Transcripts For CSPAN Capitol Hill Hearings 20130925

He has been on the floor for 5. 5 hours. We will show you some of his speech over the next couple of hours. You can continue to watch it on cspan two. We have put up a poll. Speech ond cruzs defunding obamacare. Here is the poll. Do you support ted cruz as he speaks in the u. S. Senate to defund Health Care Law . 1225 are in support voting against 394. We will also give you a choice chance to weigh in on twitter. Were also looking at some of the congressional reporters. This could be a late night up at capitol hill. It was a tweet a short while ago ed okeefe. The way you join that conversation is the cspan tage page. The senate takes its first procedural vote on the stopgap bill. Wednesday will vote and likely overwhelmingly to limit the spending bill. We will get to the u. N. Speeches just a it later on. Back to the senate, ted cruz cruzs speech. One thing we learned from henry that it willts is be short. Comments. Nator reeds we will hear from the republican leader after that. The senseless, nonending talk from my republican colleagues about the cr and the untoward. Ng is really it involves to shutdowns the cr, of course, the debt ceiling is even worse, the full faith and credit of our country. The United States should pay its bills and we should pay them on time. I want to be very, very clear again. The senate will not pass any bill that the funds or delays obamacare. It will not negotiate on any means or anyway on extending the debt ceiling because that deals with paying our bills are in the full faith and credit of our country. The last time they took us down this path, it cost the economy billions and billions and billions of dollars. Business groups, all report look only mean, and the chamber of commerce, the Business Roundtable, they say it is really terrible it they keep talking about either one of them and certainly not doing any one of them. Business roundtable said it would be calamitous. That is pretty descriptive. The best way to stop lurching, lurching on this crisis till next crisis get back to funding the government our father our Founding Fathers intended. We should discuss at great mikulskith chairman and murray whether there is any possibility of funding the government areas they believe there is. They have had conversations with some of the republican thatagues, so they believe the funding running through november 15 will provide a greater opportunity for the appropriation bill to pass the senate. I agree with them. Will file in the next day or so will prevent a shutdown through november 15. It appears that a feeling thing we are going to change at this stage, the date. We will take all of the rest of the stuff out. That, that is the change. Were going to strip out the obamacare language, the china first language, we will get rid of that. I repeat, or have been signs from the republicans that there is an opportunity to Work Together in this process and i hope it will bear fruit in the coming weeks. Thereing is very clear are a number of Senate Republicans who recognize that the Tea Party Agenda is wrong for the country, wrong for their party. I hope that these Reasonable Republicans will prevail on their colleagues in the next few days so that we do not have to shut down the government. The people are who pay the price. Well, if we go by all the time involved, we will finish sometime on sunday. I set on the floor today, in my statement that i gave on the floor, that if they want to collapse the time, fine. As i said on the floor, i want everyone to be very clear. There is no filibuster going on now. People can come and talk, but they cant do anything to change when we vote on the next boat or it if they want to collapse the time, i hope they have a successful caucus. They will say, lets get down to action. The other thing that should be concern to everyone. If we finish this on sunday, and we send it to the house, they are talking about changing it again. That is a surefire way to shut down the government area we are waiting on what they have to say. If they want to collapse the time, fine. It will give us time to go back a little earlier. We will see. Talk like a to College Professor here, but listen it doesnt matter what that top number is. Let sale was 100 trillion. It doesnt matter because the only thing that matters is january and the sequester. That is what it is all about. ,he 988, we take all that because nothing is that consequential until we have sequester which kicks in automatically in january. I for that some of your colleagues are bitter because they want to try to offer the. Nergy bill again this is kind of a interesting kind of interesting. Were not going to vote on that again. They had an opportunity under the Energy Efficiency bill. Obviously, that is nothing because they did not want that bill to pass. As you remember, they had that amendment, another nonhumane one, they were up to five of them. We can keep pushing this maybe it will help him get elected governor, which in my mind would not be a bad deal. They want the number 1058 and you should send it back to house but that does not matter. It is sequestration that matters. Sequestration is where the problem is. I am sure that none of you have do, to watche i the news hour. Last night they had a really good piece about obamacare and about Small Businesses. After watching that, it only maybe feel more strongly about how important this is for Small Businesses, for people without insurance, for people with insurance. I think that obamacare is a great thing for the country and people are excepting this trip as you know, this. As you know, as i talked about the floor o this morning. The numbers are looking pretty good. This is just like medicare. People complained about medicare in nearly 60s, but once it came into effect, people understood how it worked. Prior to medicare, 40 of the seniors they came in to the hospital had no insurance and suffered as a result. Medicare came into a building, 99. 99 have it. I think that obama will obamacare will be the same. Thanks, everyone. [no audio] it was words at were explaining it. We arewas wondering was, on a continuing resolution and i am not sure that people out there understand what it is. It means that we fail to do our job on time, that we should have. Ad 12 appropriations good afternoon, everyone. We are moving forward to not only invoke cloture on the motion to proceed to the house to the bill that the funds obama bill obamacare, that does not respects theand top line of the budget control act. Cloture will be invoked on the bill. I will be supporting that and i think other members of our conference will. Hishink that what the help house has sent us is what we wanted. Taxes and itse defines obamacare. Defunds obamacare. So what happens after culture is achieved on the resolution, senator reid has set his red straight democrats a red state democrats to fund obamacare. I think the focus needs to be on redis it that we cant get state democrats that can read the newspaper, watch the television, read the internet traffic just like we cant that shows obamacare has been a dismal failure. Haveu like what you can , you cant keep it. Premiums have gone up 2400 for the average family of four. And is why organized labor ardent advocates of obamacare are asking the president and his party for relief. I think the focus, once cloture is achieved on the underlying goal to defund obamacare, which we will have a strong vote on, bequest or not to be, why cant red state democrats listen to your there listen to their own constituents . President sd the Energy Policies are a onetwo gut punch to the middle class. Policy which is essentially an energy task on consumers. Economy which has the lowest Labor Participation rate in the last 34 years, and take home pay, average house called is down byd income 4000 a year. Now, there is a new National Energy tax. It will hit middleclass americans and families squarely in the gut. Thats the last thing that we need right now. Will getolicies that people back to work, that will increase the takehome pay for middleclass families across the country, and well get this economy growing again. You can do that by permanently delaying or repealing obamacare. You can do that by passing the keystone pipeline, which is something that has been hanging around for a long time. According to the president , it would create 42,000 jobs immediately. Thatan also stop this tax the president is trying to put on the middle class economy. The middleclass family needs a break from obamas policies. Well, one of the papers this morning talked about obamacare and said one blow after another. It had a picture of a pill bottle, there, and it said, promises and realities. Many of the promises that the president made are just not coming true to the American People. This afternoon in new york city, the president is going to be the ambassador,for his if you will, or his secretary of explaining things, bill clinton. The two are going to be in new york try to ask wayne away all the problems of the Health Care Law. I am calling on present clinton to be honest and apologize to the people who are being hurt by the Health Care Law. Many people who have parttime jobs, whoever had their hours cut, so many spouses who have receivedho have insurance through work are now going to be cut off from those policies. Also, the young people that are asked to pay more for health , in many insurance cases they dont want or need. They are being forced to do that. Neighborsto the union said that ifen he thekeep your insurance, rates will come down. I want them to apologize to the American People and the damage they have caused. Senator kruse argues that what he is doing is fighting for a very powerful and vocal part of your party. Effectively, he is saying that because youre not standing with him is business as usual. Look. I think we would be hardpressed to explain why were opposed to a bill we are in favor of. It strikes me as a nobrainer. Im not reluctant to explain voting for things that im for. Hat is the way i see it i am hopeful that the majority of the Republican Congress will see it the same way. I can only speak for myself. Senator reid just said he would like to extend the until november 15. What do you think about that . I think that is something for the majority leader and the speaker to work out, as to what the appropriate time is for this extension. I just wanted to be appropriate and acceptable for the house and senate. Will republicans peel back some time if this gets done sooner than sunday night . Object tosenator can any effort to shorten the. Rocess for i in my opinion, it would be to our advantage to shorten the process. If the majority leader were to ask us to shorten the process, i would not object. The not know who else in conference would feel differently, but i do know that if the house does not get what we send over there until monday, they are in a pretty tough spot. Havingview is, the house asked a bill that i really like and intend to support, i hate to put them in a tough spot. I would prefer the 967 level. Your is how the house looks at. The houseefer would prefer that we stay at the current level of spending. If that number is not achieved, we will fall back tonight 67 at the end of the year. Personal preference would be to stay at 967, but they are right when they say we are going to be pushed back to that at the end of the year anyways. Thank you, everyone. Republican leaders from about 2 30 eastern this afternoon, just as the senate was coming in halloween there weekly lunches, it was just about the same time as ted cruz started his speech marathon. This is part of the continuing resolution, the funding the federal government through the sever 15th and the funding the 2010 Health Care Law. I had, we are going to open our phone lines to get your opinion on it. You can follow ted cruz on c span2. You can find cspan radio on Xm Satellite Radio as well. Oure keeping an eye on facebook poll as well. Here are the tally so far. Working hundred two owning yes 400 plus. Against is we are on twitter. We are using the hashtag cspanchat. Here is one that says employers all over the country are cutting employee hours and tens of thousands of jobs because of obama care. That is cspan chat, cspanchat is the hashtag. They were looking at the issue of ted cruz on the floor. Dont call it a filibuster is the headline in roll call and we will try to get in that in just a bit. Where were taking you next is comments on the floor as he opened this afternoon. Madame president , i rise today in opposition to obama care. I rise today in an effort to andk for 26 million texans four 300 million americans for 300 million americans. This country, americans are suffering because of obamacare. Obamacare is not working. And yet, fundamentally, there are politicians in this body who are not listening to the people. They are not listening to the concerns of their constituents. They are not listening to the jobs lost the people forced into parttime work. Texans, a great Many Americans feel that they do not have a voice. Play some very small part in helping provide that voice for them. Madam president , i intend to speak in opposition to obamacare. Ofntend to speak in support the funding obama care until i am no longer able to stand. Do everything that i can, to help americans stand together and recognize that this grand experiment, three and a half years ago, is quite simply not working. I also went to say at the outset that i am particularly honored to be standing sidebyside with my friend and colleague, senator mike lee from utah. Senator leahy has shown a Visionary Leadership in standing mantle ofing up the the funding open defunding getting rid of this train wreck of a law. There is non, senator in this body, republican or democrat, who is more principled, who is more fearless, who is more and willing to fight for the principles that make this nation. Reat then is senator mike lee it is a singular privilege to serve with him and to stand sidebyside with him and so and others in this body, even more importantly, so many millions of americans across this country. Problem in washington. The problem is bigger than a continuing resolution. It is they are then obama care it is even bigger than the budget. The most fundamental problem, the frustration, is that the men and women in washington are not listening. You talk to the man and listening on the street, that is the message you hear over and over again. Why dont they listen to me . Why dont they hear what we have to say . They are to listening to the millions of people democrats, republicans, libertarians, across the spectrum who say their elected officials get to washington and stop listening. We just had a six week recess during august. Astantial members substantial percentage of members chose not to have town halls or in they did not even give constituents a chance to say their views, because it is very easy when those of us who office have been here for a long time, to know that washington knows better. To believe that washington d. C. Holds all of the answers and the rest of the country is, as is said of small children, seen and not heard. We need millions of people to get an answer for it millions of forle are asking responsibility and accountability from their representatives. Time, quite simply, to make d. C. Listen. Madam president , as a point i over and over again. We are trying to get the American People to make d. C. Listen. The whole debate we are having here today is not over strategy. It is not about process, it is not about procedure. If you read the papers, it looks like it is. Confusingsorts of anyonethe whats outside of washington dc, their eyes glaze over. Even some people in d. C. , their eyes glaze over. Atted cruz as he started 2 41 eastern. He continues on the senate floor. Were covering that live on c span two and on cspan radio. Here on cspan, we are going to open up our phone lines to see what what you are getting from senator cruz, what youre hearing from democrats and republicans on the defunding of obama. The language of the bill would defund the Health Care Law and the senate takes it up now. They will face a vote tomorrow on the cloture motion to proceed. That is coming up new coming up at noon. For democrats, 202 7370001. For republicans, 202 7370002. Others, 202 6280205. Joining us from capitol hill, sun min kim. How long is he going to speak . He told the cspan audience and the rest of america that he was going to talk as long as he can. Now we are looking at this long speech from senator cruz, we all think of that filibuster mounted by his ally in the senate, senator rand paul. He went on for about 13 hours. If ted cruz wants to be back, youll be up till 3 30 at least. What is he trying to do with the speech . Right now it is not a technical filibuster. Delay a vote, to basically a delayed in delaying tactic. The votes are already locked in. Ted cruz, he can talk as much as he wants but he is not going to delay that. What he is trying to do with the speech right now, and the other republicans who joined him are trying to do, is bring attention the eshoo of the funding issue of defunding obamacare. It is galvanizing the grassroots. It is among those who really hate the president plus Health Care Law. That is ted cruzs goal. Public, it isader sending a strong message from ted cruz to the rest of the country. If it does not affect the timetable, what does it look like Going Forward . Sometime midday tomorrow, you say, what does it look like going into the weekend . We have a lot of procedures that have to go on. We stick to the clock that is essentially laid out. Were are looking at a final sometime on monday. They like to do what is yielding back time, which is basically giving up time that they have allotted to debate the defunding bill, basically speeding up the process. An attractive option for republicans because as soon as it goes back to the house, it actually gives the House Republicans over there more time to make changes and increase the likelihood that the senate would be able to take up any changes that the house sends back. If Speaker John Boehner and his Leadership Team get the funding bill on sunday evening are month or monday morning, that really jams the idea of a shutdown. Your colleagues are reporting Late Afternoon that the house may attach obamacare delay to the cr. This is when it comes back to the house. What can you tell us about that . Is in the tentative stages right now. No decisions are made. However, especially the timing, if we stay on the schedule that , this really out does increase the chance of a Government Shutdown. There are a lot of to see jewel things they have to go through and basically you leaves them no time to take up anything if the house sends the senate back anything. House republicans think that this is a delayed. It has been a smart strategy for them. Is an issue that does not just get one or two of the moderate or conservative House Democrats. I believe that about 30 House Democrats would support it, inking at moderate democrats swing districts were obamacare could be a problem for them. Measureching it to the like the government funding resolution is what makes it a risky gamble. Kim covers for politico. Thank you for being here. For the next 10 minutes, we are going to hear what you think of ted cruzs effort. First we will hear from justin in indianapolis. Caller how are you . Independent, there is a 30 year shuffle between being a independent and being a republican. Been an independent is comforting and it is inspiring to see a representation of our voice. I think that what ted cruz is doing right now is really getting into what we think and what we feel. It is a good change. I think the winds of change are coming where we can have our voice be heard. We are not a heard in the United States of america. Are voting and our opinion counts. Host are you seeing any implications repercussions from the indications of the Health Care Law . Caller i think that hospitals are going to be paid less, i think that doctors are going to be. Going to be paid less, i think the quality is going to suffer. Thanktin, think you you for your call. You are seeing a senator on the floor who is relieving ted cruz so we can go to his desk. Other senators have come to the floor in the afternoon. Aree are about they about six hours in. Now we hear from michael, a republican caller. Caller the reason i called on the republican line is because i could not got on the other line, tt i completely agree with ed cruz here. He said wecame in, were going to help the middle class. 95 of the increase has gone to the top one percent. What about the middle class . We are still suffering. You forchael, thank your call. To the democrats line, this is allen. Caller yeah, hi. I support ted cruzs conversation 100 . I wish more people would get out there and actually bring the subject up. This is the closest ive gotten to anyone saying that what this is really all about. Really, i dont know what else to say. I support him 100 . Host likely to be a latenight in the u. S. Senate. Ofwe heard from some min kim from politikim 3 30 thisuld go to morning. The House Republican leadership is seriously considering attaching a oneyear delay of obamacares one year mandates to avoid asian Government Shutdown. Decide to go this confirmt could all but a Government Shutdown. Kansas city, missouri on our our this line. Others line. I think the Affordable Care act is the best thing that has happened ever as far as health care gores. If people really learn about it, they will when it is fully implemented, they will find out how great it is. Host if you were tasked by the president to go out and pitch it, what is the one element that you think is so good about it . Haver i think that debts increased already. You will not the excluded for preand teasing preexisting conditions. I think it will make practitioners more accountable and provide that are results and the longterm. Thank you for the call. Host now we go to our twitter chat. Covina, california. The democrats line. Roy, hello. Caller hello. I am a democrat and one of the things that i see here is that because of the intensity that the republicans continue to have to try to tear down the president in anything that he it inthey have to look at a negative way. They do not want to remember int shape this country was when he got into office. Today we are beginning to see the fruits of the labor and see progress move forward. Time, i think that mr. Obama is doing a great job and he will finish his term and do well. Thank you. Host janice on the republican line. Caller yes, i just want to say i am with cruise all the way. I have been following it today pretty well and there are some things that the American People need to will on this obama care. Plan, howh a great come the irs said they dont want obamacare . They want their own plan. And so president obama decides that he is going to sign the paperwork against the house and the congress to eliminate them, and that includes the president. So those positions dont have to be on obamacare. Too bad. They passed something they dont even like, but they expect everybody else to go under obamacare. That is wrong. If its good for the gander, it is good for the goose. Host the facebook whole is up. Poll is up. Here is how it looks so far. 1320 people saying yes, and voting against, it is some 400 plus. Gainesville florida on our others line. Caller i support ted cruzs efforts but i also dont necessarily support the republican solution to health care. I really dont support obama care because if it forces people to obtain health care or employers to give their employees Health Coverage, i fill i still think that a second or third health care if there is government insurance, it will drive up the cost of health care across the board. There will be more transparency in the market so it can drive down prices. Host do you currently have Health Insurance . Caller yes. Host are you concerned about losing it . Caller im not sure. I get it from my employer. Or your callou fro this evening. Nathaniel is in granada, mississippi, the democratic line. Caller yes, how are you doing . I am calling because i support the Affordable Health care act. I am a veteran, retired. When i retired medically from the national guard, i lost my insurance. I had to wait at least six inths for the bill to kick where they would take on a person with disabilities. I already had diabetes and i could not get insurance at all. I was a 20 year veteran. A lot of people dont know about if we aret like made to have car issues, why shouldnt we have Health Insurance are insurance . Why shouldnt we have Health Insurance . Why is that so important . Everynot important for american to have health care. Host what did you say your current insurance status was . Caller i have it now, but at the time where i came out of the discharged i was medically, i lost my insurance and i was unable to get insurance because i already had diabetes and other medical problems. I was