the b.o.p. a comprehensive approach to the collection and false of data on how well b.o.p. programs are reducing incarcerates, deterring crime and improving public safety will help the department focus resources and make strategic investments. thank you for the committees continued support for our work and i would be happy to answer any questions the committee may have. >> thank you inspector general horowitz. mr. fliets i do notteny your task. and it has been long standing. and according to the bio, you began as a correctional office in march of 1988. can you just -- because we've all quoted statistics here, in 1980 the prison population in the federal system was 25,000 and now it is over 200,000. can you just give us your perspective in terms of what all has happened and what you witnessed over your career?

>> thank you, senator. from my perspective, having joined as a correctional officer in 1988 and around that time the bureau's population was a little more than 60,000. i think historically when you book at the bureau of prisons and go back from 1940 to 1980, the bureau's population pretty much remained flat for many, many years in excess of 20,000. so in 1980, which is the primary target for this discussion, we, as an agency, we had approximately 24,000 inmates in the federal system. we had less than 9,000 employees, 41 institutions and able to operate the entour bur ---en tour bureau of prisons for $330 million. so when you look at the increase from 1980 to 2013, we were at more than 800% as far as the growth of the population. and our staffing didn't keep

pace with that growth. and with our mission, where we are tasked with anyone and everyone who is convicted and turned over to the department of justice and placed in the care of the bureau of prisons, we have a job to do, a significant job. and it takes staff to do the work that is required. >> let me ask you, from your perspective, again, you've been there, what drove the dramatic increase in the prison population. >> well the war on drugs in the early '80s had a significant drive on the growth of the population. and as a result, we were having moro fenders come into the system. and we have a long-standing practice within the bureau of prisons and this goes back into the 1930s that the re-entry efforts are always in play and that is to ensure that for our role we're providing prehab ilttation. but the challenges as we try to protect the inmates and staff in

our facilities but the driver has been the war on drugs. >> has there been any legitimate increase due to a crackdown on violent crime that we just really -- again, appropriately crack down on that, or is that really -- like re didn't -- we didn't become a more criminal society. we are always arresting and convicting people and putting them in jail and are we putting them in jail longer. i want you to address that aspect as well. >> in regards to violent offenses, the department, through prosecutorial efforts, there is a mixture of individuals, as you are aware, nonviolent and those with violence. and within our population, i think it is safe to say we have very violent offenders in our population to include a significant amount of gang members in the federal system, we have more than 21,000

security threat group members that pose significant threat to the public and staff. >> and gang violence, that generally driven by drugs? >> it can be driven by drugs. if the gangs and those who are associated with that activity and part of the structure within the money to be gained. >> and let me stick with the director in terms of in spector general horowitz's testimony. why haven't we been proactive in terms of the early release programs that have been authorized. is there a risk aversion? because who wants to be responsible for releasing somebody into the public that will commit another violent crime. can you speak to why we haven't taken advantage of those programs a little bit more robustly? >> the bureau of prisons as director of the agencies my authority is very limited when you look at taking advantage of the various programs that are being referenced.

with compassionate release, which i will start there, we, as an agency, did a thorough review and we determined a couple of years ago when we were looking at the number of individuals who would meet the criteria just for the release based on terminal illness. we dofred there were -- discovered there were a little more than 200 in the bureau of prisons and once they are identified you have to go further that those that are considered that they have the resources if they are given an opportunity through a motion and released under that program. to 200 inmates agency-wide with the population at that time that was at 220,000 is a very, very small number. >> so again we're talking about compassionate release, and early release and release to foreign nationals and under all three programs you are saying the law is written too restrictively and doesn't give you the latitude to

utilize those programs more and mr. secretary, i'll be asking you the same question. >> and we moved from medical to nonmedical. and even when we look at those cases and many are being referred, when you are looking at the criteria, as well as being responsible for public safety for any individuals having the propensity to continue more criminal activity, we have to take that into account. with the transfer program, and i do share the concerns that the inspector general has raised, we identified through the audit a problem there and we have since that time provided a number of training opportunities for our staff and educating the inmate population on their rights under consideration for the program and we have seen an increase. however, when we submit the application for consideration there is another process that takes place with the department working with the various countries who have agreements

under the treaty transfer program to make determines on when those individuals are removed. >> and of course, they would probably rather have the u.s. bear the cost of keeping those people in prison themselves. inspector general horowitz, can you speak to from your perspective why the programs haven't been utilized more fully. >> i think there are a couple of reasons. and i agree with director samuels. in many it is not the b.o.b. decision making or elsewhere in the department or the way the programs have been instructions have been placed. for example, elderly release, 65 and eldery and that was announced with many fanfare, but there is only two. we find two released under the program a year plus later. and why is that? well, in part because of the over age 65 they have to meet

strict criteria and both with regard to meeting the criteria and as we found in that program and treaty transfer, the discretionary calls that have to be made. and perhaps it is risk aversion, perhaps it is a feeling that someone got a jail sentence that -- >> let me ask. appropriately strict criteria? >> we found -- we had concerned with elderly provisions. for example, requiring people to serve a long period of time and to demonstrate a lengthy period of service for a sentence. what that meant was for inmates that were the least dangerous, presumably had low sentences, they couldn't get released because they hadn't served a long period of time. that seemed odd to us. >> so that is something we should take a look at. >> right. >> thank you. i don't want to go too much over time. senator ayotte. >> thank you.

director samuels, i want to ask you about a particular prison in my state that is important, especially inco osk county, and it is fci bur land and i wanted to ask what the status is of staffing at that facility, warden tatum has indicated the facility was staffed at about 290 and there were about 1200 incarcerated individuals there. can you give me an update on levels and also what the ultimate goal is for capacity there and staffing? >> yes. thank you, senator. right now with the planned for continued activation of the facility we are working very, very closely with the warden staff to make sure our recruitment efforts remain on target and also ensuring that as we build the population that we're making sure that the inmate to staff ratio is where it needs to be so we don't have more inmates in a facility until we are comfortable with the number of staff at the facility. and this is continuing to

progress. i know there was a concern at one period in time where the applicant pool was not where we like it but with the recruitment efforts we have a very good pool for hiring individuals to work at the facility. >> so one follow-up i wanted on the applicant pool. this is an area of our state where people are always looking for more jobs. and so to get people from the area that have strong backgrounds, one of the issues that has been a challenge is the 37-year-old age restriction. and has the bureau of prison actually re-examined this. i know i have previously written on this issue. but it is important that my constituents have an opportunity that live in the area to work there. >> yes, thank you again, senator. our focus is to make sure we are aggressively hiring from the local community and looking at veterans and we do have the ability for individuals who are

applying who have served to make waiver to -- to grant waivers and we are in the process of doing that. >> well that is very good to know and i appreciate your prioritizing hiring people from the community. i know they are anxious and would like opportunities to work there as well as our veterans. so i really appreciate your doing that. and i think you'll find that they are a really dedicated group of people in the area. so thank you for that. i wanted to follow up on the prior panel, there was quite a bit of discussion and criticism, actually, on the re-entry program, peace, from the bureau of prison and the commitment toward where we are when someone has finished their time and putting forward successful programs an path to success, which i'm interested because with our recidivism rate it costs us a lot financially and also to the individual, to the

quality of life, that the person has an opportunity to set a new start if there is not a good system in place for suck ceaces. so i wanted to get your comments on what you heard in the prior panel on this issue. >> thank you, again, senator. i will say to everyone that re-entry is one of the most important parts of our mission. along with safety and security of our facilities. and the expectation bureau-wide is for all staff, all of the men and women who work to the bureau of prisons to have an active role in re-entry efforts. in any day in the bureau of principles for education, we have more than 52,000 inmates participating in education. we have more than 12,000 individuals actively participating in our federal principle industry program which is the largest recidivism program in the bureau of prisons. those who harp are 24% less

likely to be involved in coming back to prison. and for vocational training, more than 10,000 inmates are participating. and for those who participate and compared to those who are not, the recidivism reduction is 33%. and you all are very familiar with the residential drug abuse program and we have our nonresidential programs as well. and we are very, very adam about in ensuring the programs are provided to all inmates within our population to have them involved for a number of reasons. it is safer to manage prisons when inmates are actively involved and we are definitely trying to do our part to ensure that for recidivism reduction in this nation that we are taking the leap. for the number of individuals that come into the bureau of prisons, despite all of the challenges an the figures you are hearing, the men and women in the bureau of prisons do an

amazing job. when you look at the specific fubs relative to -- numbers relative to recidivism, with the feder federal, we have 80% who do not return. and we have 20% who end up in state and local and we have always known that the overall recidivism for the federal system is 40%. the 20% that return to the bureau and the 20% that go into the state systems. and i would just also add that when you look at the bureau of prisons, and there is a study that has been done that for the state correctional systems, and it is 30-plus. when you look at the over all average of recidivism it is 67%. so i would still say that we have a lot of work to do. i mean the goal is to have 100% individuals never returning but as i've already stated for the record the amount of growth that has occurred over that time period, we are very limited with

our staffing. but it does not repov us from the commitment to our mission. if our staffing had kept pace with the growth over the years, i do believe that i would be sitting here reporting that the 80% would have been much higher. >> so i want to give the inspector general an opportunity to think on how you think we're doing on re-entry and any work you've done on that. >> we're actually, senator, in a middle of a review of the re-entry programs and in the middle of the field work to go to the institutions and look at the education because of the concerns we heard. so i can't give you a report yet out on it. i think we'll have something later in the year for you to look at. but it is a significant concern. one of the issues, i'll just pick up on what director samuels said about staffing, that is a significant issue. it is a significant safety and security issue, re-entry, because what you see is first of

