Transcripts For CSPAN Washington This Week 20240622

Were really down. I said, are you kidding me . We got 2900 people to think we ought to run the country. Year after year, and then john sununu came, and we have really gathered momentum. In 1994 we elected a class of republicans who just did not give a whit about their election. They came to balance the budget. It was remarkable. And then after 10 long years in 1997, i was one of the chief architects of allen saying that federal budget. First time we have done it since man walked on the moon. We have not done it since. We paid down the largest amount of the publicly held debt in modern history, and the economy was doing great. Some of you might remember i was a giants Television Star on fox news. [laughter] you are right back, how great i was on fox news. I also worked at Lehman Brothers and learned an awful lot about this, which is so critical in terms of understanding what motivates ceos. So i left. 10 years i was out. Im a believer that if we are really not here to serve others, i dont know why we are here. We can work a little golf and from some from time to time but so i ran for governor and i won. We did face a bad situation. We were 20 of our operating budget in the hole. We lost 350,000 350,000 jobs. It was pretty bad. Four and a half years later, we went to 2 billion in the black. We cut taxes by the largest amount in america. Our credit is rock solid. And if you have mental illness, if you are drug addicted, if you are the working poor if you are autistic if you are developmentally disabled, if you are a member of the minority community, you are in our family. You are in our family. No one gets left behind. Then i was rewarded. My first year in office i had a 28 approval rating. You dont get up everyday and work that hard to be that bad. But i 188 86 out of 88 counties. I got 51 percent of union households. 60 of women. The second highest margin of victory in modern ohio political history. It happened for two reasons. One, i created jobs, opportunity. And secondly, people feel included. There are couple of important things we need to do, and i will shut up. One, job creation is our highest moral goal. Getting people work is what it is all about. This economy, has been terrible growth. We have got to get the economy growing and we have to bad balance our budget. I have done it before, we will do it again. Secondly, as people feel that things are Getting Better every american has to be invited in. No one can feel as though they are out, they dont matter, they dont count. I am a believer that this country is great, not because of the people at the top because of the people at the foundation. That is what i have tried to do all of my lifetime. Yesterday was an interesting day. I made a decision to announce that i was running for president. [laughter] it took a little bit away from the Birthday Party but thats my story and im sticking to it. Let me take some questions. Speaker, you get to pick the folks. Speaker scamman how about that . How about the lady in orange. The pumpkin lady . Im not sure i like being called a big pumpkin. Gov. Kasich i dont even know the speaker. Ok. My question is, one of my concerns is obviously with what is going on, what happened in our recruiting stations. How do you feel about our military being able to protect themselves in recruiting stations echo and on u. S. Soil . Gov. Kasich first of all, people who are in these recruiting stations should be armed. They should be able to do their job. [applause] in my state even today, we were closing for them down, assessing everything, assessing all the armories. I want our recruiters to be also be effective and to be able to protect themselves and other people. It gets to an even bigger question. There are couple things i would tell you. The military has really run down over the. Of the last decade. Its not just been recently. Its been happening over time. There are too many bureaucrats running things inside the pentagon almost one million. When you have all these people doing all this stuff, things dont get done in the government. You are bloated, whether you are a get business or a government, it just doesnt work. Its one of the reason why privatized economic why i privatized Economic Development in ohio, because it doing it in the government we could not move at the speed of business. The same is true inside the pentagon. It needs an entire makeover. Then lead to make sure that we are buying the weapon systems we need. We need to rebuild our navy. We need to strengthen our army. We need to be older battle this problem of cyber security. In order to do this, some of that we have to do should involve the private sector. I want to tell you a story. After 9 11, i got a phone call to go and meet with the former secretaries of defense of the pentagon with secretary rumsfeld. I have no idea why they invited me. But i went to the meeting. As i sat there i began to learn that we were actually not doing well on the technology front. So i suggested in this meeting that we bring some of the best minds of silicon valley, because i was working out there, i knew these people, to help us deal with this technology problem. I brought these two guys, ones name is larry page and the other guy is sergei brin. When i met them, they came to the meeting in a volkswagen with inline skates tied to the roof. You may have heard of their company. It is called google. We took some of the best and the brightest people inside of the pentagon, and rumsfeld from time to time would convene a meeting and think these people are the work that they are doing to solve some of the technology problems. We need to do more of that. We need to be less paranoid and use more common sense when it comes to solving these big problems, because bureaucrats, god bless them, they can trip over one another and not get the job done. Secondly, when it comes to people like isis, you are either going to pay me now or you are going to pay me a heck of a lot later. I have been saying for months that we should have a coalition of people that will go there and begin to destroy that Organization Called isis. We need to do it. [applause] so people say well, you know, the polls are not good for putting boots on the ground. When do leaders have to be doing this . When leaders do this, they dont have any followers. This is something that has to be dealt with. Lets just do it. Ok . We can rally the support of the public for this. We need good intelligence. We need human intelligence. We degraded our intelligence. Snowden ought to be locked up for a thousand years for what he did. [applause] what an awful thing. Even in my state i get intelligence briefings. We dont want to lose our civil liberties. I actually give credit to rand paul for saying that we should have a balance between security and liberty. Weve got to have the security, weve got to have the information, but we dont want the government having all this stuff. I dont want people looking at everything i do. I think we can start a good balance. Then we have to be prepared. I want to tell you, i know that this stuff is unnerving to people. Scary and away. But look, we have been through civil war, racial violence oppression, world wars 9 11 cant we just feel good little bit . Cant we start to enjoy being americans again . I think we can. We are never going to stop everything but we can stop a lot of it, and we do everything all day. When it comes to those recruiting stations, they are just one piece of this whole thing. We are going to rebuild our defense so that our allies respect us. We have to mean what we say. No more redline. No more im going to have a redline and im going to walk away from it. One other thing i want to say to you. I was telling john is on the way up here. There is no religion that i am familiar with, none on the face of this earth, in history of mankind, that says that for you to go to paradise you go slaughter and kill somebody that you have never even met. I tell you something, i think we have got to lead to the world and making it clear thats just complete apostasy. It is unacceptable to humankind. That is a part of the message in my opinion, that we need to have said it loudly across this world. We have to fight for decency. Man, im an optimist maam im an optimist. America is going to be fine. I will do my best, i can promise you that. But you have to do yours too because this whole thing is not built from appeared down. It is built from here to the top. We work for you, you dont work for us. [applause] speaker scamman lady with the flag. Hi. I have been a caregiver for my husband, he has autism. I am one in five medicare dollars is spent caring for people with autism. The projection is by 2050, [applause] the projections are by 2050, 28 million baby boys will have autism. I am understand the pain of seeing these people gov. Kasich dont you know it. My question is, what will you do to make sure this devastating disease gets the attention it deserves, and also the potential bankruptcy to medicare and medicaid . Gov. Kasich let me suggest couple things. First of all, when i was in congress and we were balancing budgets i dont think to balance a budget you just go and everything. You have to figure out how to make things work better. Some things have to go, because it is like a garage sale. You clean out your house, i dont know why this is here. But most of what you have just needs to be shined up. Newt gingrich has just written an oped piece. Im very happy with what he has to to say, and john and i were there when we doubled the funding for the national institute. There are some organizations i would not double. I would be doing it the other way, but we need to do this research, this basic research at the National Institutes of health. It is absolutely critical. I think it is bipartisan. I think support for this is growing, and we need to do that. Number one. Number two, i really think we need to have incentives so that people begin to buy longterm care. Right now it is really expensive. I have it, my wife and i have it, we bought years ago. That there is very little incentive for us to buy longterm care, and i think we need to think about a way in which people can afford this. In your case it would be a situation where you would have somebody that, well, you are a caregiver yourself. You know what difference it makes to have somebody in the house. But right now, you know what it costs. It costs too much. We need to think about a way to incentivize the purchase of that longterm care. It has the other thing that i would tell you, in my state at least, we said that if you need to go in a nursing home, thats fine. But if you want to stay in your own home, you should be able to do that as well. We have also treated the caregivers very very fairly. When i came in, they were almost a part of ohio, and people wanted me to dump them out. I didnt want them to be government employees, but i did not want to lose their health care. Recently, they can get on the exchange they now can get their health care and they are protected. You do not want to hurt caregivers. Its a gift. The lord gave you a gift, to care for people. I think it is research. I think it is longterm care. I think its these breakthroughs that we need to have it medicine to make sure that our caregivers are respected in our society. But i dont know how to cure alzheimers. But there is somebody, some kid right now, who may not be getting a good education. Could be ben carson. Yeah. Somebody can rise, because you know thomas aquinas, the old catholic theologian, said that science and faith are connected. We have got to explore. We have been given the brain to fix these things and that is what we have to do. I give you a little hug maam, because thats really hard. The quicker we can get to it, i will do what i can do. Thank you. [applause] let me just say one more thing. I get criticized because i took washington money to ohio to treat the mentally ill and the drug addicted, the working poor. Somebody says, it you know, stop moralizing. Well im not a guy, im not going to voice myself on my own petard. I am a fallen guy. I do the best i can. The reason why i brought that money back is called expanding medicaid. Let me just explain that to you. Because of that, we can treat the drug addicted to our in our prisons, and they can we traced them, we turn them over to the community, and the recidivism rate for this drug addicted is 10 . The national recidivism rates rates are almost 50 . Why would i not want to treat them . As i dont have this money i dont have the resources to do it. Bipolar and schizophrenics sit in our prisons. 