Transcripts For CSPAN Washington Journal 20141114

Yeah. Im not sure how thats going to work out now. Ill be honest, my wife takes are of it all. It was quite a process to get into, i have to say. She was on the phone for many, many hours. Host brian, that cost you told us you paid, that covers you and your wife . Caller yes, yeah. And it has eye glasses and dental. Host thank you sir, thank you for sharing your experience. From the wall street journal this morning, consumers still confused ahead of insurance sign ups. The online insurance exchanges are set to go live again tomorrow when people will be able to buy new coverage taking effect on january 1. Insurance companies are required to send letters explaining changes to their customers plans before open enrollment starts. But some consumers say they havent gotten their letters yet and dont know whether they need to shop around for a new plan. Many consumers are unaware that the exchanges are reopening this weekend. A survey by consultants mckenzie and Company Conducted between november 6 and 10 found that 54 of uninsured respond yents and a quarter of those with existing individual plans didnt yet know about the new open Enrollment Period. Survey found 67 of those who have plans expected to reenroll, but only 23 of the uninsured said they would definitely sign up for coverage. About three quarters of those who are expected to stay uninsured were eligible for federal subsidaries to help with their premiums but 87 of those people didnt realize they qualified. This years Enrollment Period is shorter, feppeding february 15 and consumers must sign up by december 15 if they want a new plan that will start on january 1. Timely from the wall street journal, insurers in states using the federal health care. Gov, including tennessee, werent allowed to send letters to enroll lees that include details about next years plans until they got a final signoff on november 5. A federal spokesperson for the federal centers for medicare and Medicaid Services which overseas health care. Gov said insured letters we are sent after it was final in order to reduce consumer confusion and it is near when consumers are near to take action. They are also getting notices from health care. Gov. Well, our conversation is going to continue on this topic coming up next, Jane Odonnell of u. S. A. Today, if youre already on the line, already on the phone, already dialed in, dont hang up, were going to continue with the same kind of phone culls, but Jane Odonnell is a Health Care Reporter with u. S. A. Today, well talk with her. After that well look at the Economic Impact of the Affordable Care act. House is in at 9 00 a. M. This morning so just a two hour washington journal. Capitol hill is back in action and the new incoming senator jord leader Mitch Mcconnell talked about health care. Senator mcconnell, you did Mention Health care and i wanted to get you and anyone else to weigh in on these videos of this grouper, jonathan grouper. What does it tell you if anything thats new and does it change the way you plan to approach obama care in the new majority . Well, i think what he said, i think you all have heard the definition of a washington gap, when a politician mistakenly tells you what he really thinks. We were subjected during the obama care debate to a whole lot of stuff that we all knew was not true. Not even close to true. And what this insider is saying, confirms, that they were spinning tales from beginning to end because they knew they couldnt tell the truth about obama care and have a chance of passing it, even with its Democratic Senate with 60 votes. So, look, the American People hate to test and despise obama care. Virtually all of us would like to see it pulled out root and branch. We understand that the president is obviously not sympathetic with that point of view but well be voting on those issues, but both the overall obama care issue and the various pieces of t, like the individual mandate and trying to restore the 40 hour work week. Washington journal continues. Host Jane Odonnell is with u. S. A. Today, a Health Care Reporter for that newspaper. Open enrollment begins tomorrow. Is it going to be ready . Are the cites going to be ready . I think its going to be as ready as it possibly can be. All the works been done, were all waiting to see and im sure folks in the government are nervous, but probably not as nervous as they were last year because theres been so much more testing, its incredible. Its weeks and weeks compared to 10 days. March 23, 2010 that the president signed the a. C. A. Whats the consensus on its success . Its still pretty divided. Certainly listening to your callers and talking to people regularly, people are pretty divided. Its very politically polarized as you well know. You tend to hear from people who are unhappy more than you hear from people who are happy. Ive heard from a certain number of people that even if theyre unheam with certain aspects of finding the doctor they want in a plan they can afford, thats a big concern. But some people are getting here that they never could have gotten. So i do hear with a fair number of people with advanced stage cancers who would be bankrupt if it wasnt for the law. I do tend to hear more about people who are paying out of pocket. New republican majority, both house and senate, hows that going to affect the a. C. A. . Guest you didnt hear as much on the campaign trail, it wasnt the big hot button