all by most accounts the federal staffing ratio of in mate to staff is worse than many of the state systems, what they have. and that has been exacerbated ore time as -- over time as the prison population has grown. there is a cascading effect of that. the director and the staff have to pull people out of other programs to do correctional work that they can't be doing some of the other programs we're all talking about. and so that i think has lost -- is lost sometimes and something we're looking at right now, is the cascading effect. if you understaff the prisons the director has to first and foremost make sure the systems are safe. >> and i hope when you give us this report, i hope you give us advice on the best models phoenix you're going to invest resources to create a better path so reduce the recidivism

rate and your recommendation on the piece of what is working best and invest resources would be helpful. thank you. >> and senator. and i was handed a note that 2,000 out of the population are participating in the program. can you quickly describe why, both of you. it sounds like a successful program, why aren't more people engaged in it? because i think in total we release 45,000 from the briefing, about 45,000 every year. >> yes. if the 10,000 is in reference to the vocational training programs, we only have a limited number of opportunities that we can provide based on the number of in mates in our system. and that goes back to the crowding with increased crowding, you have waiting lists in the federal prison system, no different than any other system and the goal is to try to push as many of the inmates through and as we complete classes we bring more individuals in for participation. >> what i expect is an answer. i want to get that on the

record. inspector general. >> yes. i think that is generally what we are finding, there are limited resources and with limited resources mean limited number of classes. >> okay. senator booker. >> thank you very much. director samuels, i appreciate you being here but more importantly or excuse me also i appreciate the fact that you visited me in my office and take a look of the issues and concerns, you represent the administration as a whole, as the president has, have done some extraordinary steps around over all criminal justice reform and i'm grateful you are here today. it means a lot. i also want to echo, you are a part of the law enforcement community. and your officers put themselves at risk every single day to protect this nation and i'm grateful for the sacrifices that your officers have made and i'm glad that you mentioned on the federal and state level, we have officers not just losing their lines but officers injured severely, often in the line of duty as well and we as americans

should recognize that and that sacrifice that can be made. and i want to focus on solitary confinement and begin with solitary confinement of juveniles. there is a bipartisan dialogue going on right now about putting real limitations on the use of solitary confinement. we know this is an issue that faces thousands and thousands of children across america but when it comes to the federal system this is a very small amount. it was probably surprise a lot of people to know that we are talking about kids that are in dozens. this is two populations. children tried as adults that are housed in adult facilities and then the contracts, if i'm correct, that you do with state facilities for juveniles as well. do you think it is feasible that, as is being discussed in congress right now and i've been in the discussions in the senate, that we just eliminate solitary confinement or severely

limit it for children, being very specific for instance, by placing a three hour time limit on juvenile solitary confinement and banning it really for punitive or administrative purposes. is that something you would see as feasible and something would you be supportive of? >> thank you, senator. and i believe that for this issue, and in the federal system, as you've already mentioned, we contract out this service. we do not have any juveniles in an adult correctional facility. and the expectation that we have with the service providers for us is that at any time they are considering placing a juvenile in restrictive housing they are required to notify us immediately. and even if that placement were to take place, there is a requirement also that they have to monitor those individuals every 15 minutes. so in regards to your question with looking at the restrictions that could be considered, i would say that for our purposes, regarding this, that it would be

something that is definitely something that should be considered and looked at as a practice. >> and if congress were to act on legislation putting those severe limitations on the practice, with limitations of just a matter of hours, that is something that you would agree to something that is feasible? >> yes. >> i really appreciate that. and that is actually encouraging to the discussions going on right now. and frankly, it is a small population but doing it on a federal level would send a signal to really resonate throughout our country and frankly is already being done in some jurisdictions. pivoting to adult solitary confinement, if i may, this practice, as you know, is harshly criticized. if you listened to the other panel, there is a lot of data from the medical community, specifically, and also civil rights community and human rights communities. in may 2013 report which i know you are familiar with from the

gao found that the federal bureau of prisons didn't know whether the use of solitary confinement had any impact on prison safety, and didn't know necessarily how it effected the individuals would endure the practice or how much frankly it is costing taxpayers in general. just this year, a recent internal audit notedin aud kwasys in mental health care and reentrance for people in solitary confinement. as was head in the previous panel, many people max out in solitary confinement and find themselves going right into the gem -- well not into the general, but back into the public. in many ways i think the reports are a wake-up call of the seriousness of the issue. i first want to say, do you know, right now, how many people are in solitary confinement beyond 12 months or say 24 months or 36 months, do you have that data? >> senator, i can provide that data for you. >> okay. so we do track those folks who

are staying in -- often for years in solitary? >> yes. and senator booker, i can -- first i would just like to state for the -- the bureau of prisons, we do not practice solitary confinement. if my oral and written testimony, our practice has always been to ensure when individuals are replaced in restrictive housing, we place them in a cell with another individual. to also include that our staff make periodic rounds to check on the individuals. and i also believe that it is important -- >> and i'm sorry, i need to be clear on that. your testimony to me right now is that the b.o.p. does not practice solitary confinement of individuals singularly in a confined area? >> you are correct. o only place an individual in a cell alone if we have good evidence to believe that the

individual could cause harm to another individual and/or we have our medical or health staff it is a benefit for the individual to be placed in a cell alone. we do not, under any circumstances, nor ever had a practice of placing individuals in a cell alone. >> that is astonishing to me. and i've -- i'd love to explore that further. because all of the evidence that i have said it is a practice at the federal level. so you are telling me there are not people that are being held for many, many months alone in solitary confinement, is that corre correct? >> when you look at the bureau of prisons agency-wide, that is not a practice which we have three forms. we have our shu, special housing unit, which is the majority placed in restrictive housing. we have -- >> so in the shu, so they are not individually held?

>> no, sir. and on average, agency-wide, the average amount of time that individuals are spending on average, again total, is a little more than 65 days. >> and show the shu is not solitary confinement, they are not an individual in a cell alone. >> that is not the practice of the bureau of prisons. never has been the practice. >> i hope there will be another round. >> senator. >> how many individuals have been convicted of a violent crime in the federal courts? >> convicted of a criminal -- >> of a violent crime. >> of a violent crime. give me a second. approximately 5%. >> okay. so we have 5% violent, 95%

nonviolent. i think the thing that people need to understand, which i'm not sure people do, is that 5% that committed violent crimes, you don't even have primary jurisdiction probably on most of those crimes in the federal system. i don't think people realize that the federal law enforcement system was not designed or ever intended to address what most people think of as crime in this country. it was originally intended to be just for those kinds of crimes that because of the interstate nature of them that they needed to be handled by the federal government. that would be crimes involving the -- drugs going from country to country, and then we started nibbling away at that and started doing bank robbers and then we started doing interstate kidnapping or interstate and i

know this because we handled a lot of murder cases when i was the prosecutor in kansas city, and we had the best homicide detectives in the midwest and the kansas police department we have experienced prosecutors and handled murders every day and when there was a high profile murder case and the fbi would sniff around and try to grab that case and find some kind of interstate part of the crime so that they could take the case as opposed to us, who handled murder cases all of the time, and frankly, in my opinion, biased as it may be, had much more expertise. i say this because you are spending $7.95% is being spe-- on nonviolent offenders. and that is astounding. and you guys don't get 911 calls. nobody calls the fbi with a 911

call. i used to make the point to my friends who were fbi agents, hey, they didn't call you, they called us. so the federal system gets to pick what they -- this is not required. they get to decide what they want to prosecute. unlike state prosecutors who have to make a decision on every single case. so are you ever called in to the policy discussions about the growth of federal law enforcement and this massive amount of prosecution that is going on and growth in the prison system because these decisions are being dictated by the department of justice and how many cases they are actually filing. are you ever consulted on any of those decisions? >> senator mccaskill, i would offer that the bureau of prisons, when the discussions are taking place, we are brought into the discussion when needed by the department. but i also would share, which

i'm sure you're aware, that for any policy decisions relative to who is being prosecuted, that remained with my colleagues in the department, who would be more than anyone else regarding this issue, capable of responding to that. >> so let's get at the stuff you can do. let's talk about the elderly offender program. the way you entered into some of the contracts, you didn't specify out what the costs of home detention was versus your detention, correct? in other words, what you did, you weren't able, in the pilot, isn't this correct, mr. horowitz, they weren't able to discern what a leigh lease and home detention was costing versus incarceration in one of the facilities. >> that is correct. the gao found that in their report. >> and so you are not in the

position to cost a -- to estimate a cost of what the cost would be. >> we're working to isolate those costs. >> and how are you doing that. >> we've put together procedures within the administration division. the staff responsible for the contracting over site to monitor -- >> okay. there were 784 of 855 applicants for the elderly release program that were denied. 784 out of 855 were denied. can you explain why they were denned, that massive amount, and these are all elderly. these are not young people. >> i can take your concern back, but from the knowledge that i have regarding this, many of those individuals, it was dealing with the issue of being eligible based on criteria that was put in place. >> who sets the criteria.