20 of my resin population are bipolar schizophrenic of my prison ovulation. Population. If you treat them, they conviction normally. These programs do not have to be exploded in order to deliver good surface. It has made a difference in our state. If people are going to criticize for me before it, god bless them. Im glad i did this, you get there are peoples lives who are saved as a result of it. I sorry. I wanted to tell you that. [applause] high. My name is any annie. Im a volunteer with the league of conservation voters. My question is, what are your plans for dressing Climate Change in the state of New Hampshire . Gov. Kasich how about the worlds . [laughter] first of all, i believe that we are supposed to be good stewards for the environment. I appreciate the facts you are involved in something. But you know, we dont want to worship the environment. We work here we live here, we have to manage it. Just ask the speaker here, or stella. They have a beautiful farm. They care about that land as much as anybody does. Sometimes people come up with radical ideas about the environment, and it lends itself to worshiping the environment. I dont worship the environment. I respect and protect it. In my state, we spent a lot of money on lake erie because we dont want it to be destroyed. I also have fought with some people in my own party over the issue of renewal. I assume you like wind, you like solar, as long as that wind farm is and where you are . [laughter] i get it. The kennedys like wind, they like it on the ocean. So anyway, i think it is a mix of all that. When it comes to call, i think when we dig it we had to clean it and then burn it. It has to be a lot of different things. I think we have to be respectful of this young lady, because if we dont go the extra mile then we may be doing something that cant be approved. But i dont want to be crazy here. I dont want you not to get a job, as we have done things extremely. Its like many other things in life. It requires some balance. Respected, protect it, dont worship it. One of the most exciting things thats going to happen in your lifetime, and i dont know when it is going to happen, is going to be Battery Technology. What is that car calls . The tesla. I have it friend who has a tesla i have i have a friend who has a tesla. Your young woman. Get your friends and go for a ride in a tesla. Technology is moving where we wanted to move. My view is, not a denial, not all the scientists are crazy. Im not sure who is right but im going to be careful about it. [applause] speaker scamman im going to take that mail over there. That male. Actually a male democrat, believe it or not. John, welcome to New Hampshire. A question i have is something that affects a lot of parents of the baby boomer generation student loan forgiveness for our offspring. We have a son that is paying off his Student Loans on his first job. Back in the day when we were younger we had that National Defense loan, a lot of us took advantage of it. Do you have any proposals in your plan, if you become president im not asking for a free lunch, im asking for sensitive forgiveness or Community Service to help offset . Gov. Kasich i dont know yet what we would do about those. Lets get to the root of it. First of all, lets talk about what is to come, because my kids or 15. Here is what i we have done in the state and when i think we should be talking about nationally. Number one, we do not give any aid to a college or university unless the student completes the course for graduation. No more giving money out to people so kids walk around and never graduate and never complete a course. That creates an incentive for our universities to guide our students through in a shorter time. Secondly, we do have a Great Community College System now which allows you to be in a position of where you cut your costs for the first couple of years before you go to university. Thirdly, we have a program that ought to be aggressively expanded nationally. It started in New Hampshire. That is called College Credit last. Some students can take College Courses now, in high school, and get credit for High School Graduation and for higher education. Some kids are coming close to cutting off an entire year from going to college. They are going to shorten their ability to get a degree. Now what i have done it, is i have gotten a handful of business people. I did not select them for their affability. I selected them for their capability. They are part of a small group that is looking at all the cost drivers inside of our universities and community colleges. Ohio State University had a parking a bunch of parking lots and parking garages. Ohio state least those to a private company and they got a half 1 billion. This happened like two years ago. Why is ohio state running parking garages . We have to look at the nonacademic assets. The problem is, many of the leaders of these institutions my guys and women are saying go into it and we will implement what you come up with, but it is tough to be president and to get everyone together. This is vital. I will tell you why. I met a girl the other day with her dad, she is ringing up nearly 200,000 worth of death and she got to years worth of scholarships. The school cost her 60,000 a year. Thats 240,000 aftertax dollars. I think part of it is controlling those costs. Then on top of that, i have told the universities, if you dont get your act together online indicate education is going to take you down. I think thats part of it. You know if we had to loan forgiveness in their i think it ultimately got stripped out. I cannot make you a promise that all of a sudden were going to write it off but i think what we have to do Going Forward is to reduce these costs. But maybe you just said something that makes some sense. You do some Community Service, maybe thats a way to work it out. Its an interesting idea. I have to think about it. Because you know i dont want to make a promise oh you know will take care of it, dont worry. We will balance the budget there will be a chicken in every pot. I think is a good suggestion . What do you think john . I dont know if that works for you, but we do have to do as much as we can Going Forward. Speaker scamman right there in the front. Hi john. My name is marie. Gov. Kasich are you related to marry a . Mario . Hes my brother. Im kidding. One of the things im worried about is handouts. The number of people on food stance has doubled since 2008, and i just heard yesterday that the number of children on welfare is up to 22 . I am 100 for helping people who need help. The issue i have is with people who can work and dont want to and they just stand there with their hands out. Id like to know what you do what you would do about that. Gov. Kasich my mother used to say it is a sin not to help people who need help, but it is also a sin to keep Public People who can help themselves. We have a 11 Million People in ohio, and the last i checked we had about a hundred 30,000 people on general release 130,000 people on general release relief. Thats a big number, but lets create a little perspective. Here is what we are doing with welfare. You know how confusing it is when you go to get medical care . You go to a doctor and they tie you this, and then you got to another one, and they tell you this . The best procedure for health care in the future and maybe we should talk about it, is you have a shepherd who leaves leads you through. But if you go to the welfare department, you are on general release, you have food stance, you get it as many as four or five relief workers. You will have one caseworker, this will be and lamented that year. They believe copperheads of work for someone who comes in who is on welfare. If you as a county department will outdo what i say, i will take your money away and privatize it. Then what we are going to do and we are working on, is to get businesses in the welfare offices. In this Little County and columbus, we have businesses located in the welfare office. They train the people on relief for jobs that actually exist. They have like a 90 retention. They have hired a lot of people from the welfare lines to the work line. There are a lot of things you have to do. You have to have skills, education. Plus you have to have k12. Do you hear what im saying . We live in lake wobegon. Every school is great, everybody is doing great. They are not. In many cases, too many cases. So we have to give them the skills upfront. Change education. But here is what i want to tell you. The president can be a cheerleader. The president can hold people accountable. But the fixing of this education and this welfare system cut welfare system must be done where we live. It must reflect our values, not someone down there in washington where they dont even know what the time zone is here. One of the things i would like to do as i would like to move more of this authority and empower people like you here in New Hampshire to design your own program, rather than it being designed there. I also think doug, every county is a little different to. So it seems to me as though we should design our own ralph welfare creation program. Give them the skills they need, but you cant train them for underwater basket weaving. There is no jobs in that. Another thing that we have done in ohio, is we know what the in demand jobs are. We actually can