issue that some expected maybe a year ago that it was expected it would be. What im hearing is that there isnt going to be the mood, or even the its not likely to be repeeled. Theyre probably going to be changes made. Probably changes that everyone would agree should be made, certain loopholes closed. But youll be hearing a sell about it but i dont think its the priority that it once was. Supreme court, whats going to happen up there . Goodness, i certainly dont know that. But i would tell con seemers, even though the Supreme Court will look at whether the subsidaries are in fact legal if youre a state that didnt set up your own exchange, everythings going to go as it is now. No matter what the Supreme Court does, consumers shouldnt do anything different. They should still, what is it about 80 of people are eligible for subsidaries that buy on the government exchanges. So people should still pursue those subsidaries. Host is that the only case on health care that the Supreme Court is going to hear in the next session . Guest im not a Supreme Court reporter thats the only one im aware of. Thats the big one. Host before we go back to calls, want to point this out, the u. S. A. Today has devoted a page and a half to your story this morning. And its on rural hospitals. Rural hospitals in critical condition, this is the front page of u. S. A. Today this morning. Is this because of the a. C. A. . Guest well, some of them say its a little bit of the last straw. It certainly isnt because of the a. C. A. Rural hospitals have been in decline for a number of years, but its been a accumulation of things, the death spiral theyve been in. One of the hospitals, i went to richland, georgia, right up the street from plains, georgia. Their little hospital there, the Electronic Health records were kind of the last straw, which are required under the Affordable Care act. But largely, the populations that theyre serving, theyre serving very poor populations that are on medicare or medicaid, and of course georgias one of the states that didnt expand medicaid, expansion of medicaid would make a big difference, but wouldnt save a lot of these hospitals. Host and you have a chart in here over some of the hospitals that are closing. Lets show this. Is it centered down in the south . Guest it certainly does seem to be. There is a lot in the south. The south is where theres been the least Medicaid Expansion. There are a lot of these hospitals, its really, ive covered health care over a year, ive been a reporter for a long time. But there are so many issues that go into this. You feel it can be rather depressing and ive covered a lot of depressing things in my career. Theres so much that needs to be done in this air. Theyre not getting the care they need so they certainly need to be getting some Preventive Care and Healthy Lifestyle changes, frankly. Host Jane Odonnell is our guest, u. S. A. Today. Fred is calling from suh city, owa. Caller obama is from an old third world car who operates on socialism. I like capitalism. Hes breaking our country. Host fred, how do you get your insurance . Caller im on medicare and i buy a Supplemental Health care. And im retired. Host can i play devils advocate. You talked about the fact caller you sure cut me off fast, i thought it was my phone call but it seems like you want to control the call, if you cant do that, i guess i have to play by the rules. Host i just want to ask you a question. You talk about the president being a socialist and youre on medicare which is government funded. Do you see any connection or any conflict in that statement . Caller yes, thats true. But you can take that. Im not advocating anything about it at all. Rather to continue on this path, go ahead and take my medicare because our countrys doing down the tube. Its just a matter of time before the whole Financial System collapses, and you want us to pay for this Affordable Care act by sacrificing our military and cutting it back to dards in the ii stan most dangerous time that anybody could live at. Host ok, thank you fred. Any reaction to his call . Guest i will say as an observer of this issue, i find that it is interesting because you brought up the point that comes up for me a lot is a lot of the people that are the biggest opponents of the federal government involved in health care often do get so many entight ltments and so much of their livelihood is dependent on the government. An interesting case, im in Northern Virginia but you go out to rural virginia, its largely republican signs but a lot of federal entitlements. Host have the cost of the a. C. A. Been in line with whats predicted . Have they been higher, lower . Guest i think theyve pretty much been in line. It will take a lot to see what the Health Care Savings are. Youre not going to see the savings of these people that werent getting care, are not getting care. I think its on track so far. Host 36 billion according to a congressional budget office, net cost in 2014, the expected cost 1. 