not able to buy insurance at all. I was a 20 year veteran. I dont think that was fair for a 20 year veteran not being able to buy insurance. Host appreciate your call. Shannon on the republican line. Caller hi there. Carrying thank you for this live. Not many stations are covering it like you are and i appreciate that. And iama care to appreciate and applaud ted cruzs efforts and i want to say that i am ashamed of all the republicans who are not standing voted him who pledged to against and repeal obamacare. For example, Mitch Mcconnell and Lindsey Graham and all the other whons republicans promised to fight obamacare and are not backing ted cruz. I am ashamed of them. I think that this needs to be defund it. It is bad. It is going to hurt our country economically. Host all right, janet. Here is dan in west palm beach, florida. What do you think of ted cruzs efforts . Im going to put you on hold for a second. Please make sure you mute your set. T caller thank you for taking my call. It is kind of sickening that harry reid is like a spoiled child right now. He is not getting his one little toy and he is going to shut down the government. Yet they want to blame the republicans for that when it passed the bill that finances our entire government to continue running. It is just sickening that they continue playing the same old childish games in something that is so serious as our livelihoods. Host what is going on on the senate floor is a now six hour long speech by ted cruz and other reporters on defunding the 2010 Health Care Law. It was tied into a bill that would fund the government through december 15, although and reread,eader, would alter it and make it a twomonth result. Goahead with your comments, dan. Caller i am glad for the a portable Affordable Care act. It is the same that the republicans are doing on the senate floor tonight. Glad thatt the we have obama care for all americans. Host think you for all of your calls. Conversation continues facebook. Com cspan. The speeches by president obama and the new iranian pleasant iranian president. Going to show you all of the president s speech next and then follow it with by the iranian president here on c span. The assembly will now here and address by his excellency, barack obama, president of the United States of america. [applause] on behalf of the assembly, i have the honor to welcome to the his excellency, barack obama, president of the United States of america him and invite him to address the assembly. Esther president . President . Mr. Secretarygeneral. Fellow delegates. Ladies and gentlemen. We come together to reaffirm the founding vision of this institution. ,or most of recorded history individual aspirations were subject to the whims of pirates and empires tyrants and empires. Things were settled through the sword and clash of armies. The idea that nations and peoples could come together in peace to solve their disputes and advance a common prosperity was unimaginable. It took the awful carnage of two world wars to shift our thinking. The leaders who built the United Nations were not naive. They did not think this body could eradicate all wars. But with millions dead and continents and rubble, and with the development of new clear weapons that could annihilate a planet, they understood that humanity could not survive the course it was on. So, they gave us this institution. They believe that it could allow us to resolve conflicts and behavior andf build habits of cooperation that would build grow stronger over time. For decades the United Nations has, in fact, made a difference. Disease,lped eradicate educate children, and broker peace. But like every generation, we find new and profound challenges. Is whether we possess the wisdom and the courage to have nationstates and members of an International Community to squarely meet both challenges. It is whether the United Nations can meet the test of our time. For much of my tenure as president , most of our urgent areges are in involved around trying to recover from the worst economic on worst economic crisis of our lifetime. Things to coordinated efforts by the countries here today, jobs are being created, mobile Financial Systems have stabilized, and people are once again being lifted out of poverty. But this progress is fragile and unequal. We still have work to do together to assure that our citizens can access the opportunities they need to thrive in the 21st century. Workedr, we have also two and a decade of war. Five years ago, and nearly 180,000 americans were serving in harms way. The war in iraq was the dominant issue with our relations with the rest of the world. Today, all of our troops have left. Next year, an International Coalition will and its war in afghanistan, having achieved its mission of dismantling the core of al qaeda. In the United States, these new circumstances have also meant shifting away from a petrol war footing. The on bringing our troops home, we have limited the use of drones so they target only those imminenta continuing, i threat to the United States where there is no risk of civilian casualties. We are trying terrorists in courts of law while working diligently with those at the prison in guantanamo bay. And just as we reviewed how to deploy our military capabilities that would reflect our ideas, we began to reflect on how we deploy our intelligence so that it would balance with the privacy concerns with all which all people share. As a result of cooperation with allies and partners, the world is more stable than it was five years ago. But even a glance at todays headlines indicates that changers dangers remain. In kenya, we have seen terrorist target innocent civilians in a shopping mall. Our hearts go out to the families that have been affected. Really 100 people were recently killed by suicide bombers outside of a church. , killings and car bombs continue to be a terrible part of life. Meanwhile, al qaeda is splintered into Regional Networks and militias. Them the ability to tag carry out attacks like , but they can attack businesses, civilians, and governments across the globe. Just as significantly, the compulsions in the middle east and north africa have laid bare the divisions within societies. Is upended, and people grapple with what comes next. Peaceful movements have too , frombeen met by violence those resisting change and from extremist trying to hijack change. Spreadial strength of the weapons of mass destruction continues to cast a shadow over the pursuit of these. Nowhere have we seen these trends converge more powerfully than in syria. Protests against an authoritarian regime were met with slaughter. In the face of such carnage, secularreated to their identity. It spiraled into civil war. The threat early on, but our response has not met the scale of the challenge. We cannot keep pace with the suffering of the wounded and displaced heard displaced. America has worked to bolster the modernist opposition, but extremist groups have still taken root to exploit the crisis. Traditional allies have propped him up. On august 21, the regime used chemical weapons in an attack that killed more than 1000 people, including hundreds of children. Syria and thes in destabilization of the region of broader heart challenges that the International Community now must confront. To should we respond conflicts in the middle east and north africa . Conflicts between countries, but also conflicts within them. How do we address the choice of standing callously by while children are subjected to nerve without embroiling ourselves in someone elses civil war . What is the role of force in resolving disputes that threaten to stable threaten the stability of the region . What is the role of the United Nations and International Law in meeting cries for justice . Today, i want to outline where the United States of america stands on these issues. Syria, wect to believe that, as a starting point, the International Community must enforce the ban on chemical weapons. My willingness to order a limited strike against assad regime in response to the brazen use of chemical weapons, i did not do so lightly. I did so because i believe it is in the National Security interests of the United States and in the interests of the world. We must meaningfully enforced a prohibition which is older than the United Nations itself. The band of use of chemical weapons, even in war, has been humanity. By 98 of it is strengthened by the memory of sync soldiers suffocating in gashes, jews gassed chambers, iranians poison, and the other millions. The evidence is overwhelming that the assad regime used such weapons on august 21. U. N. And specters gave a clear accounting that advanced rockets fired large quantities of sarin gas at civilians. Aese rockets were fired from regimecontrolled neighborhood and landed in opposition neighborhoods. It is an insult to human reason and the legitimacy of this to suggestat that anyone else other than the regime carried out this attack. In the immediate aftermath of the attack, thoug e were those who question the authority of even a limited strike. But without a credible threat, the Security Council had devastated no inclination to act at all. However, as i have discussed president putin putin for over a year, most notably in saint and in the past several weeks, the United States, russia and our allies have reached an agreement to place syrias chemical weapons under International Control and then to destroy them. The Syrian Government took a first step by giving an accounting of its stockpiles. Now, there must be a strong Security Council resolution to verify that the assad regime is keeping its commitments and there must be consequences if they fail to do so. If we cannot agree even on this, then it will show that the United Nations is incapable of enforcing the most basic of International Laws. On the other hand, if we succeed, it will send a powerful message that the use of chemical weapons has no place in the 21st century and that this body means what it says. Now, agreements on chemical weapons should energize a larger diplomatic effort, to reach a political settlement within syria. I do not believe that military action by those within syria or by external powers can achieve lasting peace. Nor do i believe that america or any nation should determine who will lead syria. That is for the Syrian People to decide. Nevertheless, a leader who slaughtered his citizens and gassed children to death cannot regain the legitimacy to lead a badly fractured country. The notion that syria can somehow return to a prewar status quo is a fantasy. Its time for russia and iran to realize that insisting on assads world wealth will go to the outcome they fear, difficult for extremists to operate. In turn, those of us who continue to support the moderate opposition must persuade them that the Syrian People cannot afford a collapse of state institutions and that a political settlement cannot be reached without addressing the legitimate fears and concerns of minorities. We are committed to working this political track and as we pursue a settlement, this is not a zerosum endeavor. We are no longer in a cold war. Theres no great game to be won, nor does america have any interest in syria beyond the wellbeing of its people, the stability of its neighbors, the elimination of chemical weapons and ensuring it does not become a safe haven for terrorists. I welcome the influence of all nations that can help bring about a peaceful resolution of syrias civil war. And as we move the geneva process forward, i urge all nations here to step up to meet humanitarian needs in syria and neighboring countries. America has committed over 1 billion to this effort and we will be providing an additional 340 million. No aid can take the place of a political resolution that gives the Syrian People a chance to rebuild their country, but it can help desperate people to survive. What broader conclusions can be drawn from americas policy towards syria . I know there are those who have been frustrated by our willingness to use our military might to dispose assad and our failure to do so is weakening in the region. Others have suggested to direct limit the military strikes to deter chemical weapons shows we have not learned anything from iraq and america seeks control over the middle east for our own purposes. In this way, the situation in syria mirrors the contradiction of what has persisted. The United States is chastised for meddling in the region, accusing of having a hand in all matter of conspiracy and at the same time, the United States is failing to do enough to solve the regions suffering. I realize some of this is inevitable given americas role in the world, but these contradictory attitudes have an impact on the americas people support of our involvement in the region and allow leaders in the region to avoid addressing difficult problems themselves. So let me take this opportunity to outline what has been u. S. Policy towards the middle east and north africa and what will be my policy during the remainder of my presidency. The United States of america is prepared to use all elements of our power, including military force, to secure our core interests in the region. We will confront external aggression against our allies and partners as we did in the gulf war. We will ensure the free flow of energy from the region to the world, although america is steadily reducing its importance on foreign oil, the severe disruption could destabilize the entire global economy. We will dismantle terrorist networks that are threaten our people. Wherever possible, we will build the capacity of our partners and respect the sovereignty of nations and work to address the root causes of terror, but when its necessary to defend the United States against terrorist attacks, we will take direct action. And finally, we will not tolerate the development or use of weapons of mass destruction. Just as we consider the use of chemical weapons in syria to be a threat to our own National Security, we develop chemicals weapons that could undermine the we reject chemicals weapons that could undermine the global nonproliferation regime. Now to say that these are americas core interests is not to say these are our only interests. We deeply believe it is in our interests to see a middle east and north africa that is peaceful and prosperous. And well continue to promote democracy and human rights in open markets because we believe these practices achieve peace and prosperity. But i also believe we can rarely achieve these objectives through unilateral american action, particularly through military action. Iraq shows us that democracy cannot simply be imposed by force. Rather these objectives are achieved when we partner with the International Community and with the countries and peoples of the region. So what does this mean Going Forward . In the near term, americas diplomatic efforts will focus on two particular issues. Irans pursuit of Nuclear Weapons and the arabisraeli conflict. While these issues are not the cause of all the regions problems, they have been a major source of instability for far too long and resolving them can help serve as a Greater Foundation for broader peace. The United States and iran have been isolated from one another since the Islamic Revolution since 1979. This mistrust has deep roots. Iranians have long complained of a history of u. S. Interference in her affairs and of americas role in overthrowing the iranian government during the cold war. On the other hand, americans see an iranian government that declares the United States an enemy and taken american hostages, killed u. S. Troops and civilians and threatened our ally israel with destruction. I dont believe this difficult history can be overcome overnight. The suspicions run too deep. But i do believe that if we can resolve the issue of Irans Nuclear program that can serve as a major step down a long road towards a different relationship, one based on mutual interests and Mutual Respect. Since i took office, i made it clear inletters to the Supreme Leader in iran and more recently to president rouhani, that america prefers to resolve our concerns over Irans Nuclear program peacefully, although we are determined to prevent iran from developing a nuclear weapon. We are not seeking regime change and we respect the right of the iranian people tore access Peaceful Nuclear energy. Instead, we insist that the iranian government meet its responsibility under the Nuclear Nonproliferation treaty and u. N. National security resolution. The Supreme Leader has issued a paper against the development of Nuclear Weapons and president rouhani has recently reiterated that the Islamic Republic will never develop a nuclear weapon. So these statements made by our respective governments should offer the basis for a meaningful agreement. We should be able to achieve a resolution that respects the rights of the iranian people while gisk the world confidence that the Iranian Program is peaceful. But to succeed, words will have to be matched by actions that are transparent and verifiable. After all, its the iranian governments choices that have led to the comprehensive sanctions that are currently in place, and this is not simply an issue between the United States and iraq. Iran has evaded its responsibilities in the past and iran needs to meet its obligations in the future. But, i want to be clear, we are encouraged that president rouhani receive a mandate to pursue a more moderate course and given his statement, im directing john kerry to pursue this in close cooperation with the european union, the united kingdom, france, germany, russia and china. The roadblocks paved may prove to be too great but i believe that the diplomatic path must be tested, for while the status quo will only deepen irans isolation, for them to go down a different path will be good for the region and the world and help the iranian people meet their potential in commerce, culture, in science and education. We are also determined to resolve a conflict that goes back even further than our differences with iran and that is the conflict between palestinians and israelis. I have made it clear that the United States will never compromise our commitment to israels security, nor our support for its existence as a jewish state. Earlier this year in jerusalem, i was inspired by young israelis who stood up for the belief that peace was necessary, just and possible. And i believe there is a growing recognition within israel that the occupation of the west bank is tearing at the democratic fabric of the jewish state. But the children of israel have the right to live in a world where the nation assembled in this body fully recognize their country. And where we reject those who fire rockets at their homes or incite others to hate them. Likewise, the United States remains committed to the belief that the Palestinian People have a right to live with security and dignity in their own sovereign state. On the same trip, i had the opportunity to meet with young palestinians in ramallah whose potential is unmatched by the pain they feel and having no firm place in the community of nations. They are understandably cynical that Real Progress will ever be made and they are frustrated by their families enduring the indignity of occupation. But they recognize that two states is the only real path to peace, because just as the Palestinian People must not be displaced, the state of israel is here to stay. The time is now right for the entire International Community to get behind the pursuit of peace. Already israeli and palestinian leaders have demonstrated a willingness to take significant political risks. President abass has put aside efforts to pursue peace and president netanyahu has reafffirmed his commitment to a palestinian state. Current talks are focused on borders and security, refugees and jerusalem. So now the rest of us must be willing to take risks as well. Friends of israel, including the United States must recognize that israels security as a jewish and Democratic State depend on the realization of a palestinian state. And we should say so clearly. Arab states and those who supported the palestinians must recognize the stability will only be served through a two state solution and a secure israel. All of us must recognize that peace will be a powerful tool to defeat extremists throughout the region and embolden those who are prepared to build a better future. And moreover, ties of trade and commerce between israelis and arabs could be and engine of growth and opportunity while too many people in the region are without work. So lets emerge from the familiar corners of blame and prejudice, lets support israeli and palestinian leaders who are prepared to walk the difficult road to peace. Real breakthroughs on these two issues, Irans Nuclear program, and the israelipalestinian peace, would have profound impact in the whole region. Just as lasting peace cannot be measured only by agreement between nations, it must also be measured by our willingness to resolve conflicts within nations. By that measure, it is clear that all of us have a lot more work to do. When peaceful transitions began in tunisia, the entire world was filled with hope. Although the United States, like others, was struck by the beat of transition, and although we did not, and could not dictate events, we supported those who call for change. We did so based on the belief that these transitions would be hard and take time, but the societies based on democracy and the openness and dignity of the individual what ultimately be more stable, more prosperous, and more peaceful. Over the last few years, particularly in egypt, we have seen just how hard this transition would be. Mohamed morsi was democratically elected, but proved unwilling or unable to govern in a way that was best for his people. The interim government that replaced him responded to the heirs of the people who believe that revolution had taken a wrong turn. They made decisions inconsistent with democracy. America has been attacked by all sides of this internal conflict, simultaneously accused of supporting the muslim brotherhood, and engineering the removal of others. The United States has purposely avoided choosing sides. Our overriding interests throughout these past few years has been to encourage a government that legitimately reflects the will of the egyptian people. One that has respect for the minority rights and the rule of law, freedom of speech and assembly, and a strong civil society. That remains our interest today. So Going Forward, the United States will maintain a constructive relationship with the interim government, and will continue support in education that will benefit the egyptian people. We have not proceeded with the delivery of certain military systems, and our support will depend on egypt last project egypts project progress. The United States will a time work with governments who do not need, at least in our view, the highest international expectations, but who are working with our core interests. Nevertheless come a we will not stop asserting interests and ideals. Whether that means supporting the International Declaration of rights. We will reject the notions that these ideals are simply western exports incompatible with the ideals of the east. We believe they are the birthright of every person. Although we will be wary of efforts to impose democracy through military force, and though we will be accused of inconsistency, we will engage the upholding of the law. This is the task of our generation. This includes efforts to resolve secretary and tensions in places like iraq, bahrain and syria. We understand such longstanding tissues cannot be solved by outsiders, they must be addressed by the muslim communities themselves. We have seen grinding conflict come to an end before, most recently in Northern Ireland when catholics and muslims both realized that the endless cycle was causing both immunities to fall behind a fastmoving world. We believe those same secretary and conflicts sectarian convicts can become be overcome in the middle east and north africa. To summarize, the United States has hardearned humility when it comes to our events and interactions inside countries. The american empire may be useful propaganda, but it does not reflect americas current policy or public opinion. As recent debates within the United States over syria clearly show. This is not an america that is too eager to immerse itself in the affairs of other countries, or take on responsibility in other regions than itself. The danger for the world is that the United States and after a decade of war, is rightly concerned about issues back home. Aware of the hostilities that our engagement in the region has engendered throughout the muslim world, they disengage, creating a vacuum of leadership that no other nation is ready to fill. I believe that such disengagement would be a mistake. I believe america must remain engaged for our own security, but i also believe a world is better for it. Some may disagree. But i believe america is