>> the criteria for the pilot? >> yeah. who set it. >> that was established by congress. >> so we're the ones that said if it is a low level offender that got an 18-month sentence they couldn't go to a home program unless they served 18 months? >> well the department was involved with the final determination on what the criteria would be but that was something done through conversation between department and members of congress. >> well i would love to know who was in on that conversation, if you would provide that to the committee. and would you like to see the criteria. because if you have 95% of your population is nonviolent, and you've got -- we know that the recidivism rate for people over the age of 55 is between 2% and 3%. and by the way that is a recidivism rate that any re-entry program or drug court program or any state court system would die for. that is an amazingly low

recidivism rate. i do not understand how we cannot even -- we're turning down 784 of 855 applicants for a reason. and it seems that we are stubbornly stuck in the status quo. stubbornly stuck in the status quo. and i'm excited that we have critical mass around here that somebody against a lot of political head winds started as an elected prosecutor and i convinced the people in my community and the police department that a drug court was a taxpayer factory because the people who went into drug court were on welfare or stealing and they weren't paying taxes and all of the nonviolent crimes they were committed is because they were drug addicted and the drug court movement, our begans in 1993 and it spread all over the country and the world

because it worked so well. you know what, i begged the federal government to participate in the drug court program. didn't want to hear a word about it. i couldn't even get them to send the mules, the girlfriend mules. i said let me take your cases. your low-level drug offender cases, wouldn't hear of it in the 90s. i'm not sure if we've move that much in the department of justice and i hope we can work together. i know my time is up. i have some questions. i would -- i have some questions about reefs county and the contract and why are we using as a county as a go-between on a prison contract and the criminal alien prisons that half are immigration offenses and i'm curious about the $1 billion price tag on that. so i'll get you those questions for the report. thank you mr. chairman. >> thank you, mrs. mccaskill. >> i think we're finding an area of agreement. the federal government getting

involved in something better left to the states and local governments because they are better at it and closer to it and the common sense approach and i frequently said washington, d.c. is the law of in intended consequences and we're seeing a lot of that here today. not because of good intentions or because people aren't working hard and sacrificing but i think that is true. i want to be respectful of the witness's times, but let's not abuse the time. >> i'm grateful. and i think we're having semantic problems, mr. director. so the d.o.j. defined solitary confinement as the terms isolation or solitary confinement meaning the state of being confined to one's cell or for approximately 22 hours per day or more, alone or with other prisoners. the health consequences for solitary confinement, period, are well alerted. and this is a common practice in the federal system. but it is not just with other

prisoners, in the shu, and often prisoners in the special management units, it is common as well and the average stay in that is 277 days and in the adx or the administrative maximum prisons an the average solitary confinement is 1376 days. so this is a real problem and it does exist and forgive me if my semantics are wrong and i think i have more precision now. >> nos., and i didn't want to clarify. at the adx, when i testified in 2012, at that time we had a little more than 400 inmates at florence, colorado, which makes up one-third of the population and for that population those individuals are placed in single cell and the majority of the population also, when you look at their offenses, 46% have been

involved in some homicide at some point in their lives. >> again, but the reality is, is that the actual result -- i don't care if it is a homicide, nonviolent drug crime, what are we getting for taxpayers for putting them in a environment in which human rights folks consider that torture. and we have a medical community that has a consensus about torture. and so -- or the harmful -- excuse me, the traumatizing effect of that. and so what i'm just saying is, and again, the crime and violent, nonviolent, i'm saying this is a nation that doesn't endorse torture or believes we should traumatize folks and if there is no data supporting us having something positive coming out of this, it has to be a practice that we've -- we should end. or severely limit.

and that is what i'm saying. i'm trying to do a data driven approach relying on experts and science. and just because i want to stay on the good side of the chairman, i'm going to shift off of this issue because i have enough questions to last another ten minutes and i don't think i'm going to get that. i will tread upon his -- his indulgences as long as possible. >> no you are not. >> so a real quick point. federal bureau of prison houses 14,500 women. as we talked about in the last panel, overwhelmingly, the women have children. children of -- of a minor age. the trauma visited upon children and those -- often the primary care-givers, there is a lot of issues and i want to get to one reality in danbury, connecticut, which is 70 miles away from the greater newark area, and which is an easy reach for visitors from the investigate. that will be changed and those women will be moved -- slated to

move to alabama to a facility there which is about 1,000 miles away from the greater newark area, a drive that takes more than 16 hours. so why was the 500 mile policy enacted, which is a good thing, which is something i endorse, due to the cost of travel, would you commit to revising the rule to have a presumption of 75 miles if possible. do you understand? is there a chance to revise that rule? >> senator, when we looked at the mission change for dan berry, we made every effort for fairness through those offenders that were not only living in the new england states or as far as the residence but we have many offenders from california, from texas. and we tried to make sure that with the realignment that we move those individuals who were not from that part of the

country, so they could be closer to their family. >> and so we're taking care of the californians but there are a lot of people from the investigate -- from the northeast, women having those relationships severed and i'm going to shift for now if i can. and i apologize. just quickly looking at the private prison issue real quick and shift to mr. horowitz if i can, i don't want you to think i was ignoring you in this hearing. are you concerned about the growth of private prisons that contract with the b.o.p. and what part are accountable to the public because we have real issues with the contacts with a total costing us about $5.1 billion for taxpayers, and these are for profit companies and 330 prisoners were held in private facilities and that

number has grown significantly to over 38,000 and i'm concerned about oversight. and then there is a lack of reporting information that is just -- i can get information easily from the prisons that are being run by the director. but there is -- this unbelievable really offensive to me lack of information and data about our private prisons and what is going on there. and so i want -- the last part of the question and then i'm done, just to wait for the answer, is the abuse reports of immigrant detainees. now i understand those folks are not american citis but they are human beings. and the report of abuse at our private prisons are troubling. thousands of men live in

200 foot kevlar tents that each house about 200 men. the facilities are described as filthy, insect infested, horrible smells, constantly overflowing toilets. this is an affront for this nation and what we stand for, for me it is an affront and i'm wondering what steps are you taking to hold these prisons accountability and to live the veil that protects the american public from knowing what is being done with billions of their taxpayer dollars. >> we are taking several steps, senator, we issued the report on the reeves county facility this year and focused on that particular private prison and the concerns we found just like you mentioned, taffing levels for example, as you know, reeves county had a riot several years ago and one of the issues was supposedly staffing levels. we looked and saw there were concerns about the staffing and billing and contracting purposes and we made a variety of

recommends for that and -- recommendations for that and we are looking at leavenworth and kansas and a broader review of the bop monitoring of the contract because that is an issue of concern as the spending has increased and the number of prisoners has gone from 2% to 20% of the over all federal prison population. that is an issue of concern. so we're doing those reviews. several of the contract places like reeves. >> like adams, the northeast correctional center in ohio, have all had riots in the last several years. those are contract prisons being used by the bop and it has raised the concerns that we're looking at closely. >> and why not better reporting? why can't i or the public get the same kind of transparency in reporting that we would get with the prisons that are directly under the purview of director

samuels? >> and that is something we're looking at as well. we're looking at what kind of reportering the bop is getting from the institutions and in addition what kind of information is flowing and accessible and why aren't we doing -- why isn't more being done to be transparent about that. >> thank you, senator booker. and you can have my personal assurances that i'll continue with you personally and continue with this committee to highlight the issue. i want to thank again both of you gentlemen for the service to this nation and your thoughtfulness. i want to thank all of the witness witness. i think we did accomplish the goal to lay out the reality and admit we have a problem here. i'm not sure we have readiy solutions but we've taken that first step. with that, the hearing will remain open for 15 days until may 14th at 5:00 p.m. for the submission of statements and questions for the record. this hearing is adjourned.

[ hearing adjourned ]

coming up today at 6:00, a look at austin, texas, this is part of the c-span cities tour which visits across the nation to learn from local historians, authors and civic leaders every other weekend on c stash's book tv and c-span american history

tv and with congress on the break we are featuring the cities tour every day on our companion network c-span. and today we'll show you president obama's remarks from the iran nuclear agreement. he spoke at american university, telling the audience that congressional rejection would leave future administrations with the only option of war. watch his remarks tonight at 8:00 p.m. eastern on c-span. this month c-span radio takes you to the movies. hear the supreme court oral argument in four cases that took part in fop lar movies from the woman in gold, from the people versus larry flynt, the watergate case from all of the american's men and the 2011 drama the loving story, about the landmark civil rights laws

prohibiting interracial marriage. here the four cases that played a part in popular movies. saturday in august on c-span radio. listen to c-span radio at 90.1 fm or online at c-span or download our c-span radio app. up next, a look at the medias a role in 2016 campaign coverage from this morning's washington journal. >> mr. warren, good morning. >> good to be with you on an interesting morning, what you just noted about rome rider, is just a perfect example of kind of media confusion about the debate or debates on thursday and just sort of underscores i think there is just no perfect criteria. so yes, lindsey graham is a smart guy but if he is sort of

not registering in polls, i mean, i feel a little bit of sympathy for fox, they are sort of damned if they do and damned if they don't and you certainly couldn't have 16 or 17 guys on a stage at one time. >> what do you think it will stay over all of the coverage of campaign 2016 starting with this fox -- this process and your thoughts and what you are seeing when it comes to coverage? >> oh, i think as opposed to what would have seemed 30, 40, 50 years ago when there were just sort of a handful of real gate -- media gatekeepers deciding basically what the story line was on a given day and you might hurriedly pick up "the new york times" or the washington post and that drove particularly a not of network coverage. i think this is by enlarge terrific. it is the internet age. there is more of everything.

there is more stuff. there is more total unadulterated junk. it was like yesterday it was tweeting on stories by the political reporters, there may have been three or four who didn't tweet the fox announcement of which ten were picked. it even prompted, if you look closely, scott simon, the npr host, to wonder in a tweet, whether he was the only person who had not tweeted about who the ten were. so i think there is a lot more good stuff. there is a lot more unadulterated junk. there is a nice little piece this morning short and sweet on vox by ezra klein but i think he called it the media's five stanley cups of depression over donald trump and i think he nails it as we go from pure astonishment now to a grudging acceptance there may be a slight people that people are raising their hands on his behalf.