determine what are the current jobs and future job leads for people. Then you start moving them into it. We have so many programs. Let me give you one more. Your mom. Youre a poor mom. Your husband ran out on you. You have a couple kids and you are working at walmart. Fine, thats ok, but you want to do better. So we are asking some of the businesses to come together and put online a curriculum that you can take it take at your own speed. When you complete the curriculum you are guaranteed an interview and the state of ohio will give you a credential which guarantees your value. If you become a medical colder coder, i am told you can make 41,000 year. We want hope and opportunity for these folks. I will tell you, this amazing thing, the know that most of the people on general release and ohio is limited. You can only be on it for three years. Most people dont say on it that long. I dont even know where they go. They go into the underground economy somewhere. So it is compensated. Its not a simple and a simple answer. We want you to be trained and we want you to be trained for a job that exists. We are going to hold you accountable. That is where we are going out. [applause] speaker scamman right here. Governor, i am a newlywed millennial so i care deeply about our nations fiscal issues. I am glad to hear that the budget is one of your top priorities. I know you are a huge advocate of the balanced budget amendment. Im curious how you are going to get us there. Say you are present, you are president , what does your first budget look like . Gov. Kasich either how you eat an elephants . Slowly. One bite at a time. First of all, we need a balanced budget amendment, and we need it because congress will never live up to their of their ability if we dont force them to. I have been in congress and i have been governor. We did not have if you did not have a balanced budget requirement in ohio, you would not have a balanced budget. People are signed away way to avoid response ability. In Congress People come home and blame someone else. I know how they do it. The way the you do this is you plotted over time you plot it over time. And thats all we have to do to get the economy moving. You dont have to done it you dont to have to have it done tomorrow, but you have to get it moving. You dont play games. You have to go through it systematically. Then what you do is you figure out, first of all, do you need the program . Number two, should it be in washington or should be sent back to the states . Number three, if we need the program can you fix it so that you can make it work . And number four for the big entitlement programs, how do you do it in such a way that you bring the country together rather than everyone ripping each other apart . You put that together, you got to include some people from the other party. If you dont it is not going to work. You have heard over obamacare . Because that they shocked that through on a straight partyline vote, people are bitter about that. I have built i think, 16 budget in my lifetime. I think i was done writing all these budgets but i think i will be writing budgets until they put me in the ground. That is kind of the road you go on. Then there is another litmus test, if it is in the yellow pages wise governments doing a . You dont have to do these things. That is kind of the way you do it. Gradual. Create, send things back. Try to innovate. You are a millennial, you understand the 21st century. You remember there was a thing called the kindle and it cost a lot of money . Now i think they give you money. [laughter] speaker scamman young lady right here. Gov. Kasich one last thing i wanted to tell you serve. If we can increase the overhang of their own businesses, this economy will grow. I saw this happen. The minutes the republicans won the majority in 1995 thanks started to get better. Because there was a sense of this mess is going to get figured out. And it did. Until they went back to their spending ways. I hate to tell you this but it was the republicans in charge that blew the 5 trillion surplus. If im president , eight going to happen. Aint going to happen. [applause] thanks so much for coming to speak with us today. I am also a millennial who is really concerned about the legend and i am also really concerned about the fossil fuel budget. If we raise continue burning fossil fuels we will raise the global temperature by two degrees. That will be really catastrophic for people around the globe and for americans. My question is this. We hear a lot in the republic and party about how jobs and fuel are opposed. There is no way to cut fuel emissions and keep our jobs. But already, in the Renewable Energy economy, we are creating more jobs within the fossil fuel economy. These will create many more jobs and put us on a safer path to the future. You said your grandfather was a coal miner. I totally respect that. People need to work for their families. But at the same time, we needed to cut carbon, keep 80 of all the fields in the ground, and we can do that and create jobs in the green tech sector. Will you create will you secure my future . Gov. Kasich first of all, thats a really smart young woman. Give her a round of applause. Really articulate. [applause] first of all, i think i have already told you, it is a balance. In ohio we have cut emissions by 30 . I have told you about renewables and i think theyre very important. But i think that the power america, and frankly to power the world, all of these resources needs to be used. Im not just talking about the Battery Technology i was just talking about the Battery Technology. It is going to give us distributive power. Utilities will be complete we different than they are today. But if you take the development of wind and solar and geothermal and you clean coal you continue with natural gas. We have dealt with the methane issue. The enviros by at large like what we have done. Making sure that our water is clean. Thats another very important part. One of the first things that i did, and dont tell the speaker this, every republican voted for this bill on lake erie and i vetoed it because it would damage the streams and the tributaries. I think we are back to what i said, which is the issue of balance. But folks, i want to tell you. About a handful of the zero people, she left, but these young people. They want to change things. I welcome it. It may not be everything that i want you to do. Ive got 215yearold and a wife. Two 15yearolds. I respect what you are doing. Let me say one thing to you. You know how you are a believer in this and you are idealistic . So mine. Dont so am i. Dont ever become cynical or lost. Light for the things you believe in. Be respectful. You are the next leader. Are you going to cut carbon . Gov. Kasich i gave you the best answer i can give you. Youve got this guy recording me and i going to do the best i can. [laughter] [applause] speaker scamman this young man right here. Gov. Kasich whats that, one more. Old man. Old man. In 2018, the obamacare plan imposes an excise task tax on some health plans. How you deal with that . Gov. Markell gov. Kasich i think obamacare should go. The problem with this whole business with obamacare is it does not control health care costs. In fact, it drives up the cost of health care. It does not get to the root of the problem. My view is what we ought to be doing is incentivizing, for example, our primary care doctors. We should have her Insurance Companies and providers come together to provide quality medicine, not quantity medicine. You go in today to the hospital, and they might give you 10 tests and you only need to. Where they give you 10 . We are driving change in our states that can be taken nationally. By the way, everything i am talking about will absolutely begin nationally. It is scalable. But what we are saying is we want the Insurance Companies. We want the hospitals and the primary care doctors working together so that as prices come down they both win, and the patient is healthier. Let me explain specifically what i mean by this. Our Childrens Hospital in columbus has made an agreement with an Insurance Company around the issue of asthma. A lot of kids have asthma. The issue with asthma is, how can you be healthy without having to be hospitalized . They have significantly cut the number of hospital admissions, which means the hospital is making less money, which makes the means the insured party has more money because they do not make pay claims. They are sharing the benefits of having less kids admitted to the hospital. Thats a way not to work. Thats the way it ought to work. Drive lower prices. Let everybody share in it and we end up healthier. That is fundamentally the way i think we should do it, and obamacare does not touch that. Gov. Kasich he had one last question. Youve been consistent. What is your position on Citizens United and the outrageous amount of money being spent on political campaigns . Gov. Kasich i think it is not a great system when a handful of billionaires can decide who should be president. [applause] ok, we all agree with that, but every time we change the system we get a work worse system. We have to figure out what to do on this. If i lose i will blame the system. If i win i will think it is good. I think we really need to be careful about what we do. I am not going to get into Kind Campaign finance reform right now. My debt my buddy john mccain was in it. I have some thoughts on it but i want to make sure they are accurate. One of my friend said last night, will sometimes john kasich is so much about so many things. Why does he sometimes say he doesnt know . I will tell you why. I dont want to give you some answer that is not legitimate. Have you ever noticed that when people run for president they never keep their word . Thats because all the things they promised, they cant do. Why dont we stop doing that. I will tell you what i can do. The things that im not sure is, i will tell you that. We will get to them later. I will just have you down to the white house like when i went when i was 18. We can discuss it. Thank you all very much. [applause] gov. Kasich you know what is amazing about goober . It is like google. You can just say well i will take a uber. Thank you. Thank you. Whos that . My wife. Gov. Kasich thats a pretty wife. Thank you. Gov. Kasich who are you three . Have i seen you before . Thank you. Is your refusal to cut carbon and commit to the future due to the gov. Kasich no. No. How are you . Are you going to see if there . See us there . Thank you so much. High governor k6, governor kasich, can i get a signature . Mine are all girls, i go to an all girls school. Thank you so much. Gov. Kasich let them know that New Hampshire is important. They screen a candidate for the entire country. They do so much. Thank you so much. Gov. Kasich im trying to figure out how i can Just Campaign right here. I followed your career. Gov. Kasich keep me in your prayers. My husband is from cincinnati and he also grew up in