38 5 to 2024, trillion. Sweetie is in covington, georgia. Hi sweetie. Caller hi, good morning, im glad you took my call. Im going to try to be as nice as i can to our government. The Affordable Care act, i dont need to use it, ive been in business many years, but as a grandmother i have children that do not have jobs and theyre not able to get insurance and theyre refusing to even use the social Service System because theyre saying there are people that are worse off than them. With the Affordable Care act in my opinion, its already successful, because the calls that i heard, i do have a heart for people that never had insurance and now you have insurance, thats an excellent thing. But the whole thing with the Affordable Care act in america, if we continue to break down the person at the top, whos staff to be using his to get america balanced, youre always making references to who the forefathers were. Tell the congress they are the forefathers. The forefathers before did what they had to do. Since they had such an excellent vision, thats why were still tapping into those sources today. Host all right, Jane Odonnell. Anything you want to add to what sweetie had to say . Guest im a little confused, i wasnt exactly sure who she was mad at, but it was interesting to me that she was from georgia because i did spend so much time in georgia. I do wonder if her grandchildren arent able to get jobs, how she would feel about Medicaid Expansions that a lot of people feel it would make such a difference in that state, especially if theyre not willing to use social services. Talk about rural hospitals closing, but the cost to any hospitals that have to continue under law to take these people who arent getting health care, otherwise when they finally do have that hernia or the heart attack or diagnose of cancer they go to the Emergency Rooms and these hospitals are getting less money from the government to care for them. Host what is the resistance to Medicaid Expansion by some of the governors in the country . Host they just say its going to cost them. Sure now the federal government will help them out but in two or three years, theyre going to have to pay, what is it like 10 , and that could be backbreaking and their states are already struggling so much to stay afloat. That is the case. There is so much unemployment and so many businesses closes in a lot of these states that you can understand that point. But it does seem to spend much of next year working on a series of Medicaid Expansion. It will be interesting to see, even where we are right in the middle of maryland and virginia, one that did and one that didnt. It will be interesting to see what the affects are because these people are not getting, the states that didnt get expand arent getting any better and theyre going to need health care at some point. Host when is that series coming out . Guest in a fellowship so ill be working on that, investigating it and learning more about it. Host laila tweets in, how many doctors, clinics hospitals arent accepting obama care . Guest i dont have numbers, there are no good numbers on that, but i did talk to a few people that had a devil of a time finding a doctor who would take their plan. The provider lists are often inaccurate. Theres one man suing Anthem Blue Cross because he must have called 40 doctors and it was either an error or the numbers didnt work or they simply wouldnt take it. So there are some complaints theyre not getting the reimbursements under the Affordable Care act plan as they do under private insurance. Host speaking of numbers, this is from h. H. S. , they say that 10. 3 Million People gained Health Insurance under the Affordable Care act. 32 million still lack coverage. Political reports via h. H. S. That 9. 9 million expected to enroll by the end of 2015. You said its really hard to get good numbers, ive got a headline over here from september that says 7. 3 million have enrolled. Why is it so hard to get good numbers . Guest i did see a report that the 9. 9 million is supposedly the net and your 7. 3 is the net, so either eight or 8. 1 signed up, but then a lot of these people wound up not paying the premiums, which is another problem the doctors have. They dont know whether the persons paying their premiums so they actually treat their parkes and then there becomes a fight with the Insurance Company, they have to least cover part, i think its a month of a cost and on Insurance Companies. For three months you have this 90 day grace period where you an get free insurance. Host when h. H. S. Reports 10. 3 million signed up, does that include the 19 to 26yearolds who stay on their parents plan, Medicaid Expansion . Guest it has to because it is only 7. 3. I think its the people that got in there under their parents. But the 9. 9 is including, thats the net. So that is one of the reasons it seems like such a conservative estimate is because they were saying ok, a certain percentage, maybe another million or two, probably wont pay their premiums. O theyre estimating that now. Host is it tough to get numbers out of h. H. S. . Guest its tough to get everything out of h. H. S. Again ive only covered them for a year, but ive covered federal agencies and this is a tough administration. Host hi alex. Caller good morning. First ive been around the a. C. A. For a year and i get a great subsidary in new york and im happy with it. Just had a couple of comments. Peter, you read from the wall street journal about how many people lack a basic understanding of how they can reenroll. Then you roll that clip of Mitch Mcconnell saying people hate it. How can people hate it if for example they dont even know they can change their policy, like that. That level of ignorance, half of them really say they hate it. My second point it seems like a psychology. I was a School Teacher and i resented to have to get insurance, i always had to be a School Teacher and do something