exceptional, in part because we have shown a willingness, to the sacrifice of blood and treasure to stand up, not only for our own interests, but for the interests of all. I must be honest though, we are marlar far more likely to invest in countries who want to work with us, to invest in their people, rather than the select few. To embrace a vision of society where everyone can contribute, man, woman, shia, sunni, muslim, or jew. From europe, to asia, from the africa to americas, we are looking for those who are looking to uphold a common humanity. I believe the same will hold true for the arab world. This leads me to a final point. There will be times when the breakdown of society so great, the violence against civilians so substantial, that the International Community will be called upon to act. This will require some very tough choices. The United Nations was designed to prevent wars between states, and increasingly we face the challenge of providing slaughter within states. These challenges will grow more pronounced as states grow fragile or fail. Places where this violence can put men, women, and children at risk, with no hope from their international institutions. Ive made it clear that even one of americas core interests even when americas core interests are not threatened, we stand ready to protect basic human rights. We cannot, and should not, bear that burden alone. In mali, we supported both the french intervention im a and he African Forces who are keeping the peace. Intervention in keeping the peace. In eastern africa, we are working with partners to bring the Resistance Army to an end. In libya, when the Security Council provided a mandate to protect the civilians, we took action. What we did there, countless lives were saved. I know that some now criticize libya as an object lesson. They point to a democratically elected government struggling to bribe id security provide security. They say it is doomed to fail, look at libya. I would remind them of the americans who are committed to living people, including the ambassador. Does anyone truly believe that the situation in libya would be better if he had been allowed to brutalize and kill his people into submission . It is far more likely that without international action, libya would be engaged in civil war and bloodshed. We live in a world of imperfect choices. Different nations will not agree on every instant, but sovereignty is that the center of our order. Sovereignty cannot be an excuse for the International Community to turn a blind eye. While we need to be modest in our beliefs that we can remedy every evil, while we need to be mindful that the world is full of unintended consequences, do we really accept the notion that the world is powerless in the face of a rwanda . If that is the world that people want to live in, they should say so, and reckon with the cold logic of mass graves. I believe we can embrace a different future. If we do not want to choose between inaction or war, we must get better, all of us. We should respect the sponsor list of nations and of individuals, meaningful sanctions for those who break the rules, dogged diplomacy that resolves the root causes of conflict, not merely its aftermath. Development assistance that brings hope to the marginalized. While this may not be enough, there will be moments that the International Committee needs to acknowledge that the multilateral use of military force may be needed to prevent the very worst from occurring. Ultimately, this is the International Community that america seeks. Nations that do not convert the resources and lands of other nations, but those who carry out the founding purposes of this institution, and where we all have a responsibility, to uphold the rules established to prevent the kinds of wars that our forefathers fought. A world where human beings can live with dignity, whether they live in new york, or nairobi, or damascus. These are extraordinary times, with extraordinary opportunities. Thanks to human progress, a child born anywhere on earth today can do things that 60 years ago would have been out of reach for the mass of humanity. I saw this in africa where nations moving are poised to take off. They are able to bring power to places off the grid. I see across the Pacific Region where hundreds of millions have been lifted out of poverty in a single generation. I see it in the faces of young people everywhere, who can access the entire world with a click of a button, who are eager to join the cause of eradicating extreme poverty and work on climate change, expand freedom, and leave behind the old ideological battles of the past. That is what is happening in asia, africa, it is happening in europe, across the americas, that is the future of the people of the middle east and north africa deserve it as well. That way they can focus on opportunity, rather than whether they will be killed for what they believe. Time and again, nations and people have shown our capacity to change, to choose our better history. Last month, i stood where 50 years ago Martin Luther king jr. Told the American People, at a time when people of my race cannot even vote. I stood in the cell where Nelson Mandela and endured decades, from his people and his world. Who are we to believe that todays challenges cannot be overcome . We have seen the changes that the human spirit can bring. So in this hall can argue that we will give over to those who would seek to oppress the spirit . I know what side i want this country to be on, and we are ready to meet the challenges of tomorrow with you. We believe that all men and women are created equal, and are possessed with a dignity, and an inalienable right that cannot be denied. Ey will look to the uterine to the future with not fear, but hope. Thank you very much. [applause] [captions Copyright National cable satellite corp. 2013] [captioning performed by national captioning institute] that was president obama speech to the United Nations. We will show you the speech from the iranian president rouhani. There is an effort underway to continue federal funding to defund the federal Health Care Law. The wall street journal has a piece on the discussion that happened between former president bill clinton and president obama. Obama and bill clinton join Health Care Law. They expend intricacies of the Affordable Care act to urge americans to set politics aside and assess whether the health lot is a good deal. Party has made a litany test for party loyalty. They try to tell people to get health care for less than the cost of your cell phone bill. By the way, we covered that speech. We will air it for you on cspan at around 11 40 p. M. Eastern. It is an hourlong discussion at. Hat point in Global Initiative president obama and the iranian president might have had some sort of meeting that did not just before the iranians both before the general somebody. President the iranian residen before the General Assembly. U. S. Officials say president obama and the iranian president rouhani will not meet while both leaders are at the United Nations. Toosaid it would be complicated back in iran. Looking ahead, here is a quote from the los angeles times. Iran posing the president tells his. That he is government is ready for result oriented talks with the u. S. Next up is a speech at the u n General Assembly. U. N. General assembly. His excellency. On behalf of the general thembly, i welcome president from the republic iran. Mr. President. In the name of god, praise be to god, the lord of the world. Oursigngs and peace among prophet muhammed. Mr. President , mr. Secretary, general, ladies and gentlemen, at the outset, i would like to offer my most sincere appreciation on the election to the presidency of the General Assembly and seize the moment to express appreciation for the valuable efforts of our distinguished general mr. Chairman. Our world today is replete with fear and hope, fear of war and hostile, regional and global relations. Fear of deadly confrontation of religious, ethnic and national identities, fear of institutionalization of violence and supremism, fear of poverty and destructive discrimination. Fear of decay and destruction of lifesustaining resources, fear of disregard for Human Dignity and rights and fear of neglect of morality. Alongside these fears, however, there are new hopes. The hope of universal acceptance by the people and the elite all across the globe of yes to peace and no to war. And the hope of preference of dialogue over conflict and moderation over extremism. The recent election in iran represents a clear living example of the wise choice of hope, rationality and moderation by the great people of iran. The realization of democracy, consistent with religion and the peaceful transfer of executive power manifested that iran is the anchor of stability in an otherwise ocean of regional instabilities. The firm belief of our government in enduring peace, stability, tranquility, peaceful resolution of disputes and reliance on the ballot box as the basis of power, Public Acceptance and legitimacy has indeed played a key role in creating a safe environment. Mr. President , ladies and gentlemen, the current critical period of transition in International Relations is replete with dangers although with unique opportunities. Any miscalculation of ones position, and of course of others, will bear historic damages, a mistake by one actor will have negative impact on all others. Vulnerability is now a global phenomenon. At this sensitive junction, the age of zerosum game is over. Even though a few actors attempt to rely on archaic and deeply ineffective ways and means to preserve their superiority and domination, resource to violence to subjugate others are failed examples of the perpetration of old ways in new circumstances. Coercive, economic and military policies and practices geared to the maintenance and preservation of all superiorities and domination have pursued in a conceptual mindset that negates human ideals. Ignoring differences between societies and globalizing western values as universal represent another manifestation of this conceptual mindset, yet another reflection of this model is the persistence of cold war mentality and bipolar into the superior us and inferior others, fanning fear and phobia around the emergence of world actors on the world scene is another. In such an environment, governmental and nongovernmental religious, ethnic and even and there is no guarantee that the era of big powers will refrain from such violent discourses, practices and actions. Catastrophic impact of violence and extremist narratives should not in fact, must not be underestimated. Violence that is manifested in the efforts to deprive regional players from their National Domain of action containment policies, race regime change from outside and the efforts toward redrawing of political borders and frontiers is extremely dangerous and provocative. The International Political discourse surrounded by uncivilized controversies. In this picture, the relation between the centers of world power is homogenic. The discourse of the center stage and real debating the south to the periphery has led to the establishment of a monologue. The identity of distinctions and the xenophobia is the discourse and unfounded islamophobic to doing this represents serious threats against world peace and human security. This propaganda discourse has assumed dangerous proportions through portrayal inculcation of assumed imaginary threats and one is the socalled iranian threat which has been employed as an excuse to justify a long going of crime and practices over the past three decades. The Saddam Hussein regime of chemical and supporting al qaeda are two examples of catastrophes. Let me say this in all sincerity between this august world assembly, based on irrefutable evidence those who hardship on the socalled threat of iran absolutely no threat to the world or the region, in fact in ideals as well as in actual practice. My country has been a harbinger of peace and comprehensive peace. Mr. President , and ladies and gentlemen, nowhere has it be so deadly and destructive as north africa and west asia. Military intervention in afghanistan, Saddam Hussein imposed war against iran, occupation of kuwait, military intervention against iraq, brutal repression of the Palestinian People, assassination of Common People and political figures in iran and terrorist bombings in countries such as iraq, afghanistan and lebanon are examples of violence in this region in the last three decades. What has been and continues to be practiced against the innocent people of palestine is nothing less than structural violence. Palestine is under occupation. The basic rights of the palestinians are tragically violated, and they are deprived of the right of return and access to their homes, birthplace, and homelands. And one can hardly describe the crimes and the institutionalized aggression against the innocent Palestinian People. The human tragedy in syria represents a painful example of catastrophe of violence and extremism in our region. From the very outset of the crisis in one regional and International Actors helped to militarize the situation through arms and intelligence into the country and active support of extremist groups. We emphasize that there was no military solution to the syrian crisis. Pursuit of expansion of the tragedies and objectives and attempts to change the regional balance cannot be camoflauged behind human rhetoric. The Common Objective of the International Community should be a quick end to the killing of the innocent. While condemning any use of chemical weapons, we welcome syrias acceptance of the Chemical Weapons Convention and believe that the access by extremist terrorist groups to such weapons is the greatest danger to the region that must be considered in any disarmament plan. At the same time, i shall underline the end of ineffective use or the actual use of force will only lead to further violence and crisis in the region. Terrorism and killing of innocent people are you represents extremism and violence. Terrorism is a violent scourge. But the violence and extreme action that the use of drones against innocent people in the name of combating terrorism should also be condemned. Here, i shall say a word about the criminal assassination of Iranian Nuclear scientists. For what crime have they been assassinated . The Security Council should answer the question. Have the perpetrators been condemned . Unjust sanctions as manifestation of structural violence are perfectly inhumane and against peace and contrary to the claims of those who pursue and impose them and the political elites that are targeted but rather the Common People that are victimized by these sanctions. Let us not forget millions of iraqies who as a result of sanctions, hovered in international jargon, suffered and many more who continue to suffer all through their lives. These sanctions are violence, pure and simple, whether called smart or wise, unilateral or multi lateral, and right to peace, right to development, right to access to health and education and above all, the right to life. Sanctions beyond any and all rhetoric cause war mongering and human suffering. It should be bore in mind however, that the negative impact is not merely limited to the intended victims of sanctions. It also affects the economy and livelihood of other countries and society, including the countries imposing the sanctions. Violence and extremism nowadays have inflicted and tarnished the dimensions of life in human societies, violence and extremism leave no space for understanding and moderation as the Necessary Foundation of collective life of human beings. Intolerance is the predicament of our time. We need to promote and reinforce tolerance of the religious teachings and cultural and political approaches. The Human Society should be elevated from the state of mere tolerance to that of collector collaboration. We should not just tolerate others. We should rise above mere tolerance and dare to Work Together. People all over the world are tired of war. Violence and extremism. They hope for a change in the status quo. And this is the opportunity for all, Islamic Republic of iran believes that all challenges can be managed successfully through a smart judicious hope and moderation. War mongerers are bent on extinguishing all hope but hope for change. Inate, religious, widespread and universal concept. In the belief of the universal will of the people across the globe to combat violence and extremism to impose change, to value choice and to act in accordance with human responsibility. Hope is no doubt one of the greatest gifts bestowed upon human beings by their all loving creator and to move in a wise manner, conscious of the time. Ideals with choice of effective strategies and policies while cognizant of objective realities. They want a choice. Discourse of hope. Both at home and abroad. In foreign policy, the combination of these elements means that the Islamic Republic of iran will act responsibly with regard to regional and interNational Security and is willing and prepared to cooperate in these fields bilaterally as well as multi laterally with other responsible actors. We defend peace based on democracy and the ballot box everywhere, including syria and bahrain and other countries in the region and believe there are no Violent Solutions to world crises. The ugly realities of the Human Society can only be overcome through recourse to end reliance, interaction in moderation, securing peace and democracy and ensuring the legitimate rights of all countries in the world, including the middle east. Cannot and will not be realized through military. We seek to resolve problems, not to create them. There is no issue that cannot be resolved through reliance through prudent moderation, Mutual Respect. Irans Nuclear Dossier is a case in point. As clearly stated by the leader of the Islamic Republic of iran, the right of iran constitutes the best and easiest way of resolving this issue. This is not political rhetoric. Rather, it is based on a profound recognition of the state of technology in iran, global and political environment and end of the zerosum games and imperative of seeking Common Objectives toward reaching common understanding and shared security. Put otherwise, iran and other actors should pursue two Common Objectives as two mutually inseparable part of a political solution for the Nuclear Dossier of iran. One, Irans Nuclear program and for the matter that of all other countries must pursue exclusively peaceful purposes. I declare here openly that notwithstanding the position of others, this has been and will always be the objective of Islamic Republic of iran. Nuclear weapon and other weapons of mass destruction have no place in irans security and defense doctrine. And contradicts our funnel, religious and ethical fundamental and religious and ethical objectives. It is imperative we remove any and all reasonable concerns of irans peaceful Nuclear Program. Two, the second objective that is acceptance of and respect for the implementation of the right of the enrichment inside iran and enjoyment of other Nuclear Related rights toward the path of achieving the objective. The Nuclear Technology inclusive of enrichment has enriched the industrial scale. It is unrealistic to pursue that the peaceful nature of the Nuclear Program of iran could be insured. In this context, Islamic Republic of iran insisting on the implementation of its right and imperative of international respect and cooperation in this exercise is prepared to engage immediately in resultoriented talks to build mutual confidence and removal of mutual uncertainties with full transparency. Iran sees instructive engagement based on Mutual Respect and common interests and within the same framework does not seek to increase tensions with the United States. I listened carefully to the statement made by president obama today at the General Assembly. The political will of the leadership in the United States and hoping that they will refrain from following the shortsided interests of war mongering pressure groups. We attempt to arrive at a framework to manage our differences. To this end, equal footing, Mutual Respect and the recognized principles of International Law should govern the interactions. Of course, we expect to hear a consistent voice from washington. Mr. President , ladies and gentlemen, in recent years, a dominant voice has been repeatedly heard. The military option is on the table against the backdrop of this ineffective contention let me say loud and clear that peace is within reach. So in the name of Islamic Republic of iran, i propose the consideration by the United Nations of the project the world against violence and extremism, let us all join this. I invite all the states, International Organizations and civil institutions to undertake a new effort to guide the world in this direction. We should start thinking about coalition for peace all across the globe instead of the ineffective coalitions for war in various parts of the world. Today, the Islamic Republic of iran invites you and the entire iran invites you and the entire World Community to take a step forward and invitation to join world against violence and extremism. We should accept and be able to open a new horizon in which peace will prevail over war. Tolerance over violence. Progress over bloodletting. Justice over discrimination, prosperity over poverty and freedom over despotism. As beautifully said by the iranian poet, be relentless in striving for the cause of good. Bring the spring, you must, banish the winter, you should. Notwithstanding all difficulties and challenges, im deeply optimistic about the future. I have no doubt that the world will be bright rejecting violence and extremism. Prudent moderation will ensure a Bright Future for the world. My hope eminates from the beliefs shared by all divine religions that a good and Bright Future invades the world. As stated in the holy koran, as we have proclaimed, that servants wont will inherit the earth. Thank you, mr. President. [applause] i wish to thank the president of the Islamic Republic of iran for the statement just made. May i request representatives to remain seated while we greet the president. [captioning performed by national captioning institute] [captions Copyright National cable satellite corp. 2013] now, a look at how several states speaking before the general nations General Assembly earlier today. Cspan will cover a number of General Assembly speeches, including tomorrow, the president of venezuela. Back in the Nations Capital this evening, the speech on the floor of the senate by ted crowes and other republicans bash by ted cruz and other senators about ending obamacare continues, tied to the continuing resolution that is up ahead in the senate tomorrow. A boat between noon and one tomorrow. We are getting a response on twitter. Here are a couple of comments from this evening. Senator cruise has been joined by a number of republican senators, including, most recently, jeff sessions. From the gallery, Louie Gohmert of texas. Let us listen in. Defund this abomination of an unfair tax. Listen up, america. This is your wakeup call. Make d. C. Listen. Defund obamacare now. We do not need this injurious legislation to be enacted. Make d. C. Listen. Stay strong. Vote no on cloture. Obamacare must be stopped. The will of the majority of americans is to defund obamacare. Make d. C. Listen. Sick of our employees deludeing themselves into believing they are our bosses. Make d. C. Listen. For those who didnt follow it, were the employees, the elected representatives who work for the American People and yet an awful lot of people in this body think were the bosses. Thats exactly backwards. We you can follow that live on cspan two. Also live on cspan radio. To a reading from tweets the Senators Office has set up. Lots of comments this evening. A tweet. Finally, a tweet from jason johnson, on the staff of senator office. Cruzs toread green eggs and ham his daughters on the senate floor earlier. I am going to confess, normally, they do not watch c span. There are too few animated features on cspan. But because the girls are watching, i wanted to take an opportunity an opportunity i do not usually have when i am in , to read them a couple of bedtime stories. They are watching right now. If you forgive me, i want to take the opportunity to read the time stories to my girls. There is a point to this, and it is very simple. The urgency we have and should feel is because of our kids, because of the future they are facing, because of the limited opportunities they have. I want to read from a book of bible stories. This is called King Solomons wise words. Kingine, catherine solomon had good advice for how people could lead a good life and be happy. Here are some of his wise sayings. Children with good sense make their parents happy, but foolish children make them sad. Sweethearts, you make your mommy and me very, very happy. You will say the wrong thing if you