mckeesport. Gov. Kasich very close. Very similar. Except if he is mckeesport, hes rich. I dont know about that. Gov. Kasich thank you. Thank you. See you guys. We didnt get a chance to ask the question, but seeing you put the school loans and because you can get the loan without any faster gov. Kasich thats another thing i should have mentioned. People get the loans and they use them for things beyond. Somebody told me i forget the number, it was extraordinarily high. They use it to buy a car, do their rent. Thats what they do. The University Keeps raising their rates. Gov. Kasich you know what i said, why dont you lower your price . And he said if we lowered our price people want come here. Right now we are really unhappy about the changes that have taken place in the Nonprofit Sector and that type of thing where ing. The outright theft is unbelievable. They have been made the gatekeepers for welfare. If you are entitled to this, i get find an outrageous amount. Gov. Kasich theres two things. Its interesting. Look, we are not managing it. I mean, im no fan. Gov. Kasich im just saying if you explain peoples purpose to them they will do a lot better than they have been doing. Hi. Great talk. Gov. Kasich thank you. Thank you very much. Can we get a picture with the three of us . Gov. Kasich yeah, of course. Thank you. Thank you. Ive been taking care of my elderly mother. Gov. Kasich im so glad i did not go there, i might have never left. Thank you. How are you . Good. How are you . Gov. Kasich i hear you. I hear you. Thank you. Sir, will you secure the border . Gov. Kasich yes. We have to do that. It is interesting it did not come up. The era of selfies. See, you guys are going to have to be the french cavalry to make sure that we get it done. Oh we dont want to do this, we dont want to do that. I have been to johnstown many times. I sound like a pittsburgh, downtime . Dont i . My grandparents live in marysville. [indiscernible] how do you break through that trumped noise to get your message out . Trump noise . Gov. Kasich i just do my thing. People either love it or they dont. I just do my thing. I think there is a lot of excitement, and if it keeps up, thats great. If it doesnt, i will be governor of ohio. You do this block by block. You dont do this from the top down. Townhall meetings, take some questions. If you connect. You have to ask the people. I think there is a pretty good connection, but we will see. I dont have some narrow group. People ask questions, i asked i answer them. When you have National Security experience, when you turn a giant state around that was basically on its back and you bring it back. Its so big, its so unique. How do you feel now about the fact that you will not be on that debate stage . Gov. Kasich its too early to say. You were coming to New Hampshire talking about your record, talking about your personality. Whats unique about you . Gov. Kasich whats not unique. Its me. I dont know what to say, other than that we will see what people say. Im not sure how it will work for others. Im not a fortune teller. Look, in life sometimes it is about trying. Am i confident that i can win . Yes. If i was not confident i would not be running. Ive also governor of ohio and i have a record that is unique about everybody. I havent heard you articulate much about what you would want to do if you were elected. Gov. Kasich have you been to any of these townhalls . I talked about immigration today. Health care. The nih. The department of defense. Balancing the budget. Out of which you want me to talk about, but we will take a lot of what we do in ohio to washington. If you really kind of want to know the history that kind of tells you what you can do. I dont find that people are saying, oh wait a second. You didnt tell me about what you want to do. But if you are, i got to pay attention. I have to say ok if im not connecting. Maybe the question the better question would be what would your priorities be . Gov. Kasich balancing the budget, rebuilding the defenses. Sending a clear signal that everyone is part of the american dream. Those three things are what really matters to me. The reason why the record is important is because anybody can promise anything. It is about who delivers. Who has a record. People dont really like politicians very much. But i think if you can talk about what you have done, and some of what you intend to do, i think it brings credibility to people. We have had it two or three townhall meetings. They have been terrific. We have people signing up and i am really pleased with where we are. One more. [indiscernible] gov. Kasich i like john mccain. He is a great war hero. He was president of our congressional freshman class. I think he is a great guy. [indiscernible] on the next washington journal, a look at the ba system and other military issues with ryan colucci. He served as Deputy Director for the veterans of foreign wars. Also, kalina burger with the American Association of people with disabilities talks about the impact of the americans of with disabilitys act on its 25th university. 25th anniversary. And Jason Marbach talks about relations with the u. S. And cuba. We will take your calls and look for your comments on facebook and twitter. Washington journal, live every day at 7 00 a. M. Eastern on cspan. With current funding for highway and mass transit funding set to expire at the end of the month, the u. S. Senate meets today to consider a bill that would authorize transit funding for the next six years. Today into that debate at 2 00 p. M. Eastern with votes for amendment scheduled for 3 00. One would repeal the health care law, the other would reauthorize the export import bank. As always, you can watch the senate live on our companion network, cspan2. [captions Copyright National cable satellite corp. 2015] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] filmmakers talk about their film, best of enemies. About the debate between William F Buckley and more of it all. Gore vidal. Today i believe there is someone saying, the numbers are dwindling. Talk about hot topics, hot salacious topic number two. Where is then, i dont think that was the norm. I dont think these guys needed that. As you mentioned, the moderator was a distinguished news man, who i think was really embarrassed. He was moderating, but he disappears for sometimes five or more minutes at a time. Today was you would not have a moderator not jumping in every 30 seconds. I think really everybody at abc just stood back and let the fire burn. Tonight at 8 00 eastern and pacific on cspans q a. Monday on the communicators. Fcc communicate the fccs Michael Reilly on key issues before the sec fcc. When an item is made for an open Commission Meeting and is presented to the commission level, that document to be made available publicly. That would provide an opportunity for everyone to comment, to hone in on issues they may see. Right now we have people who raise concerns regarding our items, but they dont exactly know if the what is being put forward. Theyre kind of dealing with many different scattered structures. That is problematic for my point of view. I would rather see people target exactly where they want to see fixes. Monday night on the communicators, on cspan2. Health and Human Services i want to welcome everyone to our closing session. Were going to i think this might prove the most fruitful of all the time, we will spend some of the time examining health care transformation. I am very pleased and grateful that health and Human Services secretary Sylvia Matthews burwell is with us today. She has been extremely generous with her time attending the last two meetings and attending our governors only lunches. At h. H. S. She oversees more than 77,000 employees and her work touch it is lives of all americans. She served as director at the office of management and budget. She has also served as president of the walmart foundation, Global Development program at the bill and melinda gates, and perhaps most importantly on this moment, or most importantly to governor tom lin she is a native of West Virginia. My home state of colorado is certainly an example of working with cms on Health Care Innovation on a variety of levels. For those of you who may not be aware cms has approved the largest systems for health and Human Services in the country in colorado. This hits all components of the aaa working to provide services for individuals and reduce costs as a result of those improvements in Health Care Quality for all of our citizens. Without further adieu let me introduce the secretary of health and Human Services sylvia burwell. [applause] thank you. Its great to be able to join you all today. I am especially happy to welcome you to the Mountain State along with the governor. I want to invite all of you all to visit kirks home of the hungry smile. Its both where my sister and i both started as waitresses many years ago. If you dont want to go to kirks because they have hard serve ice cream, the dairy queen is only half a mile further and it is the most beautiful dairy queen in the nation. Im not one to brag. But its in a book. It really is. And if you actually went and sat on the patio and saw the her ons and bald eagles and the new river you would say it is. So i want to invite everybody. And tell everybody just tell them i sent you. Im from a town where Everybody Knows everybody so please do head down to hipten and check it out. And kirks was my first job. Its really where i learned about hard work. If you got stuck serving the hard serve ice cream after church, you just kept dipping. It didnt matter how the forearm started to feel after a while. You can imagine, you worked until you got it done. Thats one of the lessons i learned. I also learned about community. That was what Hillary Clinton were just an hour away its all about. I know that those are the ideas that we share as we head our conversations its something i find particularly valuable and want to do. Its been one year since i first met you all. I literally had not been secretary for a month when i came to visit and we were hosten by the governor in tennessee. I had the opportunity to get to know a number of you. Even those i think ive gten to spend some time with and see your passion and dedication for the people you serve. You all have been great partners and supporters on a wide range of issues that h. H. S. Has whether its ebola, Early Education preventative care, and i just want to start by saying thank you for your partnership in this year. You all are on the front line of governing. I know how you feel. You have to answer for your work every day. And we depend on you because your citizens are depending on you and youre crucial to our partnership. We thank you. Im here today to listen and learn so i will deliver some remarks but then want to hear the conversation. But i also want to ask you for your leadership in one of the most important things i think is happening in the nation right now and that is transforming the quality