>> the washington times highlights a chart that shows the number of minutes and appearances by donald trump and fox news. 31 appearances and five minutes of screen time. and if you media research center, there's a chart there that provides some of the coverage of gop candidates on abc, cbs and nbc. donald trump leading that pack as well. so there's fascination there with donald trump, jim warren. tell us a little bit about the time he's getting on air on these networks. >> oh, it's all over the place. the pointer institute about a week or so ago, if you remember, there was kind of a story that was dominating the media echo chamber particularly in d.c. and new york about the "huffington post" deciding to basically characterize trump coverage as entertainment. i wrote about that, and debated one of the others in the "times" on some shows, and thought, and think it's a little silly.

but then we went and checked about the amount of huffington coverage. and though they were sort of, i think, somewhat condescendingly deriding trump, they were giving him far more coverage, no matter what you call it, politics, entertainment, than any of the other candidates, especially when one looks at all the bloggers whose stuff on trump, that they were using. what it was was coverage of him disproportionate. yes, absolutely, totally disproportionate. is there some justification how he's been resonating in the early going? yeah, i think there's some justification. are there reasons for the likes of lindsey graham and other serious folks to be frustrated? yeah, there is. but it's also, you know, august of 2015. we've got a long way to go. it's a bit of a silly season. there will probably be a pretty decent audience on thursday night. but it's august. and sitting in the heartland, i

can tell you, most people aren't thinking about any of this. >> before we let you go, james warren, there's also joe biden in the news recently, a story just a headline saying biden 2016 is a media fantasy. why he's almost certainly going to sit the race out. do you agree with that headline? >> no, at this point, i don't know what he's going to do. i mean, he's obviously, you know, sitting back and knows that there's some large percentage of folks that maybe just sort of are sick and tired of the clintons. the e-mail controversy sort of reminds people why they are sick of the clintons. in their minds, hillary clinton hasn't really offered a rationale for her candidacy. the problem with him are all obvious. there's the caricature that's maybe unfair to him, but it's sort of hard to unravel about being goofy and gaffe-prone, and his best chance at it was 1988

arguably when he blew it by stealing those lines from a british politician. he thought about in 2008 and got zero traction. and he's 72 years old. so i think there's a possibility. but it is really unlikely. >> the national political columnist, "new york daily news," jam warren, thank you very much for your time this morning. >> my pleasure, as always. >> when the senate takes the august break, we'll feature book tv programming on c-span2 beginning at 8:00 eastern. at the end of the summer, look for two special programs. saturday september 5th, live from the nation's capital for the 15th annual national book festival, and live in-depth program with lynn cheney. book tv on c-span2, television for serious readers. next, health and human

services secretary sylvia burwell testifying before the house education and work force committee. representative john kline, the minnesota republican, chairs the committee. >> we will come to order. good morning, secretary burwell. >> good morning. >> thank you for joining us to review the policies of the department of health and human services. as is often the case when a cabinet secretary appears before the committee, we have a lot of ground to cover in a short period of time. that is especially true for a department this big. at the end of the current fiscal year, hhs is expected to spend approximately $1 trillion administering millions of programs, including child care, welfare, health care, early

childhood development. at a time when families are being squeezed by a weak economy and record debt, we have an urgent responsibility to make sure the federal government is operating efficiently and effectively. it is a responsibility we take seriously, which is why this hearing is important and why we intend to raise a number of key issues. for example, we are interested to learn about the department's progress in the child care and development block care program. last year the committee helped with the reforms to strengthen health and safety protections, empower parents and improve the quality 6 care. this program has helped countless moms and dads provide for the families and we hope the department is on track to implement these changes quickly and in line with congressional intent. another vital program for low-income families is head-start. earlier this year the committee outlined a number of key principles for strengthen the program, such as regulatory burdens, and encouraging better engagement with the parents. and feedback would help turn

these principles into a legislative proposal. it was in the midst of this effort that the department decided to restructure the program. some of the changes will help improve the program. however, the shear scope and cost of the rule-making raises concerns and has led to some uncertainty among providers who serve these vulnerable children. strengthening the laws is a better approach than transforming the program, and we urge the administration to join us in that effort. these two areas alone could fill up most of our time this morning. i haven't even mentioned services provided under the 1996 welfare reform law and the older americans act. of course, as you might expect, secretary burwell on the minds of most members of the challenges the country continues to face because of the health care law. families and workers and lawyers are learning more about the harmful consequences of this law. for example, patients have access to fewer doctors. controlled costs, estimated that insurance plans on the health

care expansion have 34%, fewer providers than 32% fewer primary care doctors and 42% fewer oncologists and cardiologists. the law is plagued by waste and abuse. in 2014, investigators with the nonpartisan government accountability office used fake identities to enroll 12 individuals on a health care exchange. just this month, they announced 11 of the 12 fake individuals are still enrolled and receiving taxpayer subsidies. more than 7 million individuals paid a penalty for purchasing health insurance. roughly 25% more than the administration expected and the worst case scenario. according to the associated press, at least 4.7 million individuals were notified their insurance plans were canceled because they did not abide by the rigid mandates established under the health care law. the nonpartisan congressional budget office estimates the law will result in 2.5 million fewer full-time jobs. this reflects what we've heard over and over again from

employers who have no choice but to cut hours or delay hiring because of the law's burdensome mandates. health care costs continue to skyrocket. according to "the new york times," health insurance companies are seeking rate increases of, quote, 20% to 40% or more. suggesting markets are still adjusting to the shock waves set off by the affordable care act. finally, after all the mandates, fraud, loss of coverage, fewer jobs, higher costs and nearly $2 trillion in new government spending, it's estimated more than 25 million individuals will still p lack basic health care coverage. yet, just last month, president obama said the law, quote, worked out better than some of us anticipated, close quote. of course, for those who oppose this government takeover of health care, this is precisely what we anticipated and precisely why the american people deserve a better approach. in closing, madam secretary, i want to thank you again for joining us this morning. it is our responsibility to hold you and the administration accountable when we believe the country is moving in the wrong

direction. however, there are areas i believe we can find common ground, and advance positive solutions on behalf of the american people. today's hearing is an important part of those efforts, and i look forward to our discussion. with that, i will yield to ranking member bobby jindal. >> thank you. thank you for being with us today and look forward to your testimony. today we'll hear about the fiscal year 2016 budget proposals, and the department's budget priorities. the budget was released months ago and i'm pleased to see the word priority is included in today's -- the title of today's hearing. budgeting requires making tough choices and a budget is in fact a reflection of priorities. as legislators, we decide what our priorities are and how best to invest in our country. it was reflective of many important priorities, such as protecting access to health care and insurance for all americans, giving all children a chance to

succeed, and reducing inequality around the country. in many areas, i believe we've made great progress on these priorities. the afford care act gave the opportunity to some who have health care coverage for the first time in their lives. it closed the doughnut hole for seniors and improved access to mental health services and preventive care. just weeks ago the supreme court decided in another case pertaining to the affordable care act in king v. burwell, the legality of subsidies for those obtaining health insurance through the federal marketplace, instead of a statewide marketplace was upheld. the affordsable care act was structured and designed to improve health care insurance coverage in excess across the entire country, and it has, now those living in virginia have enjoyed access to insurance subsidies just like someone in minnesota, and because of the outcome of the case, they will

continue to do so. i want to thank secretary burwell for her efforts and her department's hard work in implementing the aca. i recognize the challenge that your agency faces, and implementing the law with limited resources and unlimited attacks. but despite these challenges, the aca is working. i was also pleased to see that the president's budget request placed priority on giving all children a chance to succeed by showing robust funding through increase to child chair programs. the republican budget adopted by the house earlier this year is not reflective of these shared national priorities, despite research showing for every dollar spent on early education, there is a return of $7 in reduced costs in other parts of the budget. we must invest in quality early learning programs because all children deserve to enter kindergarten with the building blocks of success.

properly nurturing children in the first five years of life is instrumental in supporting enhanced brain development, cognitive functioning and physical health. but also too often low-income working families lack access to early childhood education, and these children tend to fall behind. in addition to this it achievement gap, children who don't participate in early learning programs are more likely to have weaker educational outcomes, lower earnings, increased involvement in the criminal justice system, and increased teen pregnancy. affordable high-quality child care is not just critical for children, it's also critical for working parents. because child care is a two-generational program. parents of young children need child care to go to work or go to school. a lack of stable child care is associated with job interruptions and job loss for working parents. child care ought to be a national priority for america's chirns and help grow our economy.

just two programs outside of the bulk of federal role in early education, the head-start program and child care development block grant. unfortunately because of limiting funding, too few children have access. this unmet need continues to grow. only four out of ten eligible children have access to head-start, and only one out of six federally eligible families receive child care subsidies. investing in programs like head-start and child care development block grant works. the time is to invest in these programs and ensure that we're giving all children the chance to succeed. lastly, it's past time for congress to raise the sequester level of the discretionary spending caps that we can make as a nation. these caps threaten nearly every program under the jurisdiction of this committee from low-income home energy assistance programs to older americans act and others.