talk too much, so be sensible and watch what you say. I will have to confess to my colleagues that is not an encouraging proverb for someone in the midst of a filibuster. Rewarded, but if you are cruel, you hurt yourself. Try hard to do right, and you will win friends. Go looking for trouble, and you will find it. Good people are kind to their animals. But a mean person is cruel. We trapped ourselves by telling lies. But we stay out of trouble by living right. It is wrong to hate others. But god blesses everyone who is kind to the poor. Kind words are like honey. They cheer you up and make you feel strong. Do not trust violent people. They will mislead you to do the wrong thing. Fools seem smart when they are quiet. I suppose that may counteract the other one. Good people live right. And god blesses the children who follow their example. Here i am, seeing the gifts from the lord. The food you get by cheating may taste delicious, but it turns to gravel. And if you try to be kind and good, you will be blessed with life, goodness, and honor. That is the first story for carolyn and catherine. The second one is what they know is my favorite story. Was my favorite story when i was a kid. It is a story i love reading them. I do not get to read it to them often, it is we have a rule at home that they get to pick the books. For what ever reason, they do not pick dr. Seusss green eggs and ham very often. Cause i let them pick. But tonight, you girls do not get to pick the book. I got to pick green eggs and ham. I love this story, and i am going to read it to you. Sam i am. That sam i am. That sam i am. I do not like that sam i am. Do you like green eggs and ham . I do not like them, sam i am. I do not like green eggs and ham. Would you like them here or there . I would not like them here or there. I would not like them anywhere. I do not like green eggs and ham. I do not like them, sam i am. Would you like them in a house . Would you like them with a mouse . Them in at like house. I do not like them with a mouse. I do not like them here or there. I do not like them anywhere. I do not like green eggs and ham. I do not like them, sam i am. Would you eat them in a box . Would you eat them with a fox . Not in a box. Not with a box. Not in a house. Not with a mouse. I would not eat them here or there. I would not eat them anywhere. I would not eat green eggs and ham. I do not like them, sam i am. Would you, could you, in a car . Eat them, it them here they are. I would not could not in a car. Ou may like them, you may see you may like them in a tree. I would not could not in a tree. Not in a car. You let me be. I do not like them in a box. I do not like them with a fox. I do not like them in a house. I do not like them with a mouse. I do not like them here or there. I do not like them anywhere. I do not like green eggs and ham. I do not like them, sam i am. Could you, would you on a train . Not on a train. Not in a tree. Not in a car. Sam, let me be. I would not, could not in a box. With a not, could not fox. I will not eat them with a mouse. I will not eat them in a house. I will not eat them here or there. I will not eat them anywhere. I do not like green eggs and ham. I do not like them, semiam. Say, in the dark. Here in the dark. Would you, could you in the dark . I would not, could not in the dark. I would not, could not in the rain. Not on a train. Not in a car. Not in a tree. I do not like them sam, you see . Not in a box. Not with a mouse or with a fox. I will not eat them here or there. I do not like them anywhere. You do not like green eggs and ham . I do not like them, sam i am. You, with aould goat . I would not, could not, with a goat. Would you, could you, on a boat . Not on aot, could boat. I will not with a goat. Train. A rain not on a not in a tree. Not in a car. Let me be. I do not like them in a box. I do not like them with a fox. I will not eat them in a house. I do not like them here or there. I do not like them anywhere. I do not like green eggs and ham. I do not like them, sam i am. You do not like them, so you say. Try them. Try them and you may. Try them and you may, i say. Sam, if you will let me be, i will try them. You will see. This page, he is simply Holding Green eggs and ham on a four, preparing to bite. Say, i like green eggs and ham. I do. I like them, sam i am. And i would eat them in a boat. And i would eat them with a goat. And i will eat them in the rain. And in the dark, and on a train, and in a car, and in a tree. They are so good, so good, you see. I will eat them in a house. I will beat them with a mouse. I will eat them here or there. I will eat them anywhere. I do so like green eggs and ham. Thank you. Thank you, semiam. Sam i am. I want to say to caroline and catherine, my angels, i love you with all my heart. It is bed time. Give mommy a hug and a kiss. Pressure teeth. Say your prayers. And that he is going to be home soon to read to you in person. And let me say more broadly to everyone, green eggs and ham has some applicability, as curious as it might sound, to obamacare. Because 3. 5 years ago, president obama, the senate democrats, told the American People, just try obamacare. Just try it. There were a lot of us. An awful lot of republicans were very skeptical, i think for good reason. Very skeptical. We were told, try it. Try it. Try it. Through unfortunately an exercise of brute political force, obamacare became a law. But i will tell you the difference with green eggs and ham. When americans tried it, they discovered theyd is like green eggs and ham, and they did not like obamacare either. They did not like it in a house or with a mouse. It is not working. Senator ted cruz, from earlier this evening. The texas senator is now in his eighth hour of his speech, some calling it a filibuster. He is talking about defunding the Health Care Law as part of a debate on the continuing resolution of funding the federal government beyond the fiscal year deadline, next monday, september 30. Many members of the house, after watching this evening including paul broun of georgia, watching by the senate floor. You can see by this live look at the capitol that the light is on. The debate continues. You can follow the speech by ted cruz and other republicans on c span2. We are also covering it on c span radio. The house is in tomorrow. They are coming in for eight legislative session at 2 00 p. M. Eastern. Ahead of that, we will see , one from robs woodall of georgia. He is a member of the funding committee. That, we will hear from maryland Democrat John delaney, who sits on the Financial Services committee. Continuing the funding of the federal government. Our guest wrote an article on job creation. Eastern. T 7 00 and we have live debate coverage coming up in the virginia democrats rate. Terry mcauliffe and kent originality and ken cuccinelli. That is on cspan three. It is one week away from the beginning of one of the first steps in the Health Care Law. That is the formation of the state insurance exchanges. It starts october 1, mandated by the law. Today, the discussion in washington, hosted by the Kaiser Family foundation, looks at how states are implementing the state exchanges. Ais is about an hour and half. Morning, and welcome to this Kaiser Family Foundation Event here in our Barbara Jordan conference center. I am the executive Vice President of the Kaiser Family foundation, and the exec if director of our commission on medicare and the uninsured. We are pleased to be continuing our series of preparing for implementation of the Affordable Care act. Today, we are really going to be looking at the preparations for our reach and enrollment in the Affordable Care act, and some of the lessons from the states. As everyone has come to know, open enrollment for coverage, especially in the health care marketplaces, formally known as exchanges, will begin on october 1. Many states are busily preparing for the outreach and enrollment efforts. There is coverage offered under the Affordable Care act, either through the Exchange Marketplaces or through the expansion of the Medicaid Program. We know that effective outreach and enrollment efforts are key to ensuring that people understand their benefits under the law, and that we can translate opportunities for coverage into actual increased coverage. Going to look at some of the on the ground work, and some of the lessons for how to move forward, as well as some of the challenges that have been resolved in maryland, nevada, and oregon. At thealso going to look experience in massachusetts of the outreach and enrollment conducted by some of the Community Health centers during their implementation of the state Health Reform. They would really gain a number of insights into how to do it right, and how it works. Today bying to start having a series of presentations from key people. We are going to kick it off first by going over some of the key findings from a report we are releasing today that looks at how to do the on the ground efforts in the three states i mentioned nevada, maryland, and oregon. We are pleased to be joined by individuals from those states who will talk about their efforts, and finally to hear from massachusetts about Community Health center efforts. Your packets have all the reports we are releasing today. We are releasing 4 reports. We have given you a lot to read. A lot of this will be found on the Kaiser Family foundation website. States leading the way in preparing for outreach and enrollment in the Affordable Care act. The second is providing outreach and enrollment assistance, Lessons Learned from Community Health centers in massachusetts. The third is an early look at branding and marketing of the new Health Insurance marketplaces. The fourth is helping hands, a look at state consumer assistance programs under the Affordable Care act. This will give you an overview of some of the efforts going on to make sure that the effort first comes. Ofn enrollment until the end march must be able to help people connect to coverage. We will start first with the report, andg states a member of our commission on the uninsured is going to prevent present those findings. Then, we are going to turn to a panel discussion. He has we have with us the resident and ceo of Health Care Access maryland, who will talk about the challenges to enroll folks in the state of maryland. We are going to be joined by teleconference by the outreach and a moment strategist who covers oregon. That will be out of portland, oregon, via teleconference. And then we are going to turn back to nikki king, who is with us today. And we will look at the access to Health Care Network in reno, nevada. Our last panelist is going to reflect on the massachusetts earlierce and their expansion effort. He is the ceo of the east Boston Neighborhood Health Center. I am going to turn to samantha to highlight some of the key findings from our report. We will continue our discussion, leaving lots of time at the and for your comments and questions. Samantha . Thank you, diane. Thank you all for joining us today. This is a very exciting time. Before i jump into the key findings from the case study report, i want to focus on the experience in maryland, nevada, and oregon. I want to provide some National Context on the coverage expansion. As i think everyone in this room knows, one primary way the Affordable Care act expands coverage is through the creation of new Health Insurance marketplaces, which will provide individuals the choice of a qualified health plan, and offer tax credits subsidies to thatate income individuals do not have access to affordable employersponsored Health Coverage, who helped purchase coverage through the new marketplaces. These new marketplaces will open for enrollment on october 1 in all states. Coverage becomes effective on january 1. That open enrollment will last through the end of march. Looking across the country, we see that 17 states have established statebased marketplaces that they will operate, while consumers in 27 states will utilize the federally facilitated marketplace. And in seven states, the marketplace will be operated in partnership between the federal government and the states. The other primary coverage expansion vehicle is the expansion of Medicaid Eligibility for adults with incomes through 138 of the federal poverty level, which is 16,000 today. This would make millions of parents and other adults eligible for the program. This expansion was intended to occur nationwide, starting on january 1. They made that expansion the state option. States are moving forward with the expansion, while 22 are not moving forward. Debate remains ongoing in three. There is no deadline by which states have to make a decision to implement expansions. States can still decide to expand their coverage at a later date. It is important to recognize that individuals can enroll in medicaid at any time throughout the year. They are not limited to the same individualsent as through the marketplaces. Regardless of the marketplace a state is operating, and whether the state is moving forward with medicare expansion, this establishes a new integrated Technology Driven enrollment process. States are building new eligibility and enrollment, as well as making major upgrades to existing medicaid systems, to implement these processes, with the help of significant federal funding for these efforts. Next, i want to turn to our case study findings. Before jumping into the project, i did want to acknowledge my co authors on this report. Collaboratorsful in research and communication, Michael Perry and john dryden. I want to extend our deep to the individuals who participated in the case study interviews. They all share their time during an incredibly busy time, to meet with us and discuss their experiences. The project would not have been possible without them. Thank you for those efforts. Gain preparation and insight into the coverage expansions. These established the state based marketplace. They decided to move forward with Medicaid Expansion. They have emerged in leading the way, per pairing for outreach and enrollment. The findings i am presenting today are based on interviews with a broad range of stakeholders in each of these states. These include state officials, marketplace officials, navigators, communitybased organizations, insurance providers, and consumer advocates. We were trying to get a Broad Community and local level view of preparations happening in each of these states. The interviews were conducted in july of 2013, in collaboration with our team. Think,dings highlight, i the challenges states have encountered, and key Lessons Learned in Health Reform efforts, moving forward. Findings i want to highlight from the report are the efforts to establish marketplaces and prepare for Medicaid Expansion. All three states moved very quickly to establish their statebased marketplaces, with maryland establishing legislation in april 2011. Moved soonoregon after, in june 2011. All three structured their marketplaces as quasigovernmental organizations or public organizations, and told us those structures had advantages, with the ability to hire and pay more quickly than usually allowed. In terms of preparing for the Medicaid Expansion, the three states are in very different starting places with their medicaid coverage. But the scope is going to vary across the three states. Maryland and oregon have already expanded coverage. Nevada does not currently provide any coverage for low income adults without dependent children. A more significant increase in eligibility in that state. To prepare for increased Medicaid Enrollment that these states are expecting, oregon and nevada are hiring additional Medicaid Eligibility workers. All three states are in an intense process of training eligibility staff, focusing on change among the staff to implement the new enrollment processes that will be going into place, moving forward. In terms of implementing the new eligibility and enrollment statesthat will help utilize these new enrollment processes, the states are chasing someone carried approaches. Oregon and nevada are building new systems that will make all determinations within a single system, whereas nevada is linking together several systems, which include 2 new systems that are being built separately. However, we did hear consensus among all three states that building the systems has been one of the most challenging aspects of preparing for the expansions. In each of the states, they were not able to build in all the desired capabilities they hoped to have by october 1. As such, many have developed contingency plans and workarounds where needed, and are devoting resources so they are available to troubleshoot problems that may arise when open enrollment begins. We did also hear a definitive plans in all three states to continue to move forward with some enhancements and improvements over time, so continuing improvements will occur even after opening open enrollment begins in october. This captures a lot of what we heard, in terms of the challenges associated with systems related to the expansion. I wantt set of findings to highlight relate to Marketing Campaigns that will encourage consumers to enroll. All three states conducted in brandingsearch and Marketing Campaigns. They each plant broad campaigns across multiple platforms. These media Team Campaigns will be primarily focused on reaching the population that is eligible for the marketplaces. Recognition they would likely reach any individuals eligible for medicaid. However, i think many respondents emphasized the Important Role communitybased organizations will have in connecting the medicaid eligible population for coverage. While all three Marketing Campaigns are focused on building Awareness Among individuals and encouraging them to enroll, each of the three states have varied in the messages and approaches used for the campaign. Describean try to those distinctions to you, i thought it might be more instructive for you to see an ad for each marketplace, so you can get a feel for the distinction yourselves. A brandnew way to get the Health Coverage you need. The Health Coverage you need got to have it leave your worries behind get your coverage online that is peace of mind through march. Er visit the website, or call us. Got to have it going to get it a nice hike with my wife. Thursdays, ballgames. A good meal. That is what i work for. Life is pretty good. My health has never really slowed me down. I now have type 2 diabetes. That can get expensive without Health Insurance. The thought of not being able to pay for more insulin when i needed it really would slow me down. The new law requires all of us to have Health Insurance by 2014. Nevada health link is here to help you or to state approved Health Insurance plans that are highquality and based on your income, regardless of Previous Health condition for the amount you pay. Learn about the changes now, by nvlink. 8557 plans will be available for purchase starting in october. Learn about the changes now. Sponsored by the state of nevada. The place in my heart is called home where the soft air meets the Cold Mountain snow i am free to be healthy and happy and strong live long and oregon long live oregon long live the oregon way every daughter and son live long in oregon are verysly, those different approaches taken by three states, but they are all focused on building awareness and connecting consumers to marketplace websites and online. Haveur packets, you also briefs that diane referenced, which looked at branding and marketing across all 17 states operating state paste state based marketplaces. If you are interested on this topic, that brief would be a great resource. I wantt set of findings to highlight relate to outreach and enrollment assistance. While Marketing Campaigns will help build awareness, we know from past experience in medicaid and chip, as well as earlier coverage expansion in massachusetts, that targeted outreach and direct assistance will be key to enrolling eligible individuals. We will hear more about the massachusetts experience from our panel, that i wanted to highlight that there is a brief that touches on that topic, as well as the second brief that looks at the development of consumer assistance programs in the marketplaces. Those are Additional Resources on this topic. In terms of our case study findings, looking at our three states, they all have adopted a regional approach to our theirer insistence to consumer assistance programs, contracting with a number of entities who will hire the individuals. Varies acrosstors the states, as do training requirements. A wide array of organizations with close ties to the local community will be serving and providing assistance. Broad focus on reaching individuals who are eligible for the marketplace and medicaid. Insurance brokers will also play a role in connecting the population segments to coverage. With regard to Outreach Strategies, respondents identified a wide range of strategies that will be used, including strategies i have highlighted here. The first is to maximize automaticata for enrollment in medicaid. Maryland and oregon plan to automatically transfer adults into full medicaid coverage. Oregon is also looking at utilizing eligibility implementation from supplemental assistance programs to facilitate enrollment into medicaid. The second key strategy identified is really reaching out to uninsured parents, who already have children enrolled in medicaid and chip. Many parents will be eligible for the Medicaid Expansion or the marketplace subsidies. States have targeted outreach plans for certain sub segments of the population, including communities of color and those with limited english efficiency. Their really emphasizes plans to do significant outreach to spanishspeaking hispanics in the states, who make up a large segment of the eligible population. Similarly, in oregon and nevada, states are working directly with the tribes to conduct targeted outreach to American Indians and provide them with enrollment. Across all three states, you have heard the Important Role of the Faith Community, and plans to conduct outreach and enrollment efforts through the Faith Community and faith leaders. Ie last set of findings wanted to touch on relates to Political Leadership and stakeholder collaboration. From respondents involved in all three states was that close collaborative working relationships among a number of state agencies is really key for successful preparation. In particular, some of these agencies included the Medicaid Agency and the department of insurance. In all three states, they are talking amongst these agencies every day, working as a team to move forward with the expansion preparation. Consistentlyheard that strong state leadership has been important for moving efforts forward and spurring that collaboration among different groups within the state. Similarly, all three states invested early on in gaming stakeholder input, which contributed to the ongoing involvement of stakeholders throughout the process of preparing for enrollment. Lastly, all three states described the positive relationship with federal partners on implementation, but noted that the delay in some of this has been an implementation , to move forward while waiting for final rules from the federal government. Up, i think the experiences from these three states show us the states that are committed to moving forward have really achieved significant progress in preparing for the expansions. And strong Political Leadership and close collaborative relationships, as well as creativity, adaptability, and a willingness to improve over time theirn key components to success. Looking ahead, october 1 will mark the start of opportunity for individuals to begin accessing coverage that will begin in january. Some people are going to enroll right away, while some will take time to explore their options. Since coverage will not begin until january, individuals can take time to research their options without missing out on coverage. The sixmonth long Enrollment Period would give states the opportunity to continue to improve their systems. We believe that experiences will likely continue to improve over time. Campaigns will help educate individuals and raise awareness, enrollment efforts will really be driven at the local level, through on the groundwork. I look forward to hearing from our panelists, who i think are going to have great perspectives on what those efforts will look like in their respective states. Thank you. [applause] cliques we are going to turn to our panelists. We are going to start with the state of maryland. Coat i amwest cathy. I thought it was important to provide a brief overview of our organization, so you can realize why a connector entity in maryland was a natural fit for us. We have been in operation 17 years. Agency to enroll children into Childrens Health care programs. We also provide a wide variety of Case Management to baltimore populations in the greater baltimore area. Individuals who were homeless, children in foster care, immigrants you name it. We are working very closely with vulnerable populations. Maryland, we are an amazing state, really far ahead of the game. But the Lieutenant Governor and the Health Secretary it has been remarkable to watch. Time,nvested a lot of energy, and resources into making sure this goes well. Health care access maryland was recently awarded a connector grant. Health care access maryland has Baltimore City, baltimore county, an anne arundel county. 