and value of health care for the folks we all serve, the american people. It is an historic time and each of us has the chance to help reshape the system, to make changes that will help business boost our economies and help the lives of the american people. It is a chance i think for us to lead together. I had the chance to discuss with a number of you health challenges. For too long our systems have failed to put the patient first. And americans have struggled to navigate an expensive and complex system. We paid for more care. But sometimes we actually got less. But in the last few years we actually started to see some turn in that. We have reduced the numb of Hospital Readmissions by 8 , which translates to 150,000 fewer readmissions between january 2012 and december 2013. We have increased safety in hospitals, with a 17 reduction in the rate of hospital acquired infections and other things that happen to people when sther in the hospitals. So that has reduced costs estimated over 10 billion. We made sure that those with preexisting conditions cant be denied coverage. There are 16 million fewer uninsured in our nation. And this is a foundation that we can build on. Like all of you, we want to build a Better Health care system. One that delivers better care, spends our dollars more wisely, and puts educated and empowered consumers at the center of their care to keep them healthy. And at h. H. S. We have been trying to take some steps to make that a reality. In january we announced historic goals to move 30 of medicare payments to alternative payment models such as Accountable Care organizations and bundle payments and 150 of those payments by 2018. That means paying for value, not paying for volume. Moving away from a fee for service approach. By doing so we can pay providers for how well rather than how much care that they provide people. Just a few weeks ago we also announced a new payment model to encourage better coordination among providers who take part in hip and joint replacements fosh medicare patients. This would create one payment with quality measures for an episode of care the 90 days from which you have your surgey to the 90 days after. So rather than being incentivized by payments theyre going to have an incentive to focus on the quality and total cost of performing a hip replacement and the included recovery. Since medicare and medicaid cover nearly one out of three americans we know we can have a responsibility to lead where we can but we will only be able to deliver truly significant and sustained change if we have the support input participation from hops we hope all of you will join this conversation because its a very important part of making sure we move as quickly through this transation as possible and we do it in a way that changes working in the private and Public Sector and we Work Together to see roon corners. Change is something that involves Things Unknown and known but if we Work Together we can wock through this change more quickly. We have seen great leadership from many of you to establish redesigns. I can look around and we are working with most of you on that. New payment is and Service Models in your state. Through Medicaid Innovation accelerator programs and the state innovation model many have Grant Funding to doup that kind of change and we can continue to provide resources and technical assistance. Another area where we have seen great collaboration with the states, you spent time earlier today, is efforts to combat the prescription open yoid and her oin abuse in our country. Last a april i wrote to you about the epidemic where i laid out our strategy and we are improving prescribing practices working to tighten that up that is where a lot of this problem starts. Ip creasing the use of medication to reverse the overdoses and responding to access to medicaid treatment. I wrote because we need your help and we want your help and ideas. And many of you have answered that call and are leading in that space. Ive had the chance to be in massachusetts with governor baker and to be in colorado to map out a path that we the federal government can work with each state to work through and make real progress. Many of you are also finding very innovative ways to combine behavioral and primary care together which is related to this issue. Today i am happy to announce that we are going to create new ways for states to use waivers to address Substance Use disorder. Our new guidance will help states can innovate implement and including developing models to Better Connect those with Substance Use to treatment. We have also heard your feedback about the waiver renewal process for existing demonstrations and to address that we have released guidance this week on a new fast track process related to the review and reapproval of longstanding medicaid and chip demonstrations. This will stream line the demonstration process and reduce the burden on states and the federal government. Additionally, we are going to award 11 million in grants to help states provide medicaid assistance treatment. Next week will make additional funding available for hundreds of Community Health centers to improve and expand the delivery and focus on treatment of op oid use disorders. That is 100 million in grant making so you have a sense that is large. It wasnt in my remarks. Im looking at the press person who will now go take care of the fact that i Just Announced that. Lets do it together. As we learn what is effective it is important that we share these best practices with each other and that is why the ngas Prescription Drug abuse academy is so important. We are also convening representatives of all 50 states. I sent a letter to you all for everybody to come together in september so that we can work to continue to build on that progress. I want to thank the governors for their leadership on the recent academies. I am confident this group will continue to do great work. I want to mention Something Else that is helping to change the system. And move us to patients at the center. As we transform our Health System we talk a lot about the best way to get people care and how to give doctors the tools they need to deliver the most effective highest quality treatments. But the revolution that is happening is also a place where we have a chance to change the very nature of care that we provide with more efficient see quensing of our own genes and the dna of tumors we can begin to personalize medicine like never before. Ived the opportunity to meet with scientists and patients. I was up at nih and met with a patient from south carolina. He came to the nih with Kidney Cancer in 1992. Like his father and sister he had a rare cancer with a mutation that is called the met mutation gene. It causes tumors to continuously grow. Since his first visit he had to have his kidney removed. On the other kidney he had 96 tumors removed. But thanks to Precision Medicine and our doctors at nih they were able to determine the genetic cause of that particular cancer and develop a treatment. At first that meant managing the tumors. They caused them to shrink. Eventually don received a trial drug and his tumors are now at the point where done lost his fath tore this disease but thanks to Precision Medicine don is actually doing just find. He sent me a note and said often the best thing you can do is give somebody hope. So some of the most interesting events h i do are with the scientists and patients doing this. They are in your state. Doing the science everywhere. I would encourage as part of this overall vision to meet with some folks. It is exciting interesting, and you see the vision of where we are going to go. Bmb i close i wouldnt be doing my job if i didnt raise the issue of expanding Health Care Coverage for many working citizens in your states. I think you know what im talking about. I want to emphasize that this is about your citizens financial and health security. It is also about the Economic Health of your states. In every state that has e if every state expanded medicaid more than 4 million americans could have access to care. These are lives that could be changed in some cases even saved. Economys actually benefit. In 2014 we reduced hospital uncompensated care cost by an estimated 7. 4 billion in the country and 5 billion of that reduction is estimated 68 comes from the states that have done that expansion. We know there are challenges but i want to make sure you all know that i am committed to working with you to find solutions. We welcome this conversation and we want to help you design a system that fits you and your state. One of my favorites parts about this last year has been building relationships with you all. I have had the chance to see your beautiful states, drink some of the best lemonade around and even be sent home with home made cookies. My children even got to eat doughnuts in a governors mantion and you know who you are, and it is official you are their favorite. What i said a year ago i still believe which is we wont agree on everything but we have more in common than we have in conflict. We have common interests. And because of that we share common ground. And a commitment to serve the american people. When we can Work Together, we can do some very grate things. So thank you all for having me back again. I look forward to your questions. [applause] the wrge accent. My twang is back. When you say sthats true. Second also, i think your approach reflects that combination of private sector experience and Public Service you have done throughout your whole career which i think all of us appreciate. So time for questions. Who wants to ask the first question . Thank you for your presentation. Really your desire to find middle ground with many governors. And to look for more flexibility. I have enjoyed our discussions in that regard. I also appreciate the connection you have to arkansas and the time you spent there. I might have missed it but i wanted to give you an opportunity to comment if you havent done so on the you mentioned the 1115 waivers but i would like for you to comment also on the 13 32 wravers. Because theres an understanding at least in my neck of the woods that the 13 32 waivers was designed to pro vide more innovation type grants, a broader arena of grants or flexibility beyond simply the traditional medicaid. But can you comment on your approach to these waivers and what guidance you can give the states. So in terms of 13 32 versus 1115 1115 are waivers that are focused on medicaid. 