the decision between her physician and herself. personalize medicine is a new f . . u @@@@@@irection which medicine should be moving. in the early february fda announced the creation of a new position to focus on offering new personalized medical methods can about. one of those on one hand the government promotes this personalized medical research and on the other hand it's stymieing the progress through effectiveness policy. comparative effectiveness will directly affect doctors' ability

to make the best decision for his patience. the federal government is the largest customer in health care industry. industry. once it no longer pays certain medicines or treatment it becomes financially unsound for manufacturers to be about to recoup the cost for research and development of the estimate their development of products. similarly innovative research on gene therapy and other personalized madison options will be threatened. second i believe the removal of the conscience protection would threaten the nation's health care access. as americans we believe no one should be forced to act in a way that violates his or her moral or religious beliefs. there are excellent health care professionals and health care facilities that do not believe abortion is their right -- is a white negative coated is right and do not provide that procedure. now the head ministration wants to remove the right to refuse and provide service that violates moral principles and or religion. besides the civil rights aspect of the policy, there will be severe impact on access to

health care, catholic hospitals, clinics and medical professionals are the bedrock of the health care delivery system and most parts of the nation. in kansas its 40% of hospitals. as for 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 practicing many americans in kansas will be left without a place for medical treatment. i'm interested during the administration plans to insure a health care system doesn't come to a grinding halt if they stop reimbursing that of all centers for freedom of choice. finally, you're intimately familiar s former insurance commissioner of the state of kansas ibid like to hear about your rationale for moving people from private health insurance to the public system. not only would this exponentially increase the cost for the taxpayer but also further ration hlth care.

the administration expressed desire for public insurance, public insurance plan that would directly compete with private health insurance plans. employers will see this as a cost avoidance and moved there in peace and costs from their own pocket book and bank account to the tax payers. we have seen this already in schip. how will we pay for this as a nation? have you accounted for the enrollment beyond just today's uninsured? further, public insurance accounts for about 40% of the health care coverage while private insurance covers about 60% of it. we know that the reimbursement rates are much lower than the actual cost when it comes to the public portion. in kansas the experiencing from 25% to 70% below cost on reimbursement rates and it's not one entity alone. its hospitals, clinics, and physicians. they try to make ends meet by shifting cost from the private insurance payments to cover the

shortfalls and the public from the insurance. today in kansas one-third of the physicians will not take new medicare or medicaid patients because of this. if hhs can't find a way to meet senior health care cost, how will they be able to pay for the entire populace under government run health care? the only way this would be feasible is rationed health care system similar to what we find in other countries like canada, united kingdom, norway, any other place on the face of the earth with a similar program and this is unacceptable. more importantly i concerned it will be the downfall of the health care quality and indeed the world as i look forward to working with you to insure every american can pursue his or her dream including access to wellness programs in the world. thank you mr. chairman. >> mr. lewis?

>> mr. treen, thank you. i have no formal statement. i will wait for the secretary's statement and hope to have the chance to ask some questions. >> [inaudible] >> thank you, mr. chairman. it is good to be with the committee today and i appreciate the greetings from my fellow kansan and ranking member of the subcommittee representative tiahrt and it's good to have mr. lewis today. i appreciate the opportunity to come and discuss the president's 2010 budget for the department of health and human services and this does mark my first appearance before the committee is secretary and i want to thank members of the committee for your hard work and leadership. i know we face tremendous challenges in the nation today and i hope we can work together to tackle those challenges. one task we need to complete to get there is health reform.

and as you consider the budget before you you and your colleagues are working on a historic effort to reform health care system. like you i know america cannot simply afford the status quo when it comes to health care. we have all heard from people throughout the country who don't know what they will do if they or their children fall ill. to many families in america are one illness or accident away from financial ruin. businesses are suffering as well. yesterday's bankruptcy of general motors reminded us the cost of health care makes it more difficult for american businesses to compete and succeed with global competitors. today was a report released by the president's council of economic advisers and outlines how health care reform can help strengthen our economy and shows the high cost of doing more of the same. the report found if we continue on the path we are on today by

the year 204,072,000,000 americans will be on insured and health care costs will account for over 34% of gross domestic product. without reform, that change and action now, federal deficit would continue to rise and americans who receive insurance from employers will see a larger portion of their salary go to health benefits instead of take-home pay. this is a problem we can avoid if we act now. the economic advisor report found real reform slows the growth rate of health care costs by about 1.5%. it would cut federal deficit, boost the economy, save jobs and put more money in the pockets of american families. for a typical family of four, real income would be up about $2,600. by 2020, and $10,000 more in