the sequester has led to woefully inadequate investment in critical national needs and puts us on a path to another government shutdown. coming back to the idea of priorities, investing in our nation's future should be congress' number one priority, not corporate tax breaks or lowering the estate tax. our focus should remain on restoring investments that strengthen our nation's middle class and help hard-working american families get ahead. so thank you, mr. chairman, and thank you, secretary burwell, for being here today. >> pursuant to committee rules, all committee members are permitted to submit records. the record will remain open for 14 days for submission of the official hearing record. it is now my pleasure to introduce our distinguished witness, the honorable sylvia mathews burwell. prior to joining hhs in june of

2014, secretary burwell served as the director of office and management and budget where she oversaw president obama's second term p. deputy chief of staff to the president, chief of staff to the secretary of the treasury, and staff director of the national economic council. welcome, madam secretary. i will now ask the secretary to stand and raise your right hand. thank you. do you solemnly swear or affirm the testimony you're about to give will be the truth, the whole truth and nothing but the truth? let the record reflect the witness answered in the affirmative. before i recognize you to provide your testimony, let me briefly remind you, or more importantly my colleagues of our lighting system. we typically allow five minutes for each witness to present. although, i will be flexible on this timeline, given you are the only witness, and you are a cabinet secretary.

i would ask you, though, to try to limit your remarks, because we have a lot of members who want to get to questions. and i will be strictly enforcing the five-minute rule, and perhaps the four-minute rule, the secretary has a hard stop time at 12:00, we would honor that and i would ask my colleagues to be patient. we'll put the timer on, but you can effectively ignore it if you'd like. it will be green and turn yellow when you have a minute to go. and red when the remark time is over. that applies only to the secretary, to my colleagues when five minutes is up, five minutes is up. now you're recognized, madam secretary. >> thank you, mr. chairman. and ranking member scott. as well as members of the committee. thank you for this opportunity to discuss the president's budget for the department of health and human services. i believe firmly that we all share common interests, and therefore, we have a number of

opportunities to find common ground. we saw the power of common ground in the reauthorization of the child development and block grant and development block grant that happened last fall, as well as the partisan sgr repeal earlier this year. i appreciate all of your work to get that passed. the president's budget proposes to end sequestration fully, reversing it for domestic priorities in 2016, matched by equal dollar increases for the department of defense. without further congressional action, sequestration will return in full in 2016. bringing discretionary funding to its lowest level in a decade adjusted for inflation. we need a whole of government solution, and i hope that both parties can work together to achieve a balanced and common-sense approach. the budget before you makes critical investments in health care, science, innovation, public health, and human services. it maintains our responsibility stewardship of the taxpayers'

dollar. it strengthens our work together with congress to prepare our nation for chief challenges at home as well as abroad. for hhs, the budget proposes $83.8 billion in discretionary budget authority, this $4.8 billion increase will allow our department to lay a stronger foundation for the nation for tomorrow. it is a fiscally responsible budget which in tandem with accompanying legislative proposals could save taxpayers a net estimated $250 billion. the budget is projected to continue slowing the growth in medicare, by securing $423 million in savings, as we build a better, smarter, healthier delivery system. in terms of providing all americans with access to affordable quality health care, the budget builds on our historic progress in reducing the number of uninsured and improving coverage for families who already have insurance. the budget supports our efforts to move towards a health

delivery system that delivers better care, spends dollars in a smarter way, and puts the patient at the center of the care to keep them healthy. the budget also improves access for native americans. to support communities throughout the country, the budget makes critical investments in health centers, and our nation's health care work force. particularly in rural and other high-need areas. to advance our shared vision for leading the world in science and innovation, the budget increases nih funding by $1 billion, to advance biomedical and behavioral research, among other priorities. it also invests in precision medicine. a new department effort focused on developing treatments, diagnostics and prevention strategies tailor to the individual interests. in providing americans with the building blocks of healthy and productive lives, this budget outlines an ambitious plan to

make affordable quality child care available to working and middle-class families. specifically, the budget builds on important legislation passed by this congress last fall, to create a continuum of early learning, opportunities from birth through age 5. this change would provide high-quality preschool for every child, guaranteed quality child care for working families, grow the supply of early learning opportunities for young children, and expand investments in voluntary evidence-based home visiting programs. to keep americans safe and healthy, the budget strengthens health and public infrastructure with $975 million for domestic and international preparedness. it also invests in behavior health services including more than $99 million in new funding to combat prescription opioid and heroin abuse. finally, as we look to leave the department stronger, the budget invests in our shared priorities of addressing waste, fraud and

abuse. initiatives that are projected to yield $22 billion in gross savings. the budget addresses the department's medicare backlog with a coordinated approach. the budget also makes a significant investment in the security of the department's information technology, and cybersecurity. i want to conclude by taking a moment to say how proud i am of the hhs team, and the employees that work on ebola. their work every day and their commitment every day. i am personally committed to a responsive and open dialogue with members of this committee, as well as with your colleagues. i look forward to working closely with you, and i welcome your questions. thank you. >> thank you, madam secretary. the light didn't even turn red. i'm unprepared now. i'm at a loss. seriously, i want to thank you, madam secretary, for your ongoing efforts to keep us informed about the department's progress in implementing the child care and development block

grant act of 2014, as well as the opportunity for the staff to communicate directly with your staff. can you update us briefly on the timeline for the release of guidance in the proposed rules in accordance with the act? >> with regard to, i think our staff has had an opportunity to go back and forth. i think that's helpful as we're producing the guidelines. i'm hopeful, i think that -- i'm not sure which particular piece you're referring to, so i want to make sure. we can follow up on that. but overall we're making progress and ho to get them out. one piece i would like to recognize with the implementation of the authorities you gave us, there is an important piece of the budget that is related to the implementation. one of the things that we were told with regard to the authorities improves the quality, improves the safety, and improves our ability to serve the communities that sometimes aren't being served, such as parents working different hours. there's funding in the budget that we're talking about today on the discretionary side, that i think is important to do that. i do want to raise that as a

part of this conversation. that there is some funding to do that. >> okay. i'm not sure that's exactly what i was getting at, but that's good. >> i'll get back on the specifics of the time line. >> just trying to get a better feel for the time line. >> exactly. >> i very much appreciate the exchange between staffs. it's very, very helpful. i wanted to take the remainder of my time, no doubt, and i'll try to be brief, but there is an issue having to do with the affordable care act that's just sitting out there, that really, really needs to be addressed. and that's the maximum amount of pocket limits for cost sharing that i'm sure you've heard about. i've heard from several employers recently about this unilateral change, the cost sharing, maximum out-of-pocket limits under papaca. we can't seem to determine where this is coming from. the statute is pretty clear,

there are two separate and distinct types of coverage. self-only, and other than self-only coverage, each with respective out-of-pocket limits. before this new rule, any combination of family members' out-of-pocket costs count towards the maximum of these out-of-pocket family coverage limits. now, the department has started in 2016 the individual out-of-pocket limit applies first before the family limit applies. that means the cost of the employer coverage will increase because insurance will pay 100% of the out-of-pocket costs sooner. i understand that you're aware, i've been led to believe you're aware of these concerns. i'm sure employers have raised this issue directly with you and your staff, probably many times. they certainly have with us. we'd like to understand under what statutory authority you did that? and then, i'd like to enter into the record letters from the arisa industry committee, the

american benefits council, conveying their grave concern for the department's new embedded maximum out-of-pocket limit rule. the letters also convey compliance will not be possible by 2016, given that employers' plans are already set for next year. it wasn't until may when additional guidance was issued that most large employers knew this change applied to them. it's real confusion out there, madam secretary. and again, i'm fairly confident that you're hearing some of this directly, but i want to make sure you heard from me. can you commit to at least tla the impact of this really significant rule change for at least a year? and if not, why not? >> with regard to the question of delay, we are now hearing and receiving feedback, and i want to incorporate that and determine what we should do to move forward. i think it's important to note why the change was put in place. and the change was actually put in place about the consumer. and the fact that when one

consumer in a family hits that individual limit, and the question of should they hit that family limit, and whether you should aggregate, or the individual. i think actually when consumers purchase, and how the consumer thinks about this issue, i hear and understand, and we are hearing from the companies in terms of how they think about the question of the maximum out-of-pocket limit, but if you are an individual, and a family, do you think that limit is your individual limit? and then there's a broader family limit for all. once you've hit your individual limit, what would happen is you would keep going. and so you would not have those things paid for. and you signed up in a place where you thought your individual limit was your individual limit, and your family limit was for all members of the family. and so that's how the consumer has tended to think about it. at least from what we've heard from the consumer side of it. that's why we have gone forward. we are hearing comments and want to incorporate those comments and understand if it is implementable. >> i'm not making light of it, but we think the statute is

pretty clear. so -- because there is so much confusion out there, and there is the uncertainty and arguably the inability to comply, we are hopeful that you will commit sooner rather than later to a delay of this rule change. i'm going to try to -- it's already too late. the light has turned red for me. but mr. scott, you're recognized. >> secretary burwell, thank you for being with us today. i wanted to ask you a few questions about the affordable care act. but first, i want to thank you for your department's outreach efforts, particularly joann grosse, the regional director in my area. she's just been outstanding in the outreach into the community, making sure that people know about it, and during the signup period was all over my district. so i'm sure she was all over the region. can you say a word about what the affordable care act does for people with insurance in terms of preexisting conditions, and