13 32 are the waivers about the marketplace. If you go and look at the legislative history, the legislative history and those that promoted 13 32 waivers were about those that wanted a single payer option for states. So that is not necessarily what 13 32 is or will be about. What 13 32 is about is about an ability to actually meet the objectives and goals and it is set out in statute pretty clearly in terms of budget newt ralt affordability, access that is happening through a marketplace approach, an exchange approach, an approach where a citizen in your state receives a tax subsidy if they are eligible to go on to the marketplace and have health through cost sharing and tax subsidies. If a state can figure out a way to meet those conditions and it is pretty clear in the statute in terms of the affordability it is about the quality it is about the access, and it is about the budget newt ralt, that we want to give states that opportunity to come in. We recently in the last week have put out additional ways in which states can come in and have these conversations with us. I think you all know they dont kick in until 2017. But i think it is probably pretty important that that, the 13 32 application to medicaid funds, that waiver isnt its about the other piece, the subsidies. And that funding. 1115 and we want to work to be flexible as i have indicated in the 1115 space in terms of thinking about how you spend your medicaid dollars and how you think about innovative ways to perhaps advance that program so they are different. Thank you. Virginia is one of those states we havent closed the gap. I could save my budget 232 just this were. So were working to a way to get it done. But i want to thank you and your office. We were successful on the state mile for innovation. This is driving no vasion reform in virginia. What is the possibility of continued funding for these types of grants to help us do the reforms at the state level or some mechanism like that . So at this time i dont think we have a plan for round three. I think many of you know weve done rounds two and thats something that i think will have to go back and look. One of the conversations thats happening right now in washington which is an important conversation that not much attention is paid to right now certainly im sure you are focused on a transportation conversation which is an extremely important one. But another one that is very important to all the states and to the nation is the actual budget conversation. And i think you all know that right now current law is a sequester level. So some of these questions will be answered as we move forward as part of these conversations about where we are and where were going to be. Im hopeful that there will be another equivalent of a ryan murray approach and that we can move forward but that has not yet happened. That is not the specific answer to your question but certainly as we think through things it is related. Delaware also received some grants that have allowed us to accelerate significantly. My question which means improving access, improving quality and cutting the cost curve. Were encouraged by how all of the stakeholders are really at the table and working together. My question is really around the cost issue nationally. And certainly some of the stuff that ive been reading recently in terms of National Health care costs and rates it seems like there are a lot of increases around the country. Despite efforts under way in many, many states to try to move away from that fee for Service Model im wondering if you can comment on that. I think with regard to the issue of overall costs and whether it is costs in the private market or markte, what we have seen is medicare what weve seen theres an article by kaiser we have seen some of the lowest growth on record. This weeks article said 50 years in terms of the question of per capita cost growth. And in medicare growth having done the Trustees Meeting over the last 5 years to give you a sense in the last five years medicare costs growth has been at 1. 2 . It was the four years before at 3. 6. Thats still growth but downward pressure. Theres a second part of your question that i think we are all hearing a lot about the issue of race in the individual market. Whats interesting is one of the things about the Affordable Care act was the question of transparency. So that things have to be shown in the light of day because i think we actually believe that the light of day is an important market function because thats how people get information. So what happens is now in each of your states if any insurer is putting forward rates above 10 they have to be made public. It has to be listed during the review period when most but most of your states review those rates. So thats what comes out and causes a lot of the conversation that is happening right now. The insurers have said that they believe that the people that will be in the marketplace next year and this is just the individual market it will be below 10 . We know that the rates that originally come out come down. We know a number of states can look around some of your rates are out governor youre actually in a state where were seeing very, very good rates and downward pressure. So i think we need to wait and see until theyre finalized but i do want to say one other thing. Its something obviously we spend a lot of time on. The question is the cost and rates and pressure. Something we want to watch. We want to make sure were on top of. One of the things i would just mention, as i look at the numbers as a payor in the outyears in terms of the cost in medicare, because it will probably be reflective of what also happens to the market in my conversations with ceos and others there is some pressure in the drug space. The one thing i would say is i think there are a number of things we think light of day is important for that in terms of knowing what drugs are costing and how much so thats something the public knows and understands. The other thing we have asked for these authorities is for Medicare Part d can we have the authority to negotiate. As you mentioned, governor, i spent time at walmart. Its a place that negotiates with its suppliers. And uses the power of the market to actually put downward pressure on price. So its something were watching. We want to keep an eye ofpblet we always keep an eye on. I think right now were watching but the conversation isnt reflective of the entire market or where this market will end but we want to be cautious as always. I mention that other issue i think we all need to focus. We certainly appreciate the year of your service youve had great outreach to the states and your team worked carefully with wyoming as we were trying to expand medicaid, which was a closs al failure by the way but they blame the governor so thats ok. As you look at health care in the states, in the country, i think one of the challenges we face in wyoming is we are a very rural state and our challenges are somewhat different than the larger states. Just on economies of scale before the aca we had 12 or 13 health Insurance Companies in the state. We have two now because some of the lists were just too big. The same is true on some of the systems necessary for payment for example. And we look to partner with some other states. We can eng there are some opportunities to do that. So just a general question. I think that Rural Health Care and rural states within our native american populations there is some unique challenges and we are working to find some of those answers but i would just encourage you and your team to continue to recognize that there is some differents between large metropolitan areas and the health care and rural areas. Just in terms of distanses and how far you have to drive when your son has a broken arm and those challenges. Its not unique. Its not new. This has always been a challenge. But certainly for smaller populated states we continue to be very concerned about we have some different challenges than large states. I agree and recognize that there is a difference. Being from West Virginia and being from a state where we have a large rural population it is something i understand and recognize. Certainly we dont have the geographic expanse. I look at some of the states. Like your own. But similar types of issues with regard to concentration and that sort of thing. And i think its when i sit in my seat and were doing rule making the one thing hopefully you will be pleased to know is now the centers for medicare and medicaid know they can not bring a single rule in for my review without telling me the impact on Rural America. Because it is hard to figure out. Or when the announcement that i talked about the hip and knee bundling announcement, it is in 75 markets. But for a market to be chosen because its mandatory the market had to be of a certain size because you had to have enough of a population that you could act warely spread what it is doing. So we had those specific conversations. The question of in Rural America how do we work to make sure in places where there is just not as much complettigs thats one of the things, how we create working markets i think is a challenge but it is one that we want to work with you all on we want to think through how we can do that. And hopefully so you know it is something thats one of the things that they now have is a list of things they have to talk about because im going to ask it. So you may as well be prepared in terms of what is the impact on rural markets because the markets are different and how we think about that is something were just going to have to figure through as a nation that we think about it in terms of markets but they are different and very regional and local. You all know that in terms of even within some of your states theres a difference in terms of what the market looks like. Thank you madam secretary we are honored to have you here. And i know that many are still having ongoing discussions with you and your department that i certainly want to express to you personally and to your staff. The professionalism. Youve been cordial and willing to listen to our issues. We thank you for that. You said something that i was kind of taken with. That is that we have more in common than we have differences. I agree with that. I think what we have in common is a very similar goal as republicans and democrats. And states in washington, d. C. To serve our people as best we can. The goal in regards to health care is to make sure that as much as is practical or possible to provide Health Care Affordable High Quality Health Care to all americans. Where we sometimes have a difference is how we do that. That is part of the debate. Youve talked about the need and the opportunity for us to have waivers or get more flexibility. And sometimes i think as we deal not specifically on this issue with you, like burger king you cant have it your way. You have to do it my way. How do you determine when it comes to the Health Care Issues when you give waivers and flexibility how do you determine how much leeway you will give to the states . How much will you let us try our own way as opposed to having to do it i dont want to say your way but under the Affordable Care act where theres flexibility how do you determine where that line is going to be drawn to give us the flexibility that we would like to have as states . Usually in making those decisions and whether its in this space or any of the other spaces that one is working, you