2013. but only if we make health reform a reality. the message is clear. health reform can give a stronger economy and better health care system and boost families bottom line but if we do morgan of the same we will all pay a heavy price. we need reform that protects what works and health care and fixes what's broken. the budget we are considering today invests in key priority areas and puts us on the path to health reform. it builds on the investments already made in a 21st century health system that you all made in the american recovery reinvestment act. it sends a clear message we cannot afford to wait any longer if we want to get health care costs under control and improve our fiscal out a book. fraud costs the nation's billions of dollars every year and the budget proposes we further crackdown on individuals who cheat the system. the attorney general and i

recently announced an interagency effort to fight and prevent medicare fraud through improved data sharing, joint strike forces and key areas of the country and increased operations. this budget includes increased funding to help hhs achieve our part of the bargain. the budget also helps mufasa towards a central goal of health reform. improving as congressman tiahrt mentioned the quality-of-care. thanks to chairman l. b.'s leadership the recovery act has already included in critical resources to buy health care seceded infections. as well as new support for prevention and wellness programs that can keep americans out of the hospital in the first place. ..

. bob to support a wide range programs. the funding in hanses nursing schools, increases access to healthcare, works with minority and low-income students, and places an increased emphasis on ensuring that america's senior population gets the care and treatment that it needs. finally, the 2010 budget will

support our department as it were to protect the health and safety of our citizens. as the recent outbreak of the new h1n1 flu virus reminded us, h h s has a significant and critical role to play in preparing for an responding to the outbreak that threaten the health of the american people. -- the outbreaks that threaten the health of the american people. it allowed them to do their work when it first presented itself. and the americans when the resources they need in the outbreak they need. -- in the outbreak. we still do not know what is coming this fall and winter. or what will happen this summer in the southern hemisphere and the h1n1 virus mixes with seasonal flu virus. putting safety of the american people first, this administration's supplemental

request would have support thinks. these funds, in addition to the funds requested in the 2010 budget will allow hhs to continue to respond to the current outbreak and remain prepared to protect the american people. mr. chairman, president obama has committed to creating a safer, healthier, and more prosperous america, and this budget will help our department achieve those goals. it invests in reform, will improve the quality of care, and continues to provide essential services that so many families depend on. i look forward to discussing the budget with you and your committee today, and i am happy to take your questions. >> thank you very much. just a couple of things. first of all, with respect to health care reform, i do hope that as the process moves along, we will not give short shrift to long-term care. i think that has to be a key

part of whatever we do. i think that has to be a key part of whatever we do. secondly, without belaboring it, i do take issue with the administration's request for low-income heating assistance. i understand that the amount that is being requested by the administration is significant in historical terms, but it still represents a reduction below last year, and i would think that ought to be corrected. let me simply express one concern about your budget for nih. i have been on this committee since 1974, and we have steadfastly, regardless of which party controlled the white house or the congress, we have steadfastly insisted that allocations to research on

diseases be handled by scientists rather than politicians. and so, we have always resisted efforts to direct a specific amount of funding at a specific disease. as you know, and i understand this happen before you were appointed, but as you know, in the administration's initial request, they have crossed that line, and they have moved to request a specific amount of funding for cancer and autism, 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 autism. but i do think that is important that we recognize that once we start politically determining

funding levels for one disease versus another, then the door is open, and every group in society is going to be expecting to be in the front car on the train. nobody is going to want to be in the caboose, and the result will be political chaos in the areas that ought to be determined by science, so this committee will not follow the lead india administration on that, and i would urge that you talk to whoever made those decisions and suggested that there is a better way to skin a cat than that 13 and the only other thing i would say, and then i would invite your comments, if you want, i would again ask that the administration, as quickly as possible, send up your full request for a pandemic fle -- fr