200,000e approximately people who are uninsured in that region. We have established partnerships with 17 different partners, which we will talk more about later. I am going to keep remarks focused on our outreach and enrollment strategies, as requested. More globally, we are looking to capitalize on the state Marketing Campaign. The state has invested 2. 5 ads,on in commercials, tv radio ads, bus ads, bus shelters, and so forth. They have also developed partnerships with Grocery Stores safeway, giant, cvs and the baltimore ravens. They found seven out of 10 people in maryland watch ravens games. We will have commercials during the ravens games, as well as on the big screen. Into giant,ll go safeway, and cbs, and meet people where they are to help with some of the enrollment processes. At the local actually, let me talk a little bit about our connector program. We have a 7. 9 million grant. We recently hired 107 navigators. That is one navigator to about 2000 people. That sounds like a lot of people, but when you look at that ratio, you shake your head a little bit. A wide varietyed of partnerships with formal partners and informal partners. Our 17 partners, what we call formal partnerships, is where there is a lot a monetary exchange. We have given them money to hire their own navigators in their organization. We are working with hospitals and a wide variety of Community Based organizations to hire their own navigator as sisters assistors. We plan to embed our own staff into other venues. We think libraries are a very important ways to go. In central maryland. We are working very closely with all the School Systems in each county. Instance, the Baltimore City Public School students, on their very first day of school, brought some information about the Affordable Care act and how their parents can enroll and sign up. We have lots of calls already from that outreach. Working with Community Colleges as well. It is a great place to go in all three of the regions. We also felt that talking to High School Seniors was very important. They are graduating. Populationvery good to talk to as they Enter College and are looking for other resources. Are going to capitalize on our existing infrastructure. There is a lot of infrastructure already in place. We are working closely with local departments of social services. We are working with local Health Departments and clinics. Working with our inhouse Home Visiting programs to provide Case Management to 80,000 people every year. Servescare maryland 150,000 people every year. We are also out reaching a child or pregnant women. There are several other people in the home that qualify for benefits. We plan to do the inreach in their homes to spread the word about the Affordable Care act and how people can enroll. It isnt for them to understand that our staff will not be sitting in the offices it is important to understand that our staff will not be sitting in the offices. They will have laptops, scanners, and printers, all portable. Put themly do hope to in a wide variety of locations in our jurisdiction. One other important thing is, Health Care Access maryland we have already had a Health Care Insurance hotline since 2008. We already get 5000 two 7000 to 7000 calls a year on that hotline. Get throughle will in that approach we have. We are going to turn to the other side of the country, to oregon. On the telephone, i would like to welcome Samantha Sheppard to offer some comments on behalf of the state of oregon. Thank you so much for having me here today. I am sorry i cannot join you in person and im joining by phone. A pretty busy time on the ground in oregon. Hard to step away. Looking ato much for the challenges we have faced. Outreach andr enrollment assistance, we have established a Community Partner program. Umbrellader one navigators, application assistance, provider entities, hospitals, and more. We had a pretty Robust Program already in oregon, two hundred organizations that already did application assistance for medicaid and chip for a number of years. We were able to build on that Community Partner program and invite new entities to join as well. Grants administered some to outreach and enrollment grantees. We have a few other opportunities that just closed, and we are getting the final agreements. Most of our partners will be funded. Are provider entities that receive general fund dollars from the state or federal government, or received grants to do this work. We are not treating them any differently. We think it is a Strong Program to have everybody in one bundle. From as it easier staffing perspective. One of our key strategies in oregon is to have ongoing staffing for our Community Partner program. We have regional Outreach Programmers who should be front line in communities across oregon, to make sure partners and Insurance Agents are coming forward to collaborate and look for the best Customer Service possible. Our regional Outreach Programs develop monthly clever to meetings, where people doing outreach and enrollment, or Insurance Agents and health directors, can come together and talk about best practices, what opportunities they can partner on, etc. Our staff also have an online social Networking Tool that we put together for our Community Partners and agents, where we can stockpile resources for them , fact sheets, flyers, and handouts they can access or reference while doing their work in the field. We know that it is hard to give every agent what they need on september 30, to go live on october 1, so we wanted to make sure we had ongoing Resources Available to them. Not everything is going to stick in training and not everything makes sense. So we knew having this Technical Assistance would be key. Collaboration is key and have tried to rise the function the functionality and the system for partners. It is the same. How they work with the consumer and access client accounts and find someone eligible and help them enroll. It is the same functionality. We are able to have conversations on the same plane. We think thats strong. The overall Marketing Campaign, you heard our ad. You have heard our campaign. We have had several musicians write us music that we are using as our key strategy and great way to get stuck in peoples minds and doing Google Hangouts and other social media to reach young people and the isolated areas of our state. If anyone has traveled to oregon, you know about one half of our population lives in the portland area. To rich the rest of the state, we havemedia will help. Also done Community Meetings for the public and other things like that as well. We have a strong relationship in our state Medicaid Agency to cover oregon, but we are streamlining our organization as well as our Outreach Program which reinforces the overall system. We expect on day one to have about 250 Community Partner organizations that are doing this work. We dont certify any individuals to do application assistance. We certify organizations. We have contracts with them. And they hire staff and bring on volunteers that they are responsible for. We train the volunteers and make sure they jump through the hoops and the Organization Makes through they go through criminal histories, et cetera, to get them into the system and make sure privacy is protected. I think thats a pretty good overview. I would add as i said earlier, we were able to build off of an existing program here but also for outreach we have a strong strake holder that has been doing outreach and we found no reason to recreate the wheel and we have tried to steal it. We would like to put a different spin on it. We have been trying to build off that includes the school flyers, as well as making sure that we are using integrated Outreach Strategies things like provider clinics, people ask the question, are you uninsured, easy strategies that are lowdollar costs and something sustainable for years to come. Thank you so much for your time. Thank you, samantha and i know you will be with us for the we areons and answers. Nowo not turn back to turn back to nikki king, from nevada. Thank you for having me. Im with access to health care in nevada. We are one of the only statewide nonprofits, which is quite a feat, because it takes nine hours to drive from reno to vegas. Nevada is huge. What do we do . I wanted to provide you background on who we are because im coming here from a perspective, we arent affiliated with the exchange but the micro. Macro. We operate a medical discount plan. We have been serving the uninsured before it was cool. So for seven years, we have been serving the uninsured with a medical discount plan. We built a network of providers. It looks like an insurance product, but its not. Built a network of 2,000 providers. Our members are between 100 and 250 of the fpl and they have access to the network and access to care coordination, which has been huge for their success. They pay the providers at the time of service a vastly discounted rate. Each member gets to choose a provider. That visit is 40. We have every kind of specialty. We have hospitals, every Health Care Service that someone would need all at vastly reduced rate. Our hospital rate is 400 a day. A 3000 cap. Specialty care is 65 and mri costs 260. We have flat rates. It has been a life saver in nevada, where if you are a single adult, female or male, you cannot get on medicaid. We have very few services apart from our safety net services. But we are the only entity in nevada that has been serving the uninsured with a comprehensive program. So we are well positioned to continue this effort. About 40 of our members will go on medicaid, because once in our history, nevada did something right, we are not at the bottom. So our state did we are expanding medicaid and do have our marketplace. Going to assist that 40 on to medicaid partnering with our navigators that are with our Community Health clinic. The rest of them, 60 , we have grown to no know and love our members on an individual on an individual basis because of the care coordination. Most of our members have never had access with dignity to the Health Care System. And thats what we have rhode have provided for them. We literally have had people crying in our enrollment room because timely they are going to be able to get the care they need at a price they can pay with their dignity. We give them a card and access the care just like the rest of us who have had the privilege of having insurance. We felt strongly that we needed to continue to serve our population. What we have done is partnered with a local nevada Insurance Company. They will provide the Health Insurance and we will continue to provide the care coordination. So what does outreach and enrollment look for us . Its completely onetoone, because we are using our care coordinators who have a relationship to first, the message is Health Care Reform is here. Most of our members are not aware that it actually did pass. We do use the term obamacare, because it does resonate and while it is negative for some, at least we dont have to explain what Health Care Reform is. Then we have moved on to we did that through robot calls, e blast, facebook and onetoone because our members pay a monthly membership fee and they like to pay with cash. We are a cash economy in nevada because of the service industry. So they come in a lot and pay. We have a lot of contact with our membership. A lot of opportunity to tell them whats happening. But then beyond that, they are like, ok, its coming. How much does it cost . Cost is everything to this group, everything. And health plans are not used to publishing costs and so, it has been a real challenge for our health plan to get comfortable with putting in writing what its going to cost. Only four rating criteria. If you are a woman that lives in a county and makes 32,000 a year and have three children, this is how much your premium will be. Finally, we are able to release costs to our membership, which is all they care about. Tell me how much its going to cost. Are you talking hundreds of dollars are talking like 40 . This has been a huge break through for us in terms of our outreach. Enrollment will be with brokers. We have become a brokerage. We have a forprofit side because thats the only legal way to do it and will be oneon one and booked out for the entire month of october to enroll them one on one with brokers we have hired. Its been an incredible ride. The biggest challenge we are facing is misinformation. Its hard to get the right information in a timely information because everything is so new. Thank you. Thank you very much. Thank you very much. Well return to the east coast to the experience of massachusetts with manny. Im the c. E. O. Of east Boston Neighborhood health sebt center. We are a large federally qualified Health Center and operate out of a single location, 100 million in revenue, over 60,000 patients and 300,000 patient visits. We are unique as we operate one of the only 24 7 Emergency Departments in a Community Health center and ill get back to that in a center. First take you back to 2006 when massachusetts passed Health Care Reform law, chapter 58, which required every resident of massachusetts to have Health Insurance coverage. That meant expanding medicaid, but it also meant creating an Organization Called the connector group, which is responsible not only for the exchange but also providing subsidized Health Insurance plans to those that do not qualify for medicaid. The connector was also responsible for the enrollment and Marketing Campaign for the state. And they spent millions of dollars on p. S. A. s, including if you are familiar with boston, you know we are big sports fans and my colleague to the left here, i think just about one out of two 50 of the population, you need to be a red sox fan to live in massachusetts. [laughter] lot of ads in fenway park using star athletes to let folks know this was coming, particularly for young adults who were not interested in carrying Health Insurance. They made 3. 5 million available to community organization, such as Community Health centers. And that money was used to expand the enrollment staff for many of those who are familiar with Community Health centers, know we have been doing this for a long time. We have had Financial Advisers and enrollment reps and helping our patients and anyone who walks through the door identify the right coverage for them or connect them with a primary care provider. With this money, we were able to expand that staff to exact 20 individuals. We also used the money to train the ep tire organization of what was coming. That was important, because we felt this was a true team effort. At any one point they would be asking the front desk staff, medical provider, nursing staff and we wanted to make sure everyone was educated at some level that was appropriate to their position about what was coming and then intensive training to the enrollment staff so they could be truly the experts to the stick in this area. And then we did our own Community Outreach, knowing our individuals were not our outpatients were not attending red sox games at 100 a ticket, we needed to go out to the churches, to the parks, train stations and where they lived, worked and spent their time to let them know what was coming and we provided direct oneon one assistance throughout the process to make sure they were enrolled. For us this has been an ongoing effort. Although we have been doing this for the last five to seven years, it doesnt stop there, because many of our patients have experienced breaks in coverage or need to go through a process. We have maintained that staff and still remain busy making sure that folks who have a break on coverage get back on the appropriate plan or those who have never signed up, make sure they do get signed up. Thank you. Thank you very much. And now im going to ask samantha to be available for questions by phone. So if the audience wants to ask questions we have to two samanthas. So let us recognize the individuals who have questions. If you would identify yourself first by raising your hands and get a mic to you and second identify the group you are with and then pose your question. Stan, maryland state education association. Yesterday, the New York Times ran an article saying that a lot in order to keep costs down a lot of the plans going on to the exchanges had a limited number of doctors and hospitals incorporated, some as low as 50 or 40 in the surrounding area and that is a huge concern that people going on the exchanges are going to have limited choices as far as doctor and hospital groups. What is your experience with that . I would like to preface by saying im not a Network Expert but i know the mailin insurance insuranceyland administration did establish benchmarks for network adequacy. I know the products on the exchange had to meet certain benchmarks to make the products available on the Health Insurance exchange. To the best of my knowledge, all the networks on the exchange are adequate. I can really only speak about the plan that were affiliated with which is st. Marys health plan. It is a Broad Network with multiple facilities. The one unique thing they have done is they have built a pen network for the primary care side and they are going to work closely with them, along with us and our care coordinators to do more they are trying to keep the primary care level that can be kept there. And theyre doing incentives where a costsharing incentive with the primary care network sm the Specialty Care network is the same that they have with their other small group plan. So it is yite broad. In massachusetts, similar to maryland, the Insurance Commission made sure there was adequate coverage throughout the state, but the reality of this Health Care Reform is there will be limited networks for groups or insurance programs. We are seeing that in massachusetts as we have some very expensive academic Teaching Hospitals in massachusetts and some health plans have limited their members from those groups or have required members to pay higher deductibles or copays if they still prefer to get their care there. Which is also true of general Health Insurance as well, not just that available in the marketplace. Question over here. Im hanna with the National Senior citizens law center. This is a question for anyone. If youve dealt with or how you are dealing with the senior population. I know you mentioned the biggest you face is misinformation and i know they are getting a lot of misinformation and if you are doing anything to counter that and more specifically, if you are talking at all about the dual demonstrations that the seniors might be eligible for and how that might change things for them. I would like to make a comment about the senior population. It has been interesting how many Senior Citizens are attending the Health Care Forums but the reality is this law is not applicable to them at all in terms of they have medicare. So many of them, this does not apply to them. The dual eligibles is a separate topic. But the vast majority of people coming to us, its not applicable. We run the medicare counseling program. We have over 40 volunteers throughout the state of nevada and we administer that program. Last week, i spoke with the director of that, and there is a lot of misinformation amongst the seniors as to when they enroll and do they enroll all the way to march or do they confine that. We set up town halls throughout the state of nevada and our volunteers are educating our senior population that everything stays the same for them. You are right, there is a lot of confusion about how the two Work Together. In oregon, we are partnering its calledogram. Sheba. So we have been cross pollinating to make sure they know each other and meet each other and begin networking and referral systems. And look at the best service. We have been incorporating fraud messaging into our campaign. We have been making sure people know what cover oregon will and will never ask for. We had a press coverage last week and ran out messaging to our lists, we will never call you and ask you for your credit card number, an agent will never ask for payment to apply and made sure folks know how to call our Customer Service number and that they are certified and not someone who is not certified. We are aware of the concern and trying to address it head on. Tony with enroll america. Just started this state coordinator for maryland. One of the things to the audience who are looking for people to be volunteers and appreciate any help in maryland recruiting volunteers. My question to several of you is, what ways can volunteers help you . Thats one of the questions having to start. Would be glad to hear what kind of needs that we could provide help with. The entities need as much help as possible to get the word out about the law and who call about enrollment. Not only do people not understand the law, a lot of people dont understand where to go. The Marketing Campaign and the media will help inform individuals. But to the extent possible, working, if you are able to do a regional approach, working with the geographic region, having ties with them would be tremendously helpful. We do a lot of Health Communications work. One of my questions came from the slide. You mentioned challenges with i. T. Can some of you describe what those challenges are or what the Biggest Challenges have been setting up the i. T. And the solutions or the things that have been helpful for surmounting those challenges . Im proudly going to kick this off to the other samantha in oregon. But in terms of what we heard when we conducted the case studies, i think in many cases, they were building new systems and if there is a lot of effort involved in getting the systems off the ground. I think sometimes communicating complex policy to the individuals actually building the systems. There was a learning curve to learn how to communicate with the policy folks. Because the systems are doing integrated determinations for medicaid as well as the marketplaces, it involves the coordination of a lot of different folks at the state level. So i think what weve heard is that the states really needed to establish strong collaboration efforts among those different agencies to get the systems built. The other challenge, which i referenced at the end, was a lot of the final rules from the federal government came out slower than i think some states would like because they needed to meet certain target deadlines in order for their systems to be ready to go on october 1. In many cases, at some point, states had to move forward with builds, where they were awaiting the final rules and staying in close contact with c. M. S. To let them know what direction they were going and making sure everyone was comfortable with where they were going. Because the i. T. Build has been a significant challenge, at least from these three states, we heard the systems are not exactly what they want them to be on october 1. They had to prioritize what was the most important thing to have built on october 1, but they are enhancing the capabilities over time and building in work arounds until they get the capabilities built in. I dont know if you want to touch on the oregon experience more directly. You hit it straight on. I would add there are a lot of cooks in the kitchen so we have to be able to communicate with all of the state systems. So various legacy systems we have to build interface systems. It can be five to 10 to 15 years old and have a myriad of data in them. We have to transmit information with all of the carriers as well as the federal hub. We can build receptors and we dont always have control of the information coming to us. There are a lot of ways information can be interpreted and the carriers have their own systems and i. T. s. Getting the Different Developers and i. T. Geniuses to speak the same language on the same time line for testing is really hard. There is also the idea that we develop the communication and cant transmit a lot of information on these interfaces yet. Knowing the connection is there and knowing it can communicate and develop eligibility determination or shopping environment, those two things are different. A lot of the pieces were developed, but then just over the past few months, have they all been connected. You can test different systems, but those gaps wont be identified. We have a flyer in our general presentation that we show that our executive director told the story about raffy and he tells the story of a 1972 honda. Our goal for october. We want to drive across our state and make sure we are picking up