job block? >> two different things that i think it does. with regard to preexisting conditions, it creates a situation where anyone with a preexisting condition is able to get insurance. and so whether it's the people that i've met as i've traveled across the country that are concerned for their children, as their children get older, if it's a child that has asthma or other conditions, or someone who has gotten cancer and they're now well, to know they won't be locked out, so preexisting conditions are no longer something that creates both health and financial worry for people in the system. with regard to the question of lockout, and job lock, there wouldn't be people who make changes for fear of losing coverage. that is a part of the numbers that the chairman stated in terms of the changes that occur. because with regard to the employer-based market, we have not in the two years that the affordable care act has been up, seen that shift from employer-based coverage in terms of the reduction in percentage of employees. we haven't seen that shift. some of the estimates are about

people, though, who will choose to make a decision to go do something entrepreneurial, if they want to start a business, or make other changes in their lives. and so the lot that was created because they were fearful of losing coverage doesn't exist because they have an option, and that option is through the marketplace. >> what has happened to the growth and health care costs due to the passage of the aca? >> thinking about it in terms of, we've had some of the lowest price growth per capita that we have seen in 50 years, in terms of slowing of that growth. i think when discussing the question of growth and cost growth, while it's a hard thing to recognize, one needs to look at historical growth and then what growth is. in the medicare trustee's report, which is let's reflect on the public costs of this growth, what we saw is growth of 1.2% over the period of the last four years. what we saw in that period before then was 3.6%.

what we've seen is a flowing in a lot of different places, both the public and the private of that growth. >> the programs under your jurisdiction, can you say a word about the effect of the sequestration if we don't do something about this sequestration? >> as we look at this issue of being funded at the lowest level in a decade, when one accounts for inflation, it is across the entire department. and whether that's an issue of head-start or child care, that will focus on in this committee, it also is in places like the nih in our research, or the cdc who has been so active this year in so many ways, whether that's ebola, or measles, and also in places like the fda, who are doing things like making sure our food is safe, and that we are watching and taking care, and that our drugs and diagnostics are safe. it's across the entire department. another place that this particular committee is interested in, i know, is the

older americans. and the programs that we have there to support those older americans around food, and transportation, as well as elder justice. >> thank you. head-start is not in the department of education, it's in the department of health and human services. can you explain why it's important -- why the services of low-income children get by remaining in health and human services, not just be an educational program and why head's start is so important? >> we have it as part of our continuum of hhs. thank you to all of you who supported the sustainable growth rate bill that had the extension of the home visiting. that starts with the care in the home, visiting the home and helping start children on the right track. and we believe that continuum as well as the changes in the authorizations in head-start that you all have done to push to improve quality. it is all part of a continuum. the continuum is related to the issues that we work on broadly

at hhs, and whether that's starting the mother on the right trajectory with her maternal health so the child is born with certain -- in a certain environment that has been taken care of for the nine months, and then continuing that early care, starting that learning early, and that brain development. the science that we know in having a 5 and 7-year-old of how quickly that nural development is occurring, sometimes it surprises me. it is what we believe is a continuum of both health and the building blocks of healthy, productive lives that we use at hhs. >> thank you, mr. chairman. >> thank the gentleman. dr. foxx? >> thank you, mr. chairman. and madam secretary, welcome to our hearing. madam secretary, i appreciate your bringing up the older americans act. we're looking at -- the committee's looking at ways to promote best practices to combat elder abuse. and i wonder if you could talk a little bit about how the department is working with other

agencies to protect vulnerable elders? >> working across the department, obviously the department of justice is a partner with some of the work we do, but most recently, whether it's with our departments and states as well as other stakeholders, the white house conference on aging, we took an approach this year where we actually went out to communities across the country, and this was one of the pillars and issues that we focused on. and used that as an opportunity to bring in the engagement and involvement of both ideas, as well as how we can implement better as a department in terms of the issue of elder abuse. we're seeking that input to improve what we're doing both within the u.s. government, but also with a number of the players that implement. and those are stakeholders on the ground in states. many of the programs are actually delivered and implemented at that level. >> and would you discuss a little bit those delivery models of the elder americans act and

what makes them work well? you're working with other agencies, i'm sure. it's the right thing to be doing. but are there ways to implement these similar delivery models across other programs, across the country? and how is the department providing leadership to do that? >> so, i think there are many things, but i'll focus in a short time on two things that i think are important in this space. one is actually the awareness of the issue. elder abuse is something that is not an issue that many focus on, and whether these providers, and the organizations in the community are a part of recognizing the issue. it is a little like our issue that is also the victims in trafficking. creating a greater awareness of it is an important thing to do. i think the other thing we think is an important thing to do is when these acts occur, that justice is served. and so that people know that

when they are taking advantage of the elderly, that's a place we need to continue to work with state and local officials on that as well as federal. . and i think one very specific example of that is the recent takedown that was done on medicare. you all probably know that our most recent takedown, which was a joint effort with us, doj, the fbi, hhs, oig and cms, it was over $700 million in false billing. many of those examples were around elder justice issues, where patients were being told they were being treated for dementia and were simply being moved from one location to another, being charged for that, and medicare was their charge. i think it is the combination of those kinds of things that we try and bring together. >> thank you very much for that. we know that you are -- congressman scott brought up head-start performance standards.

we know that head-start is the largest program we have at working with young children, but we're concerned about the impact of the new regulations that you're putting out there. we wanted you to not -- the reauthorization of 2007 required you to have regulatory revisions not result in the elimination of -- or reduction in quality and scope of services. but you are talking about a reduction of 126,000 children slots, elimination of 10,000 teachers' jobs. how can you ensure that the revisions that you're proposing are in compliance with the 2007 law? >> we have done three issuances of regulations with regard to implement the law. and this is the third of those. the first in terms of -- one of the things we did is make sure they're serving low-income communities. the other was making sure there

were reviews and people had to reapply. this is the third part. in this part, we're using evidence-based studies to improve the quality and safety, which we believe the authorization is what it told us to do. one of the things that the chairman mentioned that i think is important to mention is we got rid of one-third of the guidelines in terms of simplifying, and making it easier. with regard to some of the things you're referring to, i think you're referring to the extension of the day. and the year. and the evidence that we have seen all the scientific evidence shows that moving from 3 1/2 hours to 6 hours is an important effort to provide the quality that we need to provide. and the summers, having two children right now going through their summer, what they lose if they do not have that kind of continued education. we proposed the amount of money it would take in our budget. we're hopeful we can move forward on that. if grantees can't meet that, there's waiverability. >> the gentle lady's time has

expired. mr. hinojosa? >> thank you, chairman kline, and ranking member scott. i strongly support the health and human service budget request. and ask that we work together to forge a consensus to ensure that our families continue access to quality health care coverage and funding for head-start. we can invest in our preschool programs today, or in juvenile detention tomorrow. we have heard pope francis deliver a very strong message all over the world, urging leaders like us. the pope says we must make the right amount of investments to address poverty found in older senior persons, and children in low-income families. madam secretary, thank you for your testimony on the department's enormous progress

we've made since the enact of aca. it's a pleasure to have you testify before this committee. today in my congressional district, because of the affordable care act, there are over 100,000 individuals who now have health insurance, and 88,000 seniors who are now eligible for medicare preventive services, without paying any co-pays, co-insurance, or deductible. we know that another program, head-start, is a crucial developmental program in my congressional district, known as the lower rio grande valley. this program serves between 15,000 to 20,000 children and families. head-start has made a significant impact on improving the opportunities for eligible children, especially our nation's latino and african-american youth. thank you for your strong budget support for this program. my first question, what is at

stake for our nation if we ignore the ever-growing body of research, and we fail to sufficiently invest in quality early learning for our nation's minority children? >> i think this is why this area in our budget, and we discussed the head-start portion of it, but there's also the child care proposal, and part of the child care proposal on the discreti discretionary side comes to implementing the authorization. that's on the discretionary side. the broader proposal that we have, which is a larger mandatory proposal is about making sure there's access on this continuum. so that what we do is we take care of that child from the moment of the home visiting, and the pregnancy, through those early years of education, and that we do that both for those at the lowest level of income, and head-start is focused on that. but child care, and that's a part of what we're proposing is child care for working families, that there is supplement so they can afford that. up through that school age.