pandemic flu. as you know, there was money we had that was ridiculed by some of our members in the senate. senate. we have now again put money in-- i mean we would put it in the stimulus initially. we have now put a significant amount of money in the supplemental, but it is apparent i think to all of us that even that amount is not enough, so whatever the amount is, the administration is going to request four, i would hope that they would do it promptly. i simply and by your comments before i pesci want to the next questioner. >> mr. chairman, i will certainly share your interests in avoiding the sees specific funding in the future with the administration. i do know that the president

personally feels very strongly about the opportunity to cure cancer in his lifetime and has talked about that for years based i think in large part on his personal experience, and i think that is a funding initiative that is reflected in these the budget priorities. having said that, they are also both in the recovery act and again in the 2010 budget a significant investment in research that the president also fully supports, living science, god, the research, so i think that is a balancing act and i will share your concerns with him. it is my understanding that the budget resolution, unlike the initial budget proposal, has retooled the liheap funding in a way that i think is more suitable in terms of where you feel it is appropriate to go. i think the goal initially was to provide a little truth in

funding, to put the trigger in a case the oil prices were not as high as they had been in previous years, but i understand your commitment to the program and assure you that we share that commitment. it is an essential program for really what are lifesaving services for seniors around the country, and finally in terms of long-term care, there certainly is already an investment an interest in rebalancing lot of our long-term care issues and finding more of a continuity of care system and funding that kind of, part of the workforce funding speak to the fact that i think for many americans, a care in their home, care with some assistance before they would reach a nursing home is much preferable and often provides a much higher quality of care, so there are some underpinnings of

that already in the budget but i think it is very appropriate in the discussion of health reform over all, that we address that issue because right now as you know, medicare does not fund long-term care unless you are impoverished, and that has become somewhat of an industry to try and see that families can save some assets as one or another member of the couple faces that situation. i think that has to be part of our discussion going forward and i look forward to working with you and others on that issue. >> thank you. i would simply say with respect to nih, i think every member of this committee shares the president's concern about cancer and autism but there are also legitimate and equally important concerns about parkinson's, the gerd disease and diabetes, you name it, and i think virtually all of us are more comfoable with the final decisions being

made on the basis of what peer-reviewed-- with pier refute process leads us to the best scientific judgments as opposed to doing the a political balancing act. mr. tiahrt. >> thank you mr. chairman. i want to go back to the first, compared effectiveness. we were for did million dollars the stimulus bill passed on to your agency and it is to determine the optimum procedure or pharmaceutical for a given some them. as we experienced with jenny when she came to our office, she lost access to the best solution for some time because of medicare. how would you apply comparative defected this? will you allow it to be used like it was ford jenny joe with a ration healthcare or will you use it as an advisory tool for physicians and clinics and hospital so they can make the best decision in how to apply the information they have?

>> congressman, let me start by saying aye, in my service as kansas insurance commissioner for eight years, i spend a lot of time and energy fighting the rationing of healthcare, which i saw each and every day frankly being conducted by private insurers, who were making treatment choices and overruling medical decisions of doctors in terms of drug application, medical procedures, so i share your gold that, in transforming the health system, we not to get to a system of ration care that medical provider should make medical decisions, not government bureaucrats, not insurance companies, not others. as you know the language around compared the effectiveness research predicts medicare from using that research for cost

base decisions or spending decisions, so it is established as a methodology to do exactly what you just described, identify not only best practices and effective outcomes but really hopefully tried that in some transparent way, inform consumers, and form providers and move us in a direction where we are using more cost-effective treatments but also higher quality treatments, which are in place in some parts of the country but to what the not in place. >> apparently got the memo about rationing healthcare because they did ration jimmy joe's healthcare. >> that may have been in a formulary-- i have no idea. >> that is a danger we face in america today and seems to play out not only medicare but medicaid. curly today 60% of healthcare's privately funded, 40% publicly funded and every position covers the shortfall of public funded