people and do it on the best gas mileage and dont want to break down. We are going to keep building that honda and crews control and c. D. Players. No radio, no air conditioners, but no power locks. On day one. Thats ok. If we think about medicaid and medicare, there have been hundreds of applications since 1965 in every one of our states. We arent supposed to get it right on day one. We want the opportunity to make it better and do it well. And then keep building and keep perfecting and make it better as time goes on. Thats terrific. That would be a great ending, but instead we are going to take the next question. [laughter] my question is based on something that you mentioned, but i would like the panel to comment. You mentioned breaks in coverage. What are the primary reasons for breaks in coverage, the duration and what the other states, including you samantha are thinking about to anticipate those from happening or how to prevent those from happening. The duration question is difficult to answer because it varies based on the individual situation. The breaks we have seen is seasonal workers, those not in Permanent Employment or employment like Migrant Workers and other that, thats where we have seen our breaks. Folks not responding to mailings that are coming from the state or private Insurance Companies and folks dont understand it is at a much different reading level and the states are doing a lot to standardize these letters and make it appropriate for that population or even in the language thats necessary. But what we try to do is encourage our patience, whenever they receive them, to bring those in and again we use our enrollment or Financial Advisers to help interpret the letters and take action if one is necessary. I would agree with everything that was just said. Transient populations, the populations that fall between the cracks in many programs are those most likely to turn and fall off of coverage. Having communitybased organizations involved and ongoing relationships like Health Departments and safety net clinics are key because people often walk back in the door again and can help with the assistance. In the portal, we have the ability for Community Partners and agencies to maintain relationships. So they will have a renewal date, not on day one, a renewal date they can see in their dashboard and they can reach out to those people. As well as notifications coming from cover oregon and if they are on c. H. P. , they may help the person enroll which is really important. I see a navigator at Community Clinic inc and we are in maryland. My question is you have existing programs or clinic setting or Community Outreach setting. How did you reconcile having an existing system and then incorporating these big changes . What were some of the Biggest Challenges and while things are its all pilot and sometimes state and county officials, they are busy and not communicating, what is internally something we can do, like or i guess sort of play on our strengths rather than just waiting for communications . Some things you would have to wait to get direction on, but what are some things that you were able to like either your staff, existing staff or other programs that you were able to pick up on . I would recommend that you look at your work flows very carefully. This can be overwhelming and what you will find is increase in volume in that area, so we sent all the way to redesigning the actual waiting room space, office space for the enrollment advisers and looking at the work flows and a greeter at the front to identify what is the issue up front and making sure we are directing the patient to the right enrollment rep and the physical space and the work flow. Thats a great question, because its really easy when you are building a program in startup to build the track. Its hard to lay another track when the train is going 1,000 miles per hour. Thats been my job to head that up. We have been very strategic about what we can and cant do. My main goal is managing expectations of my staff and letting them know its ok to not do everything right out the gate and giving them a lot of freedom to make decisions and the comfort to fail, because when you are doing startups, no one and without the right information, no one has the right answer. So it has to be in my opinion done in a Team Approach and thats the way that we have approached it. I wanted to go back to your question about the breaks in coverage because this is key. We do a monthly membership fee. You can liken it to a premium. 10 of our membership drops every month. This is something we talk about on a daily basis, retention. And so how are these Insurance Companies going to retain their membership and therefore their profit to keep going . I think they are in for a really rude awakening and st. Marys health plans partnered with us. Retentionr t for this group comes down to relationships. If you dont have a relationship with them, there is no reason why they are going to select to pay their premium over gas and food. Its not going to happen. So we are constantly encouraging our members through relationships that the value of their health and putting their funding toward their health, limited resources toward their health. If you dont have a relationship with them, if you are just a piece of paper, then they will drop. I see it every day in our company. They will drop. So thats what were doing, is that retention starts with enrollment. Thats where it starts. And even further back, it starts with outreach, if you care about them, they will stay with you. Im a navigator. My question is specifically for marilyn but if anybody wants to chime in. I have heard conflicting things about what is going to happen to the resources for uncompensated care. Some people say more money could be going towards that as well and others say more people will be covered, those resources will get cut. I dont know if you would like to speak to that. I have heard conflicting information as well. I heard with the Affordable Care act there may be more people who have Health Insurance but dont know how to navigate the Health Care System and utilize Emergency Rooms or other costs or otherlth care. Sources of high cost care. I think the key with enrollment, piggybacking, insurance enrollment is critical and important, but helping people how to navigate the Health Care System, how to utilize a managed care network and understand the plan are critically important and that is part of the navigators role. I think its critical to have that Relationship Building and help people understand how they are to use insurance. It may be the first time they ever had it. We all know that outreach in the enrollment will be important. There will be people who remain uninsured and uncompensated care will not go away but hopefully it will be less as more people gain coverage. Clark ross, American Association on health and disability. Every state we have a state Mental Health agency, a Substance Abuse agency and designated intellectual and Developmental Disability agency. A number of you have talked about medicaid Health Insurance collaboration. What are your experiences in working with the special disabled subpopulation agencies . As part of our connector grant applications, its critical we work with stakeholders and communitybased organizations that serve hard toreach population. We have partnered with Mental Health agencies and we are embedded in 20 drug treatment sites in maryland. We felt it important to be involved. Those that serve the disabled, and those who are in drug treatment. Im from the Truman Foundation and i appreciate the emphasis on onetoone consumer assistance, thinking about vulnerable populations and large geographic populations and those who dont have broadband communications. How do you reach them . Samantha in oregon. I think, again, are having communitybased organizations that have relationships in those communities helps a lot and working with Community Governments and getting creative to think about meals on wheels and summer food sites and other things that bring people out of their homes where you can interact with them. We have one county that has 500 people in it and crab fest every spring and you can shake hands with every Single Person in the so finding events like that to get a hold of them like that is great. We have several partners that will be thinking. Membership lists and donation lists that they have from previous campaigns and neighborhood canvassing. It is another way to get out and make the connection. I think lastly, finding Decision Makers and Community Leaders who can be a spokesperson and come out and make a statement at services and endorse, for lack of a better term, what is happening and how folks should get covered and get in play as well as using mayors, chambers of commerce that are voices in the community and understanding that here in oregon, i5 corridor, we cant talk to everyone. We need to go to their places and listen to their needs and then empower them to do so. Im a Public Health policy consultant. My question has to do with some things that are going on in other states far more than yours and im glad to hear its not going in your yours where navigators are required to be Insurance Agents and take an additional 40 hours of training and pay for it. Thats the worst i can think of right now. But it is a case similar to what the woman said, when you are creating a new system where there was a system, you have to negotiate roles. And obviously the uninsured community didnt occupy a lot of Insurance Agents time but the issue is there, from the top down especially. I would be interesting to hear what the role of a sister, navigator, agent and broker. Thanks. I would say, i think the situation is going to be different, slightly different in every state. The states are still in the process of setting up what their assistance programs are going to look like and the brief that is in your pacts goes through a little bit about the variation we are seeing and structure and design and approaches used in each state and i think as is clear from the comments today, access to the assistance is going to have key implications for the successive enrollment effort. Just drawing on the case study findings, talk about how at least nevada has dealt with this issue, we went out there and spoke directly with Insurance Brokers in the state and heard that in the beginning, they were very add veer searl and felt it s a threat to their market originally adversarial coming and felt rt was a threat to thei market share and unsure what it would mean, but over time and through a lot of outreach from the state to the broker community, they have since come around and feel that they will have a role, a defined role and recognize that the target population that is being reached in the state is very broad and that the navigators and sisters will likely be assisting different sectors of the population and the brokers will be assisting and many are looking at it now as an opportunity to increase their market share since there are many more people that will be eligible for coverage. I think at least in that state they have worked an arrangement where all the sisters, including the brokers are working together, recognizing that they will be targeting slightly different segments of the population. I wanted to add, im not sure about my counterparts, but navigators and sisters are certified through a training. Tough take a class and take a test. Hopefully ill hear soon that they did well. Is there a charge for that . There was a small charge, yes. In nevada, you do have to go through a training. They are charging for it. And for the brokers, navigators and the sisters. In the beginning we were told the sisters because the sisters could direct to one plan and this comes down to the misinformation where the exchange is telling us one thing and the law says something else. So it wasnt until three weeks ago that our commissioner, Insurance Commissioner just said emphatically, you have to become a brokerage and have brokers on staff. Thats why we had to do that. We didnt want to do that because thats weird for us sort of as a nonprofit. But to be legal thats what we have decided to do. Then the training, the brokers went through the training. We dont have our application yet. We dont know what it looks like, how long it is. The brokers havent had the opportunity to play around with it. So its going to be interesting on october 1. [laughter] its like the car rolling extrah. Without a lot of equipment. National health care for the homeless counsel. You had mentioned specifically working with Homeless Populations and samantha in oregon, you mentioned working with transient populations, but your Program Starts at 100 . Im curious what your state is doing to reach homeless which is a zero to 50 population and what has worked in massachusetts to reach a marginalized population that doesnt have stable addresses and tends to use health care in a different way and population hasnt been eligible, just reaching them, what has worked and what you are trying. I wish i could speak to that, i cant. I dont know. And we have a huge Homeless Population in las vegas. Only two agencies ng las vegas that got the navigators. Im fearful that they would be left out. And for us, we have a large Health Benefits services the Homeless Population and they do a great job at going out and finding these individuals, going to and bringing the information to them and when they are being serviced at the Health Center, similar to us, they have enrollment reps there to help them. This is the population from massachusetts that is covered under the uncompensated care pool. For those individuals that dont have stable addresses or cannot produce any documents to be eligible for medicaid or any other services, these individuals are covered under the uncompensated care pool, which, in massachusetts, was cut in half, but still remains higher than the National Average than many states. So we are very fortunate in massachusetts to have that. I know you are well aware, but we have had tremendous success in enrolling Homeless Individuals in our program. Last year we were able to link about 85 of our Homeless Population to Health Insurance. And with medicaid going into full effect january 1, about 75,000 people, including many of the homeless will enroll into full benefits on january 1. So it can be done, is my point in all of this. Let me chime in from oregon. We are doing it through our state Medicaid Agency, they have received a state plan amendment from the federal government to use snap data as it was mentioned to fasttrack enroll people that are likely eligible for medicaid. So families and individuals who are eligible for snap, will receive a mailing saying you are eligible. We are taking the population out to use the online population because we have their eligibility information from another program and able to fast track them and enroll them. That is one key element. From an outreach stand point, we have our sisters and Community Partners that are going to be the boots on the ground offering application assistance but we have a lot of entities that are going to do outreach and public education. Making sure that states are reaching out to Community Action programs and project access now and homeless connect and when folks do the Homeless Count in february there are great resources in every community that are doing outreach that can refer to enrollment. We have a good connection with the homeless lie aceons. There is someone appoint todd help homeless kids access resources and that is another great connection to make sure folks know where they can get help or assistance. We have just heard from three states that have elected to expand the medicaid rolls and those who live in the states would be the most left out because of their income putting them well below the poverty level. We have one more question here. Im a reporter with Kaiser Health news. Two questions, the first one is, can you walk us through the process of a sister or navigator helping someone enroll in coverage. There is confusion about what they are and what they arent allowed to do in terms of personal advice and whether you think those would limit people who dont know much about insurance. What happens to the consumer sisters, be they navigators after open enrollment ends . Is there going to be a sixmonth period after march where you wont have jobs for them and come in for three months the following year . Are these seasonal employees or what happens . To answer your first question, which in maryland, im not sure about other states, there is a distinction between a sister and navigator. Sister can enroll people in the medicare program. They dont have authority to enroll people in the Affordable Health care. If they are over 138 . They must hand that person off navigatorigator. The can do medicaid as well as enroll, and explain subsidies, tax credits and help them select a very specific plan. Second question, we are kind of banging our heads against the wall, what happens after open enrollment is over. They are fulltime employees. We will boost up our education program. This is going to be a few years for people to understand what is going on. So we do plan after open enrollment ends in march. We will hit the high schools and Community Colleges and do a very robust effort during the non enrollment months. And i think its important to remember that there is no open enrollment for medicaid. People can sign up for medicaid throughout the course of the year its really the access to insurance in the marketplace. We have had a very rich discussion here. I think it cannot be understated what an Important Role, commitment at the state level to making this work is in terms of being able to move forward and get people connected to insurance. We have seen from all of our individuals here that we are building on the experience of the c. H. P. Program and do outreach to children and do outreach in the community. All enrollment is going to be local so it depends on the on thethe groundwork. And the most important thing we learned it takes a Real Partnership for people working at the State Government and especially with providers and communitybased partners. So this is a big effort Going Forward until the 1 of october starts open enrollment but doesnt stop the effort to get people the coverage they need through the Medicaid Program or through some of the individual coverage in the individual market, through the exchanges and remember that a lot of people will also be getting their coverage and through the employerbased system and for them and for the medicare population, this is not an effort to move them to something new but be part of a sustainable Health Coverage system for all americans. Thank you for joining us today and thank you samantha in oregon and to our panelists and to the kaiser team that helped put this together. Thank you very much. [applause] [captioning performed by national captioning institute] [captions Copyright National cable satellite corp. 2013] youre looking at a live picture of the u. S. Capitol as we approach the midnight hour here in washington, d. C. The light indicates that at is so working. Over the last eight hours, he has been joined by several other senators, both republicans and democrats. Live coverage of the Senate Continues on cspan2. We will take a moment here to listen in. Obama treats giant corporations and members of Congress Better than hardworking americans . I think its indefensible. And yet, this body right now, unless we act differently, is going to allow that status quo to continue. Saying senators should live by the same rules as the American People should not be controversial. It should be obvious. Make d. C. Listen. Thats exactly right. Congress has exempted itself and staffers from the monstrous law for a reason. Dont we deserve the same . Make d. C. Listen. Make d. C. Listen. Americans are finally seeing whats in the bill, and we hate it. Thank you for standing up to the status quo in d. C. Senate phone lines are jammed. Start using facts, social media. Go to, and it lists a private web site for a list of twitter accounts. Make d. C. Listen. I think that point, by the way, is really quite potent. Thats as effective as the phones are, the phones are very effective. There is email, there is facebook, there is twitter. There are an awful lot of ways for the American People to speak up and make d. C. Listen. Today the Cleveland Clinic saved my dads life. Wow. U. S. Senate saved their jobs. Make d. C. Listen. Thats powerful. How can any american support a law that punishes success . Thats unamerican. Defund america now. Make d. C. Listen. Defund obamacare because its a tax that was never read until it was passed. We the people demand representation. Make d. C. Listen. Defund obamacare because it will ruin our generation and senator cruise began his comments eight hours ago saying that he would talk as long as he was able to stand. Technically, this is not a filibuster. He will have to stop talking before procedural vote tomorrow morning in order to move ahead on the bill. Of can watch live coverage the u. S. Senate as it continues on cspan2. Herell leave senator cruz on cspan. This evening, president obama talked about the ongoing efforts indefund the Health Care Law a conversation with former president bill clinton. The president start in new york city for the u. N. Generalissimo. This is less than an hour. Hillary rodham clinton. [laughter] good afternoon, everyone. Thank you. Thank you very much. I have a great pleasure to introduce our next two speakers who are about to have a conversation concerning health care. About how to hard introduce these two men. [laughter] and the more i thought about it, the more i realized how much they have in common. They are both lefthanded. Golf, a game that does not often reciprocate the love they put into it. [laughter] y both are fanatics first fanatic sports fans and go to Great Lengths to be in front of the tv or on the side of the court or the field. Politicianse master. Each of them has only lost one election. Theyre both democrats. They have fabulous daughters. They each married far above themselves. [laughter] [applause] and they each love our country. And so, please join me in welcoming number 42 and number 44, bill clinton and president barack obama. [applause] mr. President. [laughter] are you interviewing me . That was a good thing you did. [laughter] thank you for coming. It is wonderful to be back and let me start by saying to have foreople who years now supported the incredible efforts of cgi. Thank you. Wherever we travel, all across the globe am a we see the impact that its making every civil they gave and we are every single day. And we are proud of the work you do. Let me say that we still miss our former secretary of state. [applause] and i should add that there is nothing that she said that was not true. [laughter] particularly about us marrying up. My firstrings me to health care comment. This will be a conversation about domestic and International Health and americas role in it. I want to begin by telling you that i think the first lady has done a great job in this fight against childhood obesity. We have been honored in our foundation to be asked to represent her effort in 18,000 we have lowered the calories in drink being served in schools by 90 . She has been great on that. Thatther thing i think is i was a little upset, and as you know, karl, one of your administration members, when you got to i read an article that said you didnt have a dig initiative in africa. And i said i cant say exactly what i said. [laughter] but it is inaccurate. That is the sanitized version of what i said. When the president took office tookr programs office, our programs was giving medicine to 1. 7 Million People because of an agreement that i made with president bush to use generic drugs that were approved by the fda. About half of our drugs are being purchased in that way. Under president obama, we have gone to 99 . We are treating more than 5. 