know, in terms of the decisions that we make across a wide range of issues well beyond 1115 waivers one turns generally to the intent of the statute and the intent of the policy. And this is about what the core issues are. As we think about what guides where those bright lines are, it is often about affordability and access. That is what the additional funding was about. That it was about creating a better match more enhansd money for states with in return providing broader access that is affordable. And so that kind of gives you but usually when we think about these things what we try and do is go to what is the core objective. And generally speaking as we have the back and forth try and find the places where we can be the most flexible about those things. And where it hits up against some of the Core Principles thats where we come to our places. And i think similarly for you all. And i find that in all of my conversations with you in terms of there are Core Principles that you have trouble moving beyond and even if i would like to do it a different way. So with a try and do is find that space because it is a negotiation. And thats what these are. I think when i came in actually our colleagues some of my colleagues it would have been much easier at medicaid if i just put lines, if i just and there are a couple places where i think you know some of our lines but if i just outlined it and made it this is it. But i dont think thats what gets to our ability to listen and hear. Because i can look around this table and some of you have come in with innovative ideas that we havent thought about. Things that like i dont know if it will work. But actually theres enough evidence and enough logic to indicate we should try it. And so trying to create that space for that is what we worked to do. Thank you for your incredible access that you have to governors. I have visit and cookies and lemonade. I hope you enjoyed it. Those are the ones i got to take home. We had a good time. First of all i want to congratulate you and your comments on your focus on Mental Health and i include that on addiction because i think thats one of the most serious issues our nation and our states are facing as governors have found out as i have found out in my 21 2 years as the addiction issue is ending up in our county prisons, in our emergency rooms, in our state prisons. Thats not the solution. We have got to come up with a longterm partnership with the federal government local government and everyone involved to deal with this very, very serious crisis. In fact, we had a previous seminar talking about the drug problems that we are having with synthetic drugs and everything. And it is getting worse. So i commend you and we want to work in partnership to come up with a viable solution. Two quick questions for you. One is i would love to get more information on the consistency on Medicaid Services across all states. We are having a debate within my own legislature on what level of service you get for medicaid covering certain aspects of medicine. Were fairly liberal in that aspect in north carolina. And of course some legislatures who want to continue to increase and others say were covering too much. And i would be curious if you have any consisten benchmark across states on medicaid coverage. The second thing is you have been nice enough to have us you had us visit with the president in the oval office and we had a very frank discussion and a good discussion on many things. One was about waivers and one issue im not sure if the line has moved at all is we are attempting to look to see if there are waivers that we can get for ablebodied people to require work or training in order to have Medicaid Expansion. We did this in Public Housing when i was mayor of charlotte, which was very effective. And we just want to know if there is any more flexibility. Or is that the line drawn in that area . I welcome again i want to congratulate you on your reaching out to us in an honest dialogue. So on the first question why dont we get back in terms of the benchmarks and how different states in terms of service levels. I think that might be something well get back to you and your team directly on. With regard to the question of work and how we think about that particular issue with regard to health, in terms of one of the things that i think is an important thing that actually i think both sides agree on quite a bit that was an important change, is that preexisting conditions shouldnt keep you from an ability to get health insurance. Again, maybe how one gets to that maybe but i think thats an agreement. And the idea that health care is not a conditional thing. And Health Care Different from a number of other things, different from tanive. I think you know that is operated out of the department of health and Human Services but health care is actually different. But having said that i think we think that there are incredibleably strong ways because we are with you on work and thats a place where i think we would like to see. I mean, it would be great to have people working and earning a wage that we didnt need we just as soon have people in the market beyond. And so the work idea and work concept i think we have a number of places where we have worked with a number of you all to get to a place that has innovation that drives this in a way that will get more people through your Work Training programs than youve ever seen. And so look forward to being able to have that conversation. Because i think we think we can get to a part a portion of what you want, which is i think you want work encouraged. Which is at the core of your comment about that. So i think we think there are ways to do that. Governor. Thank you secretary, for coming once again to our meetings. Its always a pleasure to be able to listen and have a dialogue with you which i think is very important. You have one of the toughest jobs in america. You certainly have had a tough job this past year. So thank you for visiting with our governors. A couple of things that i want to commend you on. One was when you were talking about paying for outcome versus volume of time someone sees a doctor. Were all about improving the health of our citizens and making sure what we are doing is working versus just what we hope might work. So thank you for that. Also interesting your comment about trying to fast track some of the waivers themselves. And if i remember right one of our requests from many of our governors if not all was if we had a waiver that you had already approved in the past, if you would consider being able to continue that improvement of that waiver because you had already done it sever times before. So like in the state of oklahoma we have a Great Program called insure oklahoma where we have a threeway match of the medicaid money the person paying a very small portion of their insurance and the employer pay a portion of it so there is buyin from everybody coming back to the question about working and paying and youve approved that for a third time. Which i am grateful for. But i think at one point in time many of us talked about if we have something thats already working and innovative cant we go ahead and make that permanent versus every single year trying to reapply for that. So i continue to ask for your conversation of that conversation of that. On the Prescription Drug Abuse Program we had a great session that governor mccal yuff and many others led us through today. But one of the things we have done in oklahoma is pass a prescription monitoring bill to help stop doctor shog in the state. It was hard to do. It took me about three years because doctors didnt want to some didnt want to have to spend the time away from seeing their patients to check this and check that. But could we not do that like for medicaid recipients, that under federal guidelines certainly under state guidelines if someones on medicaid and receiving pain pills that you require a doctor to check it every time before they give that continued addictive oipyoids . That might be something to consider. Then the last thing i want to mention, we talk about rising costs of medicaid and expenses to our state which has always been a huge challenge for all of us. Were in one of those states that over the last couple of years weve seen our unemployment drop really low. When our per capita income went up our f map funds went down and so we had a huge drop about 90 million but yet our costs went up 130 million then we grew our population. So we have more people coming in to the system, less money from the federal government because our economy had changed. And so now were going through another economic downturn with the energy sector. Yet were still really short. So something to consider. Thank you. And i wont touch all all of them. Figuring out how to make the program encourage movement to Economic Health and people being able to be in the private system where possible is something we want to continue to think about which is part of how the reductions in funding are about trying to get people to move and encourage economic growth. On the opoids i would mention almost every state has one. And in the conversations that ive had around the country with a number of you all its just really a very important enforcement tool and the ease of the tool, the ease of being able to use it how quickly its updated. And then the other thing some states do it some dont is the relationship with other states. Because people border shop. And so thats another issue that we need to work on. I think bringing folks together because one of the things when you talk to physicians about how easy it is or not to use in terms of the system. If youre asking a doctor and you say how many clicks when youre seeing a patient, you know, you dont want to spend that time checking. So thats one of the things were working on. Your idea of how we can encourage and influence people with regard to our Payment System thats one we can look into. But i do think we need to get to the space where physicians are trained with most of the physicians when i ask and i wont ask in this room. How much training did you actually receive in pain in terms of treating pain . And thats one of the issues. And so were working very hard. And i think we had a representative from the c. D. C. As part of your panel because we need to issue the new glines. But then we need to guidelines but then we need to make sure that people are trained in them. We hope we can make progress. We heard a tragic story of a young woman who had gotten her wisdom teeth taken out took too much of the Prescription Drug after her wisdom teeth became addicted. After only months it became cheaper, easier, and better to use herwin and just the trajectory. The good news is its four years shes been clean. Four years clean. But if we can stop that journey because there were many other stops along the way in terms of what happens in that picture. For the nation as you said, governor, were just seeing it everywhere. And