so what we're trying to do is create a continuum which we think is a part of the concepts of the authorization. this budget funds it fully. we think it's one of the most important priorities. as we reviewed the budget and put it together, it is a place where we made choices that we would prioritize and put a lot of our dollars, because we think it is so important to the long-term health of those children, and the well-being of our society. >> i agree with you and i recommend that you consider adding more emphasis on early reading and writing for children from cradle through the fourth year, so that they can love books and improve their vocabulary and be able to stay at grade level and do well. in my district, the majority of the uninsured population falls under the medicare -- excuse me, fall under the medicaid coverage gap. and does not qualify for assistance in health care marketplace. according to the kaiser family

foundation, up to 950,000 uninsured people would gain health care coverage if the state of texas decided to expand medicaid. what justifications, if any, have you heard, or received, and how has hhs responded to discussions that you've had with the governors like abbott in texas? >> with regard to the conversations with governors, i just spent the weekend at the national governors association. the year before i did that as well. the thing in terms of any concerns that governors have, what i want them to know is, we want to expand the program. we want to expand the program in a way that implements the statute, which is about expanding access, and doing it for low-income populations so it's affordable. but we want to do that in ways that work for states. i think in terms of answering concerns and questions, whether it's the negotiations that we did with governor pence, and i personally participated with a number of other governors, so we make sure we do this in a way

that serves the citizens of the states that may have different needs. so that's in terms of one of the issues that comes up. i want to work with governors and their states. >> thank you. i yield back. >> the gentleman yields back. i'm going to yield to dr. roe. but i want to give members a heads-up here. i'll be recognizing dr. roe for five minutes, and probably ms. davis, maybe mr. wahlberg, and after that grij val va. we'll go to four minutes, and i'm trying not to go to three or two. but i want to give everybody a chance to be involved in this conversation. dr. roe? >> thank you, mr. chairman. thank you, madam secretary, for being here. just some questions i want to bring up to begin with. then we'll get to the questions. these are things i want your shop to answer. one are the medicare wage index, or area wage indexes. if you look at those around the

country, it was never intended to be like that. but 20 of the highest are in california and massachusetts. and 14 of the lowest are in alabama and tennessee. for instance, what you get paid in santa cruz, california, is 1.7, with a medicare area wage index, and .73 where i live. it's putting us out of business. that needs to desperately be looked at. the second thing i want to bring up, and i want to know what your solution for that is, are the rack audits. the rack audits, we're all certainly against fraud and abuse. but in my state, medicare comes in, does the audit and we win 72% of them. we now, the backlog is so long, you can't get in front of anybody to get your money back that you've earned. that's unfair. i think you absolutely need to redo the rack audits. thirdly, this is a much deeper one. it may take some time. but medicare is on an

unsustainable course, as you well know, last year, in 2014, medicare spent $316 billion, and we took in $304 billion in premiums. that's unsustainable. since its inception, $3.6 trillion negative of premiums over what we've spent on the program. i'd like to know what your recommendations are to put this on a more sustainable course. i'd like to know what the issues are. and re yetably, i've got to ask some questions now that i don't like asking but i think are extremely important to ask. i also one last thing, qfr on ipad. do you think one person, you sitting in that seat, should have the power to determine how medicare dollars are spent, if it goes over this formula? i'd like to know that. there's nobody on that 15-panel

board right now. recently, we've seen two videos that showed planned parenthood physicians basically having wine and eating a salad, bargaining over the harvesting sale of dismembered baby parts. i find this incredibly offensive to me as a physician and obstetrician. have you seen those videos? >> i have not seen the videos. i've read the articles about them. >> last week in the "wall street journal," it reported that you couldn't comment because you hadn't seen it. but you need to see those, secretary burwell, as quickly as you can. and it's only eight or ten minutes. you need to look at those videos and see what the rest of us have looked at. given planned parenthood, which i think is a horrific conduct, americans may be troubled to realize that planned parenthood gets over $500 million a year through -- much of it through your shop, through medicaid and title 10 funding. having said that, with a significant financial relationship, could you tell us

what you've done to investigate these activities? >> so, first, just because it's so related to the budget issues we're discussing today, the rack issues and backlogs, we've put together a strategy, because it's such an important issue in the appeals, i just want to make sure there's a budget issue in terms of extending the number of people that we can have to review the appeals. because there are legal judges that we have to bring in. second, there are statutory changes. and on the senate side, the bill is moving to make changes that will help us. and third, administrative actions. the broader issue you've raised, with regard to the issue, i want to start by, this is an important issue that people have passion deeply on both sides of the issue. and whether that's the issues of research that are important for eyes, degenerative diseases, autism, and i'll start there. >> my time is about up.

have you had any contact with planned parenthood yet? >> with regard to the -- >> yes or no? with regard to this issue? this sale of the -- >> no, planned parenthood's funding, the $500 million you mentioned i think is a number that is a state number. with regard to medicaid and states, those are issues with the state. with regard to the amount of money -- >> what amount of their money comes through the taxpayers? we are in a limited time. i found it absolutely amazing to me that planned parenthood could complain about a woman having an ultrasound before she terminates her pregnancy. and then use this, an ultrasound, so they can harvest body parts to be sold for fetal tissue. i find that absolutely astonishing. mr. chairman, i yield back. >> the gentleman yields back. ms. davis, you're recognized. >> thank you, mr. chairman. i wanted to go on and just ask mr. chairman for unanimous

consent that the cbo scores show the repeal of the affordable care act that would be entered into the record. thank you, madam secretary, for your service, and joining us today. you mentioned nih earlier. i know that you care deeply that we continue to fund this at higher rates. we absolutely cannot fall behind the global community in how we address science and innovation. i think that's very, very important and i'm pleased that the president has increased that funding. but i also wanted to talk about not just the innovation piece of it, but really the access piece, and affordability. and particularly focus on the changes that you have recommended in reforming medicare part "d." specifically, in ways that you call for in the budget request

in terms of reducing medicare costs, both for the government and the consumer, and looking at the question of giving authority to you, and to the department to negotiate drug prices. in medicare part "d." can you talk a little bit about that? and why that is part of the budget? and why you think that this is so important? >> i think that we believe that the ability, as we look and address the issue, one of the issues brought up, the question of the long-term health of medicare and how we work on that, is we look at some of the issues that will be driving costs. we believe drug costs are a part of that. we see that happening. we see that both in terms of the numbers we see now. in the out-year projections, we also hear it from the private sector. having come from the private sector, and having come from a company known for its negotiating on price, walmart, the idea that we use market

mechanisms to try and put downward pressure on price is something we think is important. so that's why we've asked for those authorities. so that we can try and work with the pharmaceuticals and negotiate to keep downward pressure on that price. that's what we hope we can do. we see it as part of the overall issues that we're being asked about, how we transform the system for the long term. we think there are things we need to do and pressure we need to put. >> what do you see as some of the key problems as you move forward with this? >> i think with regard to this particular issue, it's not one -- it is a legislative and statutory issue. it will take a statutory change to grant the authorities to be able to negotiate. that's not something that administratively we can do. so it is something where the action will sit with the congress. >> thank you. for working on that. i know it's not simple way of moving forward. but it does seem to make a difference. and there have been so many

stories lately about how the high costs have not just bankrupted families, but made it very difficult for people to access important life-saving drugs. i wanted to just for a moment also talk about the increasing access for folks here. we know that the aca really has been a huge success in helping to reduce a number of the uninsured. i actually have a constituent in my district who was going regularly down to tijuana to get the medications that she needs. and this now means, as a result of her being insured, that she doesn't have to do that any longer. and it's been a big difference in her life. so i wonder if you could just talk a little bit about how dramatic the increase in the underinsured population has been, and what the additional coverage has meant in terms of the increasing patient outcomes? >> with regard to that, we'll

try and be brief. in terms of numerically, the number i think you know is over 16 million, the number of the reduction in the uninsured. with regard, i think, what tells the story better are the individuals and whether that's the woman who was 26, uninsured, her mother told her to sign up. she needed insurance. but in the end she listened to her mom. a month later she discovers she had stomach cancer. and had the coverage she needed. that coverage both helped her from her health, she is now actually recently married. in addition to that, though, the financial security in terms of her business and her availability to continue on in that way as well. so i think it's the individual stories, combined with the numbers in terms of what we're seeing of what the extended coverage means. >> right. yeah. i particularly have heard about that when it comes to type 2 diabetes. and the prevention, it's made a real difference for those folks. thank you for your service.

>> mr. wahlberg, you're recognized for five minutes. >> thank you, mr. chairman. and thank you, madam secretary, for being here. and thank you for reaching out to us before this as well. i want to ask you, the first question, how many fictitious claims have been paid since the inactment of obamacare and how much has been lost due to this fraud? just to bring it into context here, earlier this month gao had various undercover test performance throughout the 2014 coverage year. the report revealed some stunning things. that the marketplace approved subsidized coverage for 11 out of 12 fictitious applicants created by gao, resulting in a payment they state of about $30,000 to insurers on behalf of these fake enrollees. for seven of the fictitious applicants, gao intentionally

did not submit all the required verification documents to the marketplace, and the marketplace even then did not cancel subsidized coverage for these applicants. despite the inconsistent and incomplete information. and so subsequent to that, how many fictitious claims have been paid since the enact of obamacare, and how much has been lost due to the fraud? >> so, with regard to the example, we take very seriously the issue of program integrity. we want to continue to improve it. we look forward to the gao's recommendations out of that study. we look forward to understanding what they are, because we welcome the opportunity. with regard to the question in answering the number, because gao didn't find actually that there were fictitious claims, they did when they had individuals who came through the system. first they came to health care.gov, the marketplace, couldn't get through. then they actually came through the phones. that's where they got through.