1 Million People, three times as many for less money. [applause] that is a stunning legacy so that more money is put into so you and bed nets to save more money and save more lives while doing it. I want to thank you for that. Its important. [applause] maybe at the end of this conversation, we can get back to some of your current Global Health initiatives, but lets talk a little bit about the Health Care Law. We are about to begin on october 1 open enrollment for six months and id like to give you a to tell themof all why, when you took office and teetering on the brink of a depression, you had to start the recovery again, why in the midst of all this grief did you take on this complex issue . Why notple were saying just focus on the economy and leave us alone . So tell us why you did it. First of all, i think it is important to remember that health care is the economy. A massive part of our economy. So the idea that somehow we can separate out the two is a fallacy. Usond of all, the effort for multifaceteda Health Care Crisis has been going on for decades. And a person who just introduced us, as well as you early in your presidency, had as much to do with helping to shape the. Onversation as anybody here in the fact is we have been come up until recently, the only advanced industrialized nation on earth that permits large tobers of its people languish without Health Insurance. Not only is there the cruelty of people who are unable to get health incurs, having to use the get health as insurance, having to use the emergency room doctor, but we are also more efficient than anybody else. So when we talk about, for example, our deficit, you know this better than anybody. Onlyeason that we have not current deficits but also projected longterm deficits, the structural efforts at that on theis primarily based fact that we have a hugely inefficient, wildly expensive Health Care System that does not produce better outcomes. And if we spent the same amount of money on health care that canada or france or Great Britain did or japan or any other industrialized country with the same outcomes are better outcomes, that essentially would remove our structural deficit. Which would then free up dollars for us to invest in Early Childhood education and infrastructure and medical research and all the other things that can make sure that we are competitive and growing rapidly over the long term. So my view, when i came into office, was we have a crisis. We have to get the economy going. But we have to start tackling some of the structural problems that have been building up her years. Building up for years. What accounts for our deficit and are dead and causes pain and misery to millions of people all across the country, it is a huge burden on our businesses. I was at a ford plant in and there is a big stamping plant. Seller now the biggest in the United States. We took that leap back from the japanese we took that lead back from the japanese automakers. Every u. S. Automobile that is a coupletured requires of thousand dollars in added Health Care Costs that our foreign competitors dont have to pay. So this has anything to do with the economy in addition to what i consider to be the moral imperative that a mom should not have to go bankrupt if her son or daughter gets sick. That a family who is dealing and is already struggling to pay the bills shouldnt also be wondering whether they are one illness away from losing their home. And i think most americans agree with that. [applause] first of all, folks, for those of you who are from the United States, that is as good an overview as youre ever going to hear of what this economic issue is. But you remember the president said that our structural deficit would disappear if we had a comparable Health Care System in terms of cost to the french and germans who are consistently rated the highest. It is about a trillion dollars a year. Somewhere around 44 of that money is governmentfunded money. So you just run the numbers. Over half of our deficit has already disappeared because of Economic Growth and the revenues you raised and the spending we cut. And you pretty much get rid of the rest of it if we just have a comparable a copper handsomely system a copper handsomely competitive system a comprehensively competitive system. They announce twe car company that provides Health Care Benefits to employees. We are not a Health Care Company that sells cars to cover our health. We have to go to canada. It was one of the few companies willing to go on record and say this. So thank you for doing it. What does this open enrollment mean . How will people get involved . When you have universal enrollment, you can manager costs better and cut inflation. To give the president i will give the president a chance to talk about all the good stuff. But i will let you know one thing. In the last three years, inflation and Health Care Costs have dropped three years in a row for the first time in 50 years. 50 years. [applause] weree that, the costs going up at three times the rate of inflation for decade. So now what . What will you do on october 1 . Tell them how this has to work. The me give folks a little bit of background on what is already in place and then what happens on october 1. When we passed the Affordable Care act, there were a number of components to it. A big part of it was essentially providing a patients bill of americans and advocates have been fighting for for decades. So we wanted to make sure, if you already have Health Insurance, you get a fair deal. That you are being treated well by your insurance. Prohibitednated, Insurance Companies for putting lifetime limits which come oftentimes, if a Family Member got sick, they thought they were covered until they hit that limit and then they have no way of paying. We said to Insurance Companies youve got to use at least 80 of your premium that you are receiving on Actual Health care, not on administrative costs and ceo bonuses. And if you dont, you have a rebate you have to rebate anything that you spent back to the consumer. So there are millions of americans who received rebates. They may not know that they got it because of the Affordable Care act or obamacare, but they are pretty happy to get those rebates back. It made sure that the Insurance Companies were treating folks fairly. Person that any young who doesnt have Health Insurance can stay on their parents Health Insurance until they are 26 years old. As a consequence, what we have seen is steadily the rate of uninsured for young people dropping over the last three years since the bill passed. Ofiously providing a lot relief to a lot of parents out there because a lot of young people have been entering the job market at a time when jobs are tough to get and oftentimes benefits are slim. This is providing an enormous security until they get more firmly established in the labor market. We provided additional discounts for seniors under the medicare program. Seniors have saved billions of dollars when it comes to getting their Prescription Drugs. There have been, over the last three years, a whole array of Consumer Protections and savings for consumers that result directly from the law that we passed. To those who say they want repeal it, typically when you ask them about what about all these various benefits, they say, that one is good, and we would keep that, and you go down the list, and there is not too much that people object to. You will recall also at the time that part of the way we paid for the Health Care Bill was, we said, medicare is wasting a lot of money without making seniors healthier. There was a lot of outcry about how we were taking money out of medicare. Well, it turns out that we were right. Change how doctors and hospitals and providers were operating, rewarding them for outcomes as opposed to simply how many procedures they did. You started seeing practices change among millions of providers across the country. Medicare rates have actually slowed in terms of inflation. Seniors have saved money. Folks are healthier. Haveof those savings we been able to use to make sure that people who do not have Health Insurance get Health Insurance. This brings me to october 1. The one part of the Affordable Care act that required several years to set up, but a critical part, was, how do we provide Health Insurance for individuals who do not get Health Insurance through their job . It is a historical accident that in this Country Health care is attached to employers. Part of the problem is, if you are out there shopping for Health Insurance on your own, you are not art of a big pool pool. Part of a big there is no aggregation of risk for insurers. They will say, you are 50 years old, you have high blood pressure, and we look at the actuarial tables and we figure you are going to get that, so we will charge you 1500 a month for Health Insurance, which the average person has no way of affording. There is no pooling of risk. We said we need to set up a people whoo pool currently do not have Health Insurance so they have the same purchasing power, the same leverage that a big company does when they are negotiating with an Insurance Company. Essentially, what weve done is created what we call marketplaces, and in every state across the country, consumers are now able to be part of a big pool. Insurers have to bid, essentially compete, for the business of that pool. Are we now have set up these marketplaces that provide highquality health care at affordable prices, giving people choices so they can get the Health Insurance that they need and want, and the premiums are significantly lower than what they were able to previously get. I will take the example of new york state. Put in their bids to participate in these marketplaces. It turns out that their rates han whato 50 lower t was available previously if you went on the open market and you try to get Health Insurance. 50 lower in this state. [applause] california, about 33 lower. In my home state of illinois, the Just Announced about 25 lower. Just by pooling and creating competition so that insurers have to go after peoples business the way they go after a group plan, we have drastically reduced premiums and cost. On top of that, what we are now doing is saying, if with the better deal that youve got, you still cannot afford it, we are going to give you tax credits tos to subsidize your purchase of Health Insurance. Wes the net result will be continuing to roll out what the actual prices are going to end up being, but i can tell you right now that in many states across the country, if you are a 27yearold young woman, dont have Health Insurance, you get on that exchange you will be able to purchase highquality Health Insurance for less than the cost of your cell phone bill. Because all the insurers who participate are required to provide free preventative care, free contraceptive care, that young woman, she may make up what she is spending on premiums just on her monthly use of health care. This is going to be a good deal for those who do not have health. Nsurance those who already have Health Insurance are Getting Better Health Insurance. The best part of the whole thing is, because of these changes we initiated in terms of how we are paying providers, Health Care Costs have grown, as you pointed out, mr. President , at the slowest rate in 50 years. We are bending the cost curve and getting at the problems that are creating our deficits in medicare and medicaid. [applause] i should point out that so far in most states, one of the good things, at least, that i do not know would happen when we began this, in the United States, more than 80 of american states had only one or two Companies Providing Health Insurance who had more than 80 of the market. There was, in effect, no price competition. What i was terrified of, we would open these things, and there would only be one company to show up to bid. We would be having an academic conversation. Instead, it has led to the establishment of more companies doing more business. I think part of it is that they have more confidence that they can deliver health care at a more modest cost. But i thinks good, it is important for you to tell people why we are doing all of this outreach. This only works, for example, if young people show up, and even if they buy the cheapest plan, they claim their tax credit. It will not cost them much. 100 a month or so. Weve got to have them in the pool, because otherwise all these projected low costs cannot be held if older people with preexisting conditions are disproportionately represented in any given state. Youve got to have everybody lined up. Explain all the work you have been doing on the outreach for the opening on october 1. I think president clinton makes a really important point. Work any pool is essentially those of us subsidizealthy somebody who is sick at any given time. We do that because we anticipate we will at some point get that. We hope a healthy person is in our pool, so those costs and risks get spread. That is what insurance is all about. What happens is, if you dont have pools that are a Cross Section of society, than people who are already sick were more likely to get sick, they will rush out and buy insurance. People who are healthy, they say, you know what . I wont buy it. You get what is called adverse selection. What happens is the premiums start going higher and higher because the risks are not spread broadly enough across the population. You want to get a good Cross Section in every pool. That is why Big Companies have an easier time getting good rates for their employees than smaller companies. Employees, have five one person is stricken with breast cancer, lets say, and your rates potentially shoot up. But if it is 1000 employees, then it gets spread out. On october 1, open enrollment begins. All of these folks can start signing up for the marketplace. What we want to make sure of is that everybody in every category, every age group understands why Health Insurance is important, understands why they should sign up, understands the choices that are going to be available to them. They will be able to go to a webpage ap on the tap on the webpage, and they will be able to shop, just like you shop for an Airline Ticket or a flatscreen tv, and see what is the best price for you, the best plan suited for you, and go ahead and sign up right there and then. Period willrollment last from october 1 until the end of march. There will be six months for folks to sign up. Prettyy, this would be straightforward. Have of people do not Health Insurance. A lot of people realize they should get Health Insurance. Been aace it, it has little political, this whole obamacare thing. What you have had is an unprecedented effort that you have seen ramp up over the last month or so in which those who have opposed the idea of universal health care in the first place and have fought this thing tooth and nail through congress and through the courts and so forth have been trying to scare and discourage people from getting a good deal. Some of you may have seen some of the commercials out there that are a little wacky. Have, and weage we are using social media, we are talking to churches, we are groups,to various civic and what we are saying to people is, look, go to the website yourself. Care. Gov, take a look at whether or not this is a good deal, and make your own decision. Ist we are confident about that when people look and see ,hat they can get high quality Affordable Health care for less than their cell phone bill, they are going to sign up. They are going to sign up. Part of what i think the resistance we have seen ramp up, particularly over the last couple of months, is all about, his opponents of Health Care Reform no they are going to sign up. One of the major opponents, and asked, why is it that you would potentially shut down the government at this point just to block obamacare, he basically fessed up and said, well, once consumers get hooked on having Health Insurance, and subsidies, then they wont want to give it up. [laughter] you can look at the transcript. This is one of the major opponents of Health Care Reform. It is an odd logic. Essentially, they are saying people will like this thing too much, and then it will be really hard to roll back. Important that people just know what is out there, what is available to them, and let people make up their own minds as to whether it makes sense or not. Now, one last thing i want to say. I do think sometimes people come up to me and they say, well, if this is such a good deal, how come the polls show that it is not popular . One of the things you and i both know is that when you come to health care, there is no more personal and intimate decision for people. This isnts this is something that people really care about. The devil you know is always better than the w dont know. What the campaign was about in the 19 in the 1990s. It was scaring people with the prospect of change. Part of our goal here is just to make sure people have good information. There have been billions of dollars spent making people scared and worried about this stuff. Rather than try to disabuse bit ofof every single misinformation out there, what we are saying is, look for yourself. Take a look at it. You will discover that this is a good deal for you. First of all, i completely agree with that. Weve got to drive people to the website and the website. The Supreme Court decision upheld the health care laughton said that states did not have to set up these marketplaces the Health Care Law and said that states did not have to set up these marketplaces. They also said states did not have to expand medicaid coverage to help people whose incomes are up to 138 of the federal poverty level. There are some states, believe it or not, that want the marketplace but do not want the medicaid. Going to lead to a cruel result. There is nothing the president can do. It is not his fault. That is what the Supreme Court said. He could have this bizarre situation where, lets say, a business with 60 employees or an individual going into the individual market will get the forfit of tax credits everybody with incomes at 138 of the federal poverty level, but they will not get it for ofple between 100 and 138 the level. Low income people who desperately need Health Insurance, we will have the cruelest of situations in those states. There is nothing the president can do about it because of the Supreme Court decision. We have to persuade the states to come on. More and more states with republican governors and legislatures are doing it. Arkansas, we are doing well down there. A little hometown bias, there is nothing wrong with that. A couple of things that are happening that i think are very interesting first of all, im sympathetic to some of these republican governors who are under a lot of pressure because the whole issue of whether you are for obamacare or not has become a litmus test your test. Lyricallyem, it is tough. Sometimes, state legislatures have refused to allow governors to go ahead and implement it. But as you indicated, what we have seen is that when republican governors take a look at the deal they are getting, where im at in addition to these exchanges, we are also providing a much more significant match, much more federal money, to provide health the federal government is picking up the tab. This is helping them because people are no longer going to the emergency room. They now have good health care. You are seeing some republican governors step up and say, i may not like obamacare, but im going to go ahead and make sure that my people are benefiting from this plan. That is one good thing that is happening. The second thing that is happening, there are a couple of states, and arkansas is a good example, kentucky is another good example, idaho, an interesting example these are states where i just got beat. I do not have a big constituency in these states. [laughter] well, i take that back. You know what . 40 is still a lot of people. I am losing by 20 in these states. Wereovernors waltzed still able to say, we are going to set up our state exchanges, their own marketplaces, and each state is just using their own name for it. Conference a videoconference with all the state directors of all the marketplaces, and i am talking to the director in kentucky and in kentucky it is called kentucky connect, and in idaho, it is the Idaho Health Care exchange. There is a story that came out of kentucky where some folks were signing people up at a county fair somewhere, and some guy goes up and starts looking at the rates and decides he is going to sign up, and he turns to his friend and says, this is a great deal this is a lot better than obamacare. [laughter] which is fine. I dont have pride of authorship here. I just want this thing to work. Arkansas just came out with its has been true in virtually every single state, not only are premiums lower than lowerere, they are a lot than even the most optimistic predictions were about how low they would be. Once these marketplaces are up and running, that what is for additional event a pretty conservative principle, which is competition and choice, well, in the Insurance Market, competition and choice works. What we are seeing is that people are going to be able to get the kind of health care that they have never been able to get before. States are going to benefit from it because they are going to save my. One thing save money. There are probably very few of you in this room that you not have Health Insurance, but if you dont, you should sign up starting on october 1. One of the things that many people do not realize is that the subsidy that all of you uninsured ishe about 1000 per family. 1000 everybody here who has Health Insurance pays about on thousand dollars more about 1000 more for your familys insurance than you otherwise would have because hospitals are mandated, they are required, to provide service to anybody who shows up. Got happens is, when youve 15 of the population without Health Insurance, i end up showing up at that emergency room at the emergency room. So, you pay for the most expensive care there is. Hospitals have to recoup the money some way. The way they do it is to charge , and people who have Health Insurance and up picking it up. Reduce what will help the increasing healthcare costs is making sure that that hidden subsidy no longer exists. Lets talk a little bit about business. We are out of time, but i think it is really important. As you pointed out, most people work for asurance living or someone in their family does, and they get their insurance through their workplace. That all employers have to participate if they have 50 employees or more. Many employers with fewer than 50 employees already voluntarily provide some Health Insurance. With 50 ormpanies more and the companies with fewer than 50 are somewhat concerned. The employees that have to be insured are those that work 30 hours a week or more. There were many people who speculated that when this law came into place that it would add to the cost and there would be a lot more parttime workers instead of fulltime workers. I will say the president sometime and energy some time and energy on this. So far, that is not true. The overwhelming number of people who have been hired coming out of this recession, they have been hired at lower wages, that they have been full time employees. An increaset been in the percentage of our employment in parttime work. There has been an increase in relatively lower wage new jobs, but that means they need Health Insurance even more. Themin, very briefly, to how this is going to work, how private employers are helped to buy their insurance and the requirements. First of all, if you are a Large Employer or an employer with more than 50 employees, you are already providing Health Insurance, you dont have to do anything other than just make that you can show you are providing Health Insurance. There was a lot of news recently about how we delayed the so called employer mandate. Is,r the law, what it says if you have more than 50 employees, you are not providing Health Insurance to your employees, then you are going to pay a penalty to help subsidize, to help pay for the fact that we, the taxpayers, are going to have to provide your employees with Health Insurance. Which, by the way, is only fair. Aroundf the controversy the Affordable Care act had to do with these socalled mandates, both the employer mandate and the individual mandate. The employer mandate says, if you dont meet your responsibilities by your employees, and they end up getting medicaid or they are ending up in the emergency room, you are dumping those costs onto society. That is not fair. We will charge you a couple thousand dollars to help pay for health care for those employees. For the individuals, what we said was, we are going to make Health Insurance so affordable, so cheap for you, so heavily subsidized if you are not making a lot of money, that if you are not getting Health Insurance, it is because you decided you do not want to. You dont need to. Circumstance, what happens when you get hit by a bus, have inverted heaven forbid . Or somebody in your family gets sick . We are not going to just let somebody bleed in front of the emergency room. What we have said is, youve got to take responsibility. Penalty if youl do not get Health Insurance. This is where a lot of the controversy and unpopularity came in. People generally do not like to be told, youve got to get Health Insurance. Loyers do not like to tell like to be told, youve got to give your employees Health Insurance. But as a society, what we cannot to say, you have no responsibilities whatsoever, but youve got guaranteed coverage. Issue ofes the whole preexisting conditions, which we havent talked a lot about. It is really important. One of the central components of this law, one of the main perverts of these per versities of the Healthcare System before this law passed, there were millions of people around the country, if you had gotten sick before, you had a heart