healthcare by cost shifting. they use the term cost shifting. a budget cost shifting. as you move towards public health insurance, how are you going to pay for it? how are you going to avoid not having the ability to cost shift as you shrink that portion of privately funded health insurance? that is the direction it is going to go and here is how it works. the employee listed employees, he pays five vendor dollars a month for each employee to have healthcare. that is $60,000 a year. if you give give the alternative to push them into medicaid like we did with schip he is going to say i had a 60,000-dollar break here so he says to each one of these templates, you know we are going to change the benefit package. you do have access to it through medicaid, and he saved $60,000 a year and it comes to the taxpayers to pick up that cost, so how are you going to pay for the public health insurance program that your department is moving ford and the administration is moving

forward? >> well, congressman i think that the president starts with a principle that he does not support dismantling the system that we have for employer-based health coverage, and recognizes that 180 plus million americans have coverage they like, have coverage that they want to keep, heavy dr-- >> it is not a point about keeping a doctor. excused me for interrupting. today, it is going to be in economic damage for the employer. the individual won't have a choice. it will begin play that makes the decisions based on pushing cost to taxpayers would be a cost advantage to him. >> i would suggest the biggest cost shift going on right now is the uninsured americans to come to the doors of that hospital in wichita and in topeka and kansas city every day and those costs are shifted directly on to private employers for desperately trying to keep their

employer coverage. the system of providing a payment for every american, of having preventive care, of driving while the scare reduces the kind of cost shift that we have right now which falls most often on small business owners and small coverage, so is the health plan is being debated and really constructed in congress, i think that having a fair payment system, having shared responsibility in making sure all americans have access to more affordable but more effective healthcare treatment at the front and prevents the kind of cost shifting that you love just described. >> healthcare reform this need to occur? i think we should have a good open debate about whether we use a different alternative rather than just a single-payer system that we are moving towards now, and i'm glad you are open to that debate. >> i am, and congressman i can assure you i don't support and the president does not support a single-payer system for kelly wants to build on the system we have recognizing 180 million

seth-- man's at coverage they like. were trying to do with how to give more effective and affordable coverage for everyone else. >> thank you very much mr. chairman and welcome madam secretary. what a delight to have you here today, knowing of your interest in healthcare and also your record as a governor. i want to say a particular thank you. we have had a chance to work together whether in regard to what was happening in rural america and your focus in that area but also in this job as in fact with their leadership and the president's leadership we be able to provide affordable healthcare for every american that has been a long time in coming, and we didn't succeed in 1993 and the problems of only gotten worse. we cannot fail this time around and i believe the president believes that, as to you. want to force associate myself with a comment on healthcare that the german pointed out. i'm a strong proponent of a

public plan as 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. i also would remark on the issue of this committee and on a bipartisan basis i think what we have tried to do is not taken juice the various diseases or illnesses that are focused on at the nih and our other research institutes, so that while i too have a personal interest in cancer, as a survivor, but if you will earmarking with autism and of cancer, i think we are best if we are not picking and choosing. i am going to go to another question hopefully in the second round and i will come back to healthcare but i wanted to briefly talk about early childhood and head start if i might, and the recovery program

to provide a funding to the forehead start, and is part of the safety net, but the dollars as you know don't increase the base funding for the program. the recovery act also provided resources for child care and development block grant, but again, it isn't a part of the really the 2010 budget, which only included a slight increase for the block grant program, and what i wanted to do was to check in with you about your plans for working to ensure that the increase recovery act funding is sustained in 2011 and beyond with regard to early childhood and healthcare, and helen factor plan to work with the secretary commerce secretary duncan, to look at the coordination of services for children who are under five. >> thank you congresswoman. as you have just said, the 2000

budget does include an increase in funding for head start and early headstart that would start with a platform that was put in place by the enormous investment of the recovery act money, and i think that is so essential. i have 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 can make in america, and their research on brain development is pretty clear that come up between birth and for years old particularly is an enormous growth period. we in fact, i had the first one when i was still governor of kansas, and he was already the secretary about the