at that point, because they are gao, they were able to do things that for everyone else would be perjury, that would have up to a $250,000 fine affiliated with it. >> and they were successful. >> and were successful in breaking the law. in terms of what they were doing to go through. with regard to the next step, and there are a number of gates. there's the gate at health care.gov in terms of that was where it was caught. got through at the point, you know, the question of confirmation of information. then because they did not file taxes, what will happen to these individuals is in this year as per statute, they will no longer be able to get subsidies in the next year because at that point the irs will let us know that they have not filed taxes. >> we don't know how many fictitious complaints may have been filed already, other than gao? >> we know of the 11 examples of gao. >> we do know that. 12 examples, 11 got through. >> with regard to, those are the

only examples we know of. as gao said in the report, they didn't know of other examples other than those that they had created. >> they don't, yes. but you don't know either? >> with regard to the things we have in place, what we do know is we do have a number of steps in place. within 90 to 95 days, we go through data matching. this year already, 117,000 people who have not -- we don't know they're fictitious. we know they have not provided the right documentation. and the first quarter of this year, 117,000 people came off. several other -- over 2,000 people received information we did not have enough justification for their income. and, therefore, their aptc, their tax credit would be adjusted downward. we're on a constant path of making sure we have the information that aligns with what we have been told. and if not, we're taking action. >> without getting into specifics of these cases, that were successful, again, which

shows that there should be concern, can you explain to the committee what processes likely failed to allow these fictitious applicants to gain subsidies? >> there are a series of processes that occur. and in terms of the gates, when people have lied about their information, is something that can happen in the system. it can happen in all of our sis 2e78s. the way we catch that is in the data matching and information. so it depends on whether they've lied about which part, and that could have to do with -- >> which ones failed? >> pardon me? >> do we know which ones failed? >> no. because we have not seen the gao examples. one of the things that would be very helpful to us would actually see the example. what we know is what you said. and if we have the information, then we can find where the system may not be working. in terms of the system, are the examples i gave you. >> what is keeping you from getting the examples if that's the case? this came out earlier in july. >> at this point the gao has

neither given us recommendations or -- >> have you asked for it? >> we have asked the gao in terms of can we understand how you did this. they say they're protecting their sources and methods. >> mr. grijalva, you are recognized for five minutes. >> thank you, mr. chairman, and thank you, madam secretary. with regard to the gao question just received, the gaming of the system and the process, is this such a rampant phenomena, that it is undercutting the very pinnings of the affordable care act, or are we dealing with an issue that as you get more information, to deal with it? >> at this point there are a number of gates, and efforts on program integrity in place. and that's the initial information gathering, which we check at the hub, at that point. when that goes through, we also, when we don't have data matching, as i said, within 90

to 95 days, we review those cases. we take action. at the point of the filing of taxes, and the examples that were given, folks didn't file their taxes, that's that's the point at which subsidies will go away. we have a number of gates in place. we are implementing those. if we can understand place where is people think those aren't working, we do want to understand that so we can work to improve. >> the gao shared their methodology with you, and those examples -- we are waiting for that, correct? >> we are looking forward to gao coming out with recommendations which is the part that has not yet occurred. >> thank you. the president's commitment to early childhood education, it's reflected in the budget proposal, $1.5 billion extra for early headstart -- and for headstart itself. briefly, if you can tell us, the budget levels and spending caps established by the majority,

what's that going to do to the fact that you are trying to build capacity, you are trying to stress quality and accountability for providers for these children? and what does that do to capacity? >> with regard to the levels i think that if you are going to meet those levels and you want to fully fund headstart, what it will be are dramatic cuts to things like nih or cdc in terms of other places. i think we have put together a budget that is a budget that as i mentioned there is savings in terms of deficit reduction that comes from the hhs budget as whole. that we put together a plan and an approach that affords us the opportunity to fund all of those things. but at the current cap levels you would not be able to do that. so you would not be able to implement the changes in headstart or you would have to make dramatic choices in other places. one of the largest budget areas for hhs is nih.

>> and i think the last point, community health centers, that was mentioned briefly in your testimony. at least in my community that's an essential network for health delivery, an essential part of the affordable care act delivery system. if you could talk to the committee as to that role, and how the budget that you are talking about is reflecting an continued commitment that the president made to the health centers at the inception of the affordable care act discussion. >> we appreciate the work that was done also in the sustainable growth rate bill in terms of these issues. the community health centers serve approximately one in 15 americans actually are served by community health centers. we think they are an integral part of care, an integral part of primary care. a very important part as we expand access that we have an ability to serve.

that's why he was extended as part of the original affordable care act and are extended now as we see the number of uninsured drop so there is places for people to go because of that. we believe they are an essential part of coverage especially in communities that don't have as much, rural, minority or other communities, that these are an important part of that. they are also an important part of integrating the behavioral health and primary health together so we can get to the place where that type of coverage is one. >> thank you. i yield back to the chairman. >> the gentlemen yields back. we are going to move members to four minutes. we are watching the clock. i can't seem to get it to slow down. mr. guthrie, you're recognized for four minutes. >> thank you. madam secretary thank you for being here again. i appreciate it. i want to talk about through employer sponsored health insurance, the small market group definition. affordable care act in section 1304 expands the small group definition to 100 employees.

particular concern are employers from 51 to 100. if you are below 50 you are not mandated to provide. once you start growing then you are able to self insure when you have got a bigger pool so a lot of bigger businesses aren't having the same issues. so the trap seems to be -- and i've heard from a lot of employers and insurers, and actually a lot of colleagues on both sides of the aisle have been working, how do we fix this problem. i've seen estimates of a 30% increase from different studies but the issue is employers from 51 to 100, if they go into the small market group definition will have expensive mandated benefits. and there is a big concern. as i said it's bipartisan over here in the capitol. so i just wonder if you have looked at this issue and what actions are you looking at taking? >> looking at the issue right now, one of the things i would and if we could follow up with you and your staff to make sure we are getting the comments you

are hearing directly from employers or other groups. it would be very helpful. there is another side in terms of expanding the other market that people argue but would love to hear directly if you have those comments as we are reviewing that. >> absolutely. >> it would be helpful to hear the specifics of why people assume it will work the way that you describe it working. there are others that argue the other side of this issue. it would be helpful if we can follow up on that evidence. what i understand in terms of a policy perspective, and then the question is would have we have authorities. those are the two questions we're examining right now. it's a timely conversation. if i could ask that we follow up with your team or you directly -- >> absolutely. >> to have those comments i would appreciate having the facts from the field to inform our conversation. >> there is a bill, hr 1624, it is 158 cosponsors and bipartisan. it's not just a -- it is a very bipartisan look at what's going on. having said that, mr. chairman, i have a letter. we'll share it with you from 19 employer groups regarding this.

i'd like to enter it into the record. thank you madam secretary and i yield back. >> gentleman yields back. mr. courtney you are recognized for four minutes. >> thank you mr. chairman. thank you madam secretary for your accessibility since taking over. much appreciated. just for the record i wanted to note we had a great opportunity to talk about observation coding issue which still is a widespread problem out there for folks who are discharging from hospital and unbeknownst to them find themselves in a coverage gap for medicare to cover medically prescribed services. since we spoke about the two day midnight rule yauv got -- i've got a sheaf of information from folks that again i will show you with why this is not a solution to this problem. but i will move on. if chairman mentioned earlier about the insurance rate increases that were reported a

while ago in the press. i would just point out coming from connecticut, a state which embraced this law is now in year three of the its exchange. just a couple days ago some of the insurers who participated in the exchange revised down ward their initial rate requests. anthem came in at 6.7. revised down to 4.7. this is prior to the rate review. the co-op came in with a 13% rate increase. they revised down to 3.4%. the largest insurer on the exchange, they came in with a whopping 2% increase earlier. they have now revised downward to .7%. i point this out because there is a cohort that has claims experience under its belt now. the fear amongst actuaries that the walking wounded in the exchanges were going to spike up in recent years. we're actually seeing incredible

stability in terms of the rates. we are also seeing new insurers coming into the marketplace. harvard pilgrim is now knocking on the door and is coming in to sell their product in connecticut. again, your department has been boosting the insurance department rate review piece of this. i was wondering if you could share from a global standpoint, you know, whether or not some of these fears are overstated. >> with regard to the rate issue, it is i think what you are pointing to is one of the things about the act that is important is about adding transparency and the light of day to things in the marketplace to make a market work so that individuals have information and that there is pressure in the market to make it work. and that was one of the ideas. and so when people saw the rates, the rates that were reported are only the rates really in most states that are above 10% because that's required. if a company is going the raise the rates above 10% part of the law it it has to be posted we have to report it while the insurance commissioners review it. that's the other part. it needs to be reviewed. it doesn't just happen if they propose it. if they are going to propose

above a 10% they need to justify it. that's a part of the process at work. what you see in terms of connecticut and what just happened is, that creates downward pressure in terms of the public pressure and the requirement that you have to justify rate increases. we think overall what we have seen last year is that the rates come in here and there is downward pressure. we also see in states like connecticut and actually california just came through yesterday. and their rates were at 4%, lower than their increase of last year. so that's what we will continue to watch and monitor. the reason we recently had a conversation with the state insurers to make sure they know and are using that tool of rate review to put that downward pressure which we believe is an important thing to do making the market work. >> as a former small employer who double digit increases were just a matter of of course, to see a 2% or a .7%, really, that is eye popping in terms of the stability. >> the difference. >> i yield back, mr. chairman.

>> gentleman yields back. mr. barletta, you are recognized for four minutes. >> secretary burwell, my district is home to businesses that sell cigars to adult consumers. they are concerned about the expansion of the fda's regulatory authority under the tobacco control act. their shop serves a distinctly adult clientele. i don't believe this category was the intent of congress in 2009 when the law was passed. can you tell the committee what steps you are making to ensure such businesses which are a staple of main street america are not regulated out of business? >> with regard to -- right now as we are in the middle of a rule making process i think you probably know that we actually proposed two different alternatives as part of the rule. to gather the evidence and