attack, if you had had cer, if you had diabetes, lets say, when it first happened, you had a job, you got your, and then you lose your job or you are trying to change jobs , and you try to go out and get Health Insurance the Health Insurance company could not only deny you, but had every incentive to deny you. They would rather have healthy premiumso are paying and never asking for a payout. They do not want somebody who actually early they can anticipate might get sick. Hugein mind that a percentage of our society has some sort of preexisting condition. They can be locked out. You can do everything right. Work hard, build a strong middle class life, but if you have been sick and then you lose your job or something happens, you may suddenly be locked out of the Insurance Market or the premiums may be so high that only somebody fabulously rich could afford them. What we said is, you know what . Insurance companies, you can no bar somebody from getting Health Insurance just because theyve got a preexisting condition. But the only way that works is if everybody has a requirement to get Health Insurance. Think about what happens if you do not have that rule all of us, not all of us, but a lot of us who were trying to figure out how to save some money would say, im not going to worry about it until i get sick, and when i am diagnosed with something that is going to be expensive, i will go to the Insurance Company and say, you cannot prevent me from getting Health Insurance just because ive got a preexisting condition. So, they could potentially gain system, and it would not work. Said,at we have done is youve got to provide Health Insurance to anybody. That is the deal. The flipside of it is, everybodys got some responsibility, and we will help you pay for to get Health Insurance. That is where a lot of the misunderstandings, the frustrations about Health Care Reform came in. I should add, by the way, that this was the same proposition that was set up in massachusetts under a governor named mitt romney. It is working really well. 99 of people in massachusetts have coverage. The same principle was ironically considered a very smart republican, conservative principle. Just to finish up the question, when it comes to businesses, if you are already providing Health Insurance, that is great. You dont have to do much other than just make sure that you show us that youve got Health Insurance for your employees. If you have more than 50 employees and you are not providing Health Insurance for them, you now have the opportunity to join a pool of Small Businesses to get a better price and a better deal on Health Insurance. You are eligible for tax credits in providing Health Insurance to your employees, up to 35 of the premiums for each employee. Benefit, ae a tax tax credit from the federal government. Up if you still end providing Health Insurance for your employees after that, then we are going to go ahead and penalize you for it. Understand why some businesses would not want to pay for it. If they are not currently providing Health Insurance for their employees, that means they would rather have those additional profits then make anre that their employees th make sure their employees are getting a fair deal. In some cases, they may be operating under a small margin. Keep in mind, since companies are exempted, the average Small Business with five employees, momandpop shops, 10 employees, they are not under that requirement. Im not that sympathetic to accompany if you have more than 50 employees and are generating some significant revenue, we are making it affordable. They should do the right thing. [applause] i agree with that. We have to close, but i think there is one less issue we ought to deal with. Most important thing, obviously, is to get people enrolled in this. We will work through it as we go along. You just heard the president say that so far in virtually every state, the actual prices of the insurance are coming in quite low, quite a bit lower than they were originally estimated. With the original price estimates and with the government obligated to provide subsidies, which cost money on the budget, it was nonetheless estimated that in the first 10 thes, this would keep National Debt 110 billion lower than it otherwise would have been. Which means if we come in at even less, we can bring the debt down more or we can subsidize more Small Businesses and get more Small Businesses into this loop. People come up to me and say, you know, now you sound like the people you used to criticize who say we could cut taxes alltel on and increase spending. Dont give me that. That sounds good too good to be true. Before you leave, you should tell people how we can spend more, not so much in direct andding, but in tax credits still wind up reducing overall federal spending by 110 billion in this decade. A couple things in terms of how this whole thing got paid for. It is really important, first of all, to point out that the total cost of the Affordable Care act, to provide Health Insurance for every american out there at affordable rates, is costing about the same amount over the course of 10 years as the costs of the Prescription Drug bill that president bush passed. Except that was not paid for. We felt obliged to actually pay for it and not add to the deficit. [applause] what we did, it is paid for by a combination of things. We did raise taxes on some things. Said that fore high income individuals, you can pay a slightly higher medicare rate, medicare tax. We bumped that up a little bit. Said that for employers who are currently providing a so pland Cadillac Health care , where there are so many bells and whistles there is no incentive to actually spend wisely when it comes to health penalizeare going to you for that not only to raise a little bit of money, but also to say, you are encouraging the worst aspects of the Health Care System where you spend a lot of money and you do not get better outcomes. I mentioned to you medicare we basically said there is a Program Medicare called Medicare Advantage that provides some additional options for medicare recipients above and beyond , and it isdicare very popular with a lot of seniors you get eyeglasses and other benefits but it turned out that it was so uncompetitive that we were providing tens of billions of dollars in subsidies to Insurance Companies under this Medicare Advantage plan without Getting Better outcomes for seniors. What we said was, we will keep Medicare Advantage, and we will give them a small premium if they are providing Better Services for seniors, but we will make you compete for a little bit. We are going to save tens of billions of dollars in the process, and that will go into paying for the Affordable Care act. The bottom line is, through these various mechanisms, we have raise enough money to pay for reviving Health Insurance for those who do not have it, to provide these tax credits in the marketplace, and, at the same time, because we are driving down costs, we actually end up saving a little money. It is a net reduction of our deficit. The irony of those who are talking about repealing obamacare because it is so wildly expensive is if they actually repealed the law, it would add to the deficit. It would add to the deficit. Couple of been a republicans in the house who have been smart enough to say, we are going to repeal all of so 2530,000,000 people do not get Health Insurance, but we are going to keep the taxes that obama raised. We just will not talk about that. That way we can say we reduced the deficit. Obviously, you are doing some funny business there with the budget. Look, nothing is free. Wantottom line is, do we to continue to lead live in a society where we have the most inefficient Health Care System on earth, leaving millions of people exposed to the possibility that they could lose everything because they get sick , where we have little children and families going to the emergency room once a week because they have asthma and other preventable diseases because their families are not linked up with the partner position who is providing them regular care, where the cost to society for reduce productivity, illnesses, etc. All burden our businesses is that the kind of society we aspire to . I think the answer is no. Resistion that we would or at least some would resist as fiercely as they would or have, make this the number one agenda, is perpetuating a system in which millions of people across the country, hardworking americans, do not have access to health care, i think, is wrong. [applause] we have to close, but i will close with a story. I told you all this morning that the employee that our health axis program lost in Access Program lost in the kenyan mall was a dutch nurse. We spend a lot of time in the netherlands. Partners here, i went to celebrate the 200th anniversary with them. They started as a fire Insurance Company with 39 farmers 200 years ago. In this bigthere tent in theith a shadow of a 13th Century Church and a big dutch will melt windmill. Executive, you have Health Insurance. Everybody is on an individual mandate. You just subsidize people based on their incomes. He said, yes, i have it. We all do. He said, we dont make any money on it. He said, we shouldnt. This guy is a huge insurer. Can you imagine same somebody saying that in america . He said, i got no business in the work. He said, health care is a public good. Youve got to find a way to finance it for everybody. [applause] he said, it is just an intermediary function that somebody has to handle, but in the end, it is how it is delivered, how it is price, and how healthy you can keep your people. The first lady is trying to keep us all healthier, and you are trying to change the delivery and the pricing. You have to cover everybody to do it. I think this is a big step forward for america. This will come over the next decade, not only make us healthier, but it will free up, in the private sector, funds that can be reinvested in other areas of Economic Growth and give us a much more well balanced economy. First, weve got to get everybody to sign up. Everybody, sign up go to healthcare. Gov. Thank you very much. [applause] [captioning performed by national captioning institute] [captions Copyright National cable satellite corp. 2013] gentlemen, please remain in your seats while the president s of the United States depart the room. Thank you. Several live events to tell you about tomorrow on our companion network cspan 3. Cybersecurity commander and nsa director general Keith Alexander speaks at the billington Cyber Security summit at 8 00 a. M. Eastern. At 10 00, the Senate Environment and Public Works Committee hosts a hearing on Infrastructure Investments and growth and highways. Later in the day, the Senate Aging Committee looks at the longterm Financial Outlook for retirees and ways to improve their financial security. That is at 2 15 p. M. Eastern. We will be live at 7 00 p. M. Eastern for a debate between the Major Party Candidates for governor in virginia, democrat Terry Mcauliffe and ken cucc inilli, Republican Attorney general. 1998, book tv has shown over 40,000 hours of programming with top nonfiction authors, including bob woodward. We were going to do the book after he died, but he preempted , quitend i was horrified honestly. Then i was delighted. Peopleways thought that were more alike than they were different. So, the artist in me rose to that occasion, that if i can create something that is so ofing and permits the kind distance that you sometimes need from what is painful, then people will understand. Understanding is basically what is fundamental. Argumentint is that no is given to that effect. None of the relevant facts are considered. This is regarded as one of the halfdozen cases where a just war theory entails that the use of military force was legitimate. National the only Television Network devoted exclusively to nonfiction books, every weekend. We are marking 15 years of book tv on cspan 2. On the next washington journal, we will discuss the possibility of a Government Shutdown and efforts to defund the Affordable Care act with republican representative rob woodall from georgia. A member of the budget committee. We will also hear about the debate in congress over health care and spending from a member of the Financial Services committee, maryland Democrat John delaney. Guestotlight on magazines will be timothy noah who wrote an article for the pacific standard. Washington journal is live on c span everyday at 7 00 a. M. Eastern. The senate is scheduled to take a procedural vote wednesday on the housepassed a bill that will fund the government for several months and defund the Health Care Law. Leaders of both parties spoke with reporters tuesday just off the senate floor. Senseless, nonending talk from my republican and debts about the cr ceiling is really untoward. Shutdowns, the cr and of course the debt ceiling is even worse, the full faith and credit of our country. The United States should pay its bills, and they should pay them on time. I want to be very, very clear again the senate will not pass any bill that defunds or delays obamacare. Or the debts a cr ceiling. It will not negotiate on any means or any way on extending because thating, deals with paying our bills. The full faith and credit of our country. The last time they took us down this path it cost the economy billions and billions and billions of dollars. , allng business groups republicanleaning, the chamber of commerce, the Business Roundtable, have said that it will be terrible if they keep talking about either one of them, and certainly not doing either one of them. The Business Roundtable said it would be calamitous. Pretty descriptive. Way to stop lurching, lurching on this crisis to the to get back to funding our government the way the Founding Fathers set it up, through the appropriations process. I discussed at great length with rayirman mikulski and mur about whether there is any possibility of funding the government. They believe there is. They have had conversations with some of the republicans. That a funding measure that runs through november 15 will provide a greater opportunity for appropriation bills to pass the senate and i agree with them. The amendment that i file in the next day or so will prevent a shutdown through november 15. The only thing we are going to change, it appears at this stage, on the cr is the date. Anomalies, few noncontroversial, we will change those little bit, but other than that, that is the change. We will strip out the obamacare language, the china first language we will get rid of that. I repeat, there have been signs from the republicans that there is an opportunity to Work Together in this process, and i hope it will bear fruit in the coming weeks. There is very clear are a number of Senate Republicans who recognize that the Tea Party Agenda is wrong for the country and wrong for their party. I hope that these Reasonable Republicans will prevail on their colleagues in the next few days so that we do not have to shut down the government. How do you see this playing out, senator . If we go by all the time involved, we will finish sometime on sunday. Are you in favor of accelerating i said on the floor today that if they want to collapse the time, fine, but i want rybody to be very clear there is no filibuster going on now. People can come and talk, but they cannot do anything to change when we vote. So, if they want to collapse the time, i hope they have a successful caucus and say, we are wasting a lot of time, and lets get down to action. The other thing that should be a concern to everyone if we finish this on sunday, send it back to the house, the house is talking about changing it again. That is a surefire way to shut down the government. I am waiting to see what they have to say. If they want to collapse the time, fine. Maybe it will give time for us to get the bill back a little earlier. We will see. [indiscernible] dont want to talk with a College Professor here, but listen it doesnt matter what the top number is. Lets say it were 100 trillion it doesnt matter. The only thing that matters is january and the sequester. That is what it is all about. That,88 billion, we take because nothing is that consequential until we have sequester, which kicks in automatically in january. There has been some talk from your colleague senator vader that either he wants vitter that he wither wa he either put inhe energy bill when the house kicks it back. Is kind of interesting great we are not free to vote on his amendment. Under theopportunity Energy Efficiency bill. It got us nothing. They did not want that bill to pass. As you remember, we had that amendment, another noncommittee to fivet, there were up nongermane amendments, and suddenly, 40 energy commitments. He can keep pushing this. Maybe it will help them get elected governor, which in my mind, would not be a bad deal, if you know what i mean . Some of your colleagues have said that they wanted the number 1050 8 billion. That does not matter. Lets not have the number. Lets have it at 1 trillion, and another 1 trillion. It doesnt matter. [indiscernible] im sure that none of you have the time like i do to watch the news hour. Last night, they had a really and piece about obamacare about Small Businesses, and after watching that, it only made me feel more strongly about how important this is, obamacare, for Small Businesses, for people without insurance, for people with insurance. I think that obamacare is the right thing for the country. People are accepting this. As i talked about on the floor this morning, the numbers are really pretty good for obamacare. That is an understatement. Once the exchanges kick in, it will be just like medicare. People complained about medicare in the early 1960s, but not for long. Once it came into effect, people understood how it worked, just like i was the chairman of the biggest hospital district in nevada prior to medicare, 40 of the seniors that came to the hospital had no insurance. They suffered as a result. Medicare came into being. 99. 9 now have it. That is the same thing with obamacare. Thanks, everyone. Good afternoon, everyone. As you know, we are moving forward to not only invoke cloture on the motion to proceed to the housepassed bill that defunds obamacare, that does not raise taxes, and that respects the top line from the budget control act. Cloture will be invoked on the bill. I will be supporting that. I think other members of our conference will. We think basically what the house has sent us is what we wanted. A bill that honored the top line from the budget control act, that did not raise taxes, and defunded obamacare. So what happens after cloture is achieved on the underlining continuing resolution. Senator reid has set up his red state democrats to vote once again to fund obamacare, or to decide they were for it before they were against it, and to vote no. Be,ink the focus needs to why isnt it that we cannot get rid state democrats who can read the newspaper, watch the television, read internet traffic like we can that shows the obamacare has been a dismal failure . If you like what you had, you cannot keep it. Rather than see premiums go down an average of 2500, they have gone up 2400 for the average family of four. This is the very reason why organized labor and other ardent advocates of obamacare are now asking the president and his party for release. For relief. Once cloture is achieved on the underlining bill to defund obamacare, which we will have a strong vote on, the question ought to be, i cant read state democrats listen to their own constituents and give them and the rest of the country some relief from this bill that obviously is not performing as advertised . And the president s Energy Policies are really a onetwo gut punch to the American Economy and middle class families. I want to talk a little bit about energy. Lastly, the president announced a policy that is essentially a National Energy tax on american consumers. We you got an economy where have the lowest participation rate, Labor Participation rate, in the last 35 years, and you have takehome pay, average Household Income has gone down by almost 4000 since the president took office, and 60 of the jobs created this year so far has been parttime jobs, you have a pretty weak and sluggish economy. That is why when the president keeps piling on in the form of obamacare mandates and requirements, and now a new National Energy tax, it will hit middleclass americans and families square in the gut. That is the last thing that we need right now. We need policies that will get people back to work, that will increase takehome pay for middleclass families, and we will get this economy growing again. By permanently delaying or retailing obamacare. You can do that by passing the keystone pipeline, which is something that has been hanging around for a long time, and according to the president s own state department, would create 42,000 jobs immediately. You can do it by killing, stopping this National Energy tax which the president is trying to put on the American Economy. The American Economy and middle class families need a break from obamas policies. Well, one of the papers this morning talked about obamacare and said, one blow after another. It had a little picture of a pill bottle there, and it said promises and reality. Many of the promises the president made are just not coming true for the American People. City,fternoon in new york the president is going to be the for his ambassador, if you will, or his secretary of explaining things, bill clinton. The two of them are going to be in new york trying to explain away all the problems of the Health Care Law. Calling on president clinton to actually be honest and apologize to the people who are being hurt by the Health Care Law. So many people who had parttime jobs have had their hours cut. Lost whoses have have received insurance through work are now going to be cut off from those insurance policies. Also, the young people who are being asked to pay a lot more for Health Insurance. In many cases, insurance they do not need, they cant afford, even with the subsidies. They are being forced to do that. Also, apologized to the Union Members who believed the president when he said, if you like what you had, you could keep it. Your insurance rates will come down. None of these things have come true. Im hoping with both president s together, they level with the American People and apologize for the damage they have caused. Senatoror mcconnell, ted cruz argues that what he is doing is fighting for a vocal part of your power of your party. He says the fact that you are not standing with the means that washington is business as usual. Is he have a point . Aboutu worried retribution, especially the two of you up for reelection with primary challengers . I think we would all be hard pressed to explain why we are opposed to we are in favor of. Invoking cloture on a bill that defunds obamacare, doesnt raise taxes, and respects the budget control act, it strikes me as a nobrainer. Explainreluctant to voting for things that i am for. That is the way i see it. I am hopeful that a majority of the republican conference will see it the same way. Does he just not get it . Can i ask you, do you think that ted cruz i can only speak for myself. Senator reid said that he would like to extend the cr until november 15 as opposed to december 15. What do you think about that . That is something for the majority leader and speaker to work out as to what is the appropriate time for this extension. It would have to be acceptable to the house and senate. Ipublicans, as far as know maybe you do not control all of republicans, but will republicans and youll back sometime to get this done sooner yield backght some time to get this done sooner than sunday night . Toanyone senator can object shorten the process. My own view is that it would be to our advantage to shorten the process. If the majority leader were to ask us to shorten the process, i would not object. I dont know who else in the conference may feel differently, but i do know that if the house doesnt get what we send over there until monday, they are in a pretty tough spot. View is, the house having passed a bill that i really like and intend to support, i hate to put them in a tough spot. [indiscernible] house i would prefer the 967 billion dollar level, but here is the way the house looks at it. They view the cr as an extension of the current rate of spending. The budget control act controls what the top line will be for the next fiscal year. If that number is not achieved, we will fall back to 900 67 billion at the end of year. My personal preference would be to stay they are right when they say the level push us back. Reaction to your the talks . Our live look here at the u. S. Capitol. The light indicates at least one house of congress is in session. Early wednesday morning, 1 a. M. Eastern, it is the senate texas senator cruise came to the floor the floorcruz came to to talk about defunding the Health Care Law