fashion and the president then and continues to oppose  taxing employer based health benefits feeling it would dismantle the current system that hundred eighty plus million rely on having said that he also proposed and i think continues to support  tax credits for particularly for small employers but for a variety of individuals and employers who are currently really struggling in the marketplace so i think and has said he's open to further discussions about the whole taxing issue i think there's no question that i'm looking toward the future there are a variety of ideas on the table in both the house and the senate but at least he feels at this point that providing  tax to all employer benefits would dismantle the market that so many rely on thank you thank you  urgency that he has placed in putting these funds board that we provided in the economic recovery package but i want to be if you have any specific outreach efforts for the african american latino asian pacific american and native american communities to be able to compete with these and how you're coordinating bad and also ensuring that minority serving institutions such as hispanics are in institutions that historically black colleges have the benefit of being able to  community and not for profit organizations that i think is not exclusively targeted to minority groups but certainly would be an applicable source of funding to build capacity  n the kind of neighborhood resource groups that are often so vital to deliver services and i think that back to congressman jackson's notion there are also an expansion as you know of community health centers and workforce and community house minority student loans being paid so we can increase the number of health providers so i think there are a series of strategies that are in that i'm braless that are really aimed to drill down services to appropriate populations twenty ten budget request does include an increase request for mental health services particularly for children grant proposal to serve eleven thousand more children and provide services to thirty five thousand additional para something that i now congressman kennedy and others have worked diligently so i think expanding those health services is an important feature of this budget   could you explain your work with your counterpart arnie duncan about early education and how we could better use the monies that are being appropriated for head start early education programs from his point of view in his department so that the dollars are really used where they're needed the most as opposed to across the board because frankly  need to target the dollars target them towards children whose come from families where there's domestic violence where there's a depression where the parent is in jail where there is addiction we know those are the dollars that are going to go to make the biggest difference as opposed to trying to blanket the whole country with dollars for every child we'd love to do that for every child but frankly in the metrics of things those aren't going to be as successful as if we really target the dollars to where they make the most sense if you can respond to that is one point and then the second point is in terms of the prominence of mental health in the administration and where it will figure into health care reform obviously there's been no point to the sampson director but could you comment on the notion of medical home as a central part of any  meaning coordination integration of services and mental health being a key part of any medical home that is being adopted under the president's plan for purposes of reimbursement and particularly the program which reimburses doctors in the white coat community through the codes for their work doing spree screening intervention and treatment for mental health services well i would identification that you've been able to make of what are the most cost effective strategies and the best practices but i can tell you that there's no question as we look at overall health costs focusing on mental health as a strategy is going to be extraordinarily effective depression is often an underlying related link to a number of chronic diseases that we just talked about as being one of the cost drivers and vice versa if you suffer from depression you often are more likely to have some of the conditions which create chronic disease so there's a partnership there that has to be addressed as we look at ways to reduce not only the seventy five percent of health dollars we're spending on chronic disease but also to produce healthier lifestyles in the long run the earlier focus the early identification of precursors to mental health issues is done in young children so having a strong link in the early childhood head start community with those warning signals of violence potential and high stress households and as you say substance abuse households and focus on those children as a early prevention strategy also pays huge dividends down the road so i'm we've had those discussions i can tell you with potential sansa directors looking for  somebody who really understands that this can't be an isolated strategy as standalone or a second or third chapter it's got to be at the forefront of our dealing with health reform thank you very much  that there was an increase they're very happy for the other tribes who have seen their health care facilities being listed in the upgrade their anxiously waiting their opportunity as well so i know we'll be working with  you with that and i was with some problems in mexico to in fact i'll get some information to you i personally was in a hospital that i thought should have been shut down i was very concerned about the patients who were there and the patients who there were concerned about the type of health care they were going to get juan pablo had great health care this one moderate and another one was awful i want to also look i'm going to be submitting a question for the record on on health care technology i'm concerned with some of the contracts and i know the chairman was trying to get copies of all the contracts that had been submitted by the administration for providing many health care services but i'm very concerned about the health contract that was submitted under  previous administration very supportive health care but i don't want the fox watching the hen house that might be happening but i would like to just very quickly point out to you that i'm very concerned about low cost high quality states like minnesota we're doing everything the medicare program could ask to have done we're delivering services in a cost effective manner yet we are being hammered we're going to we're losing physicians because of the reimbursement for formula so i applaud you for making high quality health care long term sustainability of medical and health care reform a priority but i urge you as we move forward to bring a comprehensive health care reform i urge you i can urge you to carefully craft provisions to avoid having a disproportionate impact on medicare beneficiaries like states in minnesota that are doing everything that's asked for them but at times being paid half half the amount for states with doctors and  company compared to what we're doing it probably won't come as a great surprise to you that i had just this conversation with senator clover char an hour or two ago before i came over here so i'm very well aware of that situation and the last thing i think we want to do is discourage high quality lower cost services from being delivered in fact we want to highlight them not only best practices but drive other systems toward delivering that same describing for the future but i can tell oftentimes there is a prohibition that currently exist companies cull aberrated in terms of sort of price varying degrees of oversight that currently take place in terms of rules submissions and loss ratios and so i think having as we as we move forward in and health insurance  health reform one of the issues can you deliver an insurance package to more americans at a more affordable rate and again i'm a believer that not only appropriate oversight is important but competition is very important and i've seen that work effectively in marketplace strategies over and over which again is why i think that having some public option side by side with the private plans is the way to keep keep it competitive marketplace and give consumers and employers the kind of choice they need