its not geographic any more its not social yo economic. The number of people that you all probably know whose children have some of these issues, you know, im sure everybody in this room does. So one we really want to work on. Governor walker. And then governor nixon. More of a comment than a question. First thank you for being here for the second time. I appreciate your presentation in washington in february. And that began a process with me. As you know a week ago i began the process for alaska to become the 30th state to accept Medicaid Expansion and i share it with the concern about talk about rural. Were pretty rural too. And our methods of getting to our those that need care dont always involve a road. In fact it seldom involves a road. I just want to thank you for your passion in this area. And for your staff and your access. I mean, i know youre the person that gets it done but boy they are the ones that answer the calls as well. So i really appreciate that. We feel sometimes we are a little removed from sort of mainstream america so to speak. And we are. We dont reach out to neighboring state across the lines weve got russia and canada so theres not a lot of option there is. But we do feel when we have a need washington has been helpful to us very much. So its a process that i have begun. We have 45 days to get through before i can actually sign it. And but we appreciate your helping us this far and look forward to working with you over the next 45 days and beyond. Thank you. Thank you. And thanks for your leadership on this issue. I appreciate i will stipulate to all the thankings. Youve really reached out and worked very hard and we really appreciate not just you. You set that mentality through the entire of your department. On behalf of all of us we feel that at a lot of levels and appreciate it deeply. Hence, this feels a lot different than a congressional hearing, i would imagine. Thats on tuesday. That will be on tuesday. Ive talked to actually a number of folks from your states yesterday in preparing. Weve not yet succeeded in the important task of expanding care to working mosens. Theres an old horse term sometimes you let the bridle out sometimes you have to use the whip. As you look at Cost Containment looking forward, you have some triggers that are difficult for states and difficult for hospitals and Everything Else that are built into the Affordable Care act. Whether it is on reimbursements for medicare, equaling out payments. Or the disproportionate share. Give us a sense how much pressure youre under to use those tools while being very politic in your comments here in front of all of us and the cameras. Literally, i think that some of the folks dont think that is going to happen. Whether it is a year or two years from now that is going to happen. And it can cause the delay of those instead of having it smooth in could cause a cataclysmic effect on states that dont move in in a timely fashion. If that becomes a cliff it has a very cataclysmic effect in rural areas and other underserved areas. So my ability to predict on this one because i think it involves two thing that is i probably dont have a lot of say. One is one year, five months, about i think 10, 15 days is all that i will be here. So most of the decisions youre talking about will be at a period where i will no longer be here. The other thing i would just say is as you know, the congress is engaged on these issues. I think part of the way to so my ability to predict i think the one thing we think about it as a nation, because i think we should be focused on these. Its if it was a congressional decision to whether to adopt it. No. To turn it off. To date it has been turned off. So when the congress has previously taken action,. To extend. Right. And so the question of whether they will do that again is just something that i am not going to get the question really is, and you dont have to answer it here. But the question is whether the administration is going to ask them to continue to extend in a budget document presented to the congress this year or not. With regard to where we are going to be in the budget i actually will be reviewing our mandatory proposals in the next coming months. But i think the broader issue of how we think about the issues of Cost Containment, why those provisions were put in is because it was thought that it would be more Cost Effective to pay for uncompensated care and indigent care through a systemic approach in the states. Instead of the way that we were doing it. I think there are a number of tools that exist some of them youve mentioned a number of them. There are a number of states that have low income pools. I had a very public conversation with one of your colleagues in florida about these issues. And so how can most cost effect ively help low income people have access. How that plays out in the current environment is something we have to evaluate as we go through it. Thank you. The experience in kentucky could be enliggetning i think on a couple of these issues. Competition. Before we fully implemented the Affordable Care act and expanded medicaid we had two companies in the state that would sell health insurance. We now have five. That was that obviously is encouraging to us because we have been working for 20, 30 years trying to get other companies to come in. We just had no success in it. Now, we have that kind of competition. The second thing regards Rural Health Care because were a state of about 4. 4 Million People. A lot of our folks live in rural areas. And we particularly have always had issues with Rural Health Care with rural hospitals. And how they can stay open. As the demographics change. And we have gone and our hospitals as a whole have gone from about 25 uncompensated care to about 5 . And our rural hospitals, our small rural hospitals have particularly benefited from this because for the first time in their memories and in mine theyre in the black. Their bottom line is actually in the black because theyre getting paid for the care that they are delivering. Now, theres still a lot of problems with Rural Health Care and were going to continue to juggle those. But at least from a revenue standpoint having expappeded medicaid is has been a boon to our providers in terms of getting more money into their pockets its been a boon to our economy in that before we did it we got Price Waterhouse cooper to come in and project what was going to happen and whether we could afford it down the road. And they projected that over eight years we would create about 17,000 new jobs and have about 15 billion infused into our economy. Well, with implemented based on that. And after the first year i said lets go take another look, because now weve got actual numbers. At least one year of hard numbers. So i got deloite consulting to come back in and take a look at our first year. Well they came back and said were sorry to tell you that Price Waterhouse coopers was wrong. They told you you were going to create 17,000 jobs in eight years. Youve already actually created 12,000 jobs in the first year in the health care area. And that it looks like youre going to infuse about 40 billion into your economy over the next eight years ininstead of the 15. So for my friends who are concerned that, number one, the federal government may back up at some point and not do their part, or that these numbers at some point may change and we cant afford it, you know, my message would be this. You can stop. You know, the court case says any time we want to we can stop. So if either one of those things happen, you can say, we cant do it any more because we cant afford it. And in between now and if that ever happens a whole lot of people, 400,000people in kentucky are now having Health Care Coverage most of them for their first time in their lives. So its just if you can get past and i know a lot of legislatures have trouble just because of the name of the act. But if you can get past that kind of politics, this is a winwin for both of your people and your economy. Because youre going to create a lot of jobs and put a lot of money into your economy in addition to improving the lives of all of these people. There are screenings for cervical cancer, Breast Cancer diabetes, you name it, have gone just like this because for the first time these people can get these screenings. And what thats going to do is its going to cut down on the big costs down the road because when they werent getting the screenings the first time we had seen them is when they end up in the emergency room or inpatient stays in the hospital. Now were able to work with these people to teach them how to take care of themselves. And to take responsibility for themselves. Thats part of this deal. Is that your citizens need to learn how to do this. And they really want to know how to do it. Thats what were finding. So if there are ways that you can massage things around and get to this point, its going to be a big benefit to the folks in your state. Thank you so much. You want to come up to virginia for a couple of days . I could use that. All right. I think weve almost worn out the secretary. I didnt see any more questions. On behalf of the entire organization i want to express our gratitude for all of your engagement with all of us over these past couple of years. We really appreciate it. Thank you. [applause] i will look forward to working with you all this year on a range of issues that i hope will not actually im looking around this table and i didnt have to call any of you about ebola. Some other issues. But i hope that we will have a good year moving the ball forward on the many, many places that we overlap and the many places that we fund. We want to hear from you. We want to know when were getting it right and wrong. I believe we have much bigger spaces of commonground than we do places of disagreement. There will be sole of those and i know that but i think we can work on a lot of areas where we can move the ball forward. So thank you and thanks for having me again. Thank you. Washington journal is next with your calls and this mornings latest headlines. Followed by newsmakers with Harold Rogers of kentucky. Later secretary of state john kerry joins Energy Secretary ernest missouri yizz and secretary jack lew to testify about the iran agreement at a Senate Foreign relations hearing. Also and jason discusses some of the issues facing the u. S. And cuba now that relations have resumed. Host president obama finished his trip to kenya abdicating his country choose a path to progress and be more inclusive of women and girls. The senate meets at 2 00 this afternoon to resume work on the highway transportation bill. The bill had passed with fund, road and bridge projects for three years and if legislation does not pass the fund will run out by the end of the month. Well discuss more about the bill and the political back and forth but in light of todays meeting on transportation, we want to hear from you about the best way to improve public