i didnt really like. Now i can do what i want to do and not be tied to my employer for my Health Insurance. Host how much do you pay a much . Caller yeah, i pay around 100 a month for my premium and receive a subsidary of little over 200 a month. And i have a bronze plan. Host are you employed . Do you have a full time job . Caller im self employed. Host ok. Caller and yeah. Host anything else you would like to add . Caller well, i wanted to ask your guest, the psychology of it, it seems im more liberateded. The gentleman from iowa who calls and hates obama, yet hes on medicare. What a great thing to be in our old age and not have to be consumed with this fear of going into hundreds of thousands of debt to get your hip replaced or your heart fixed. Its a wonderful thing. I dont know why people are so afraid of it. I wonder if your lovely guest could tell us. Guest it does seem to be politically motivated, generally. Psychology, some people, whether i was in georgia or no matter where i was, there is a certain, you know, knee jerk reaction or kind of gut feeling. I shouldnt have to, i, meaning as a taxpayer, shouldnt have to pay for these people who cant pay for themselves. But, you know, i think when a lot of people see the subsidaries they can get and if they are indeed successful getting doctors, i think they would probably agree with the caller, where i found more complaints are the people who are more middle class arent getting subsidaries because as individual insurance, it isnt cheap to buy insurance on the exchange, or through just generally speaking it was never cheap. So they tend to get kind of upset and people, people, my company and other companies who are seeing they have higher and higher deductable plans get pretty upset and companies will often blame the Affordable Care act. Sometimes that prickles down. Host in the wall street journal, this democrat is giving up on obama care, nonprofit, professional and former Hospital Insurance coordinator currently works as a counselor at a social Service Agency in denver. He writes i voted for president obama again in 2012, then received a cancellation notice from my Health Insurance. This was due to obama care, the so called Affordable Care act. However i couldnt afford anything else. Obama care is a failure for anyone who thinks this is a misprint because no democratic activist would make such a comment, let me add that it is too big, too complicated and too expensive without a public option within its network of exchanges, obama care is a giant blank check to the Insurance Companies that pushed it through congress. Is that accurate in your view . Guest well, im not going to give my opinion, but my thoughts on that are that it has done a fair amount of good. It is fairly complicated. I think its going to take a while and require a lot of adjustment on a lot of people. I hear this a lot, people are still angry about is socalled promise that you can keep your plan. I heard from someone yesterday who said president obama said i could keep my plan and i couldnt. And their rates went up considerably. So you can understand why people are upset if they have very limited income and theyre paying 300 more out of pocket. Host how widespread was people losing their plan . Caller well, it was quite a few people. Millions of people probably. I dont remember the number exactly. But it was quite considerable. Now they may, they did get to keep them for a while but youre going to start to see more people get upset. There will probably be a second wave. Host doug in north carolina, gets employer insurance. Hi doug. Caller good morning, how are you doing today . Just wanted to flake a comment, i was listening to several of the callers, and there was a gentleman on just now talking about the gentleman being dissatisfied with the medicare, medicaid. I worked all my life, since i was 14 years old working in tobacco, in north carolina. Im quite tired of having to take the burden on of everybody else. My deductable went up to 2,000. I went to purchase some meds and usually would have a 10 co pay and now my meds are going to be 120. Host and this is through your employer insurance, doug . Caller yes, sir. Host why do you think the cost has gone up . Caller because this failed plan host that your opinion or have you been told that by the people who run your insurance . Caller no, its my opinion. To me, its and she was making a comment that a lot of these comments may be politically driven. But, to me, its taken away from our individual liberties. By forcing us to do this. Youve got people that will get out and work every day, and are having to take on the burden of everybody elses insurance because they wont get out and work. Im in a business where i see it a lot. People come in and theyre driving vehicles that are worth more than my car, but yet theyre Getting Services from the government. Individuals need to take on responsibility. Weve been put into, i think a lot of people are being put into a nanny state and being dependent and made to be dependent on the government. Where i came from, you get out, you work hard, and you pay your way through life. Host thats doug in north carolina. Jane odonnell. Guest he did sum up some of what ive been saying. He makes a very good point. I was talking to a colleague who has the same kind of thing where theyre paying out of pocket, hes paying out of pocket for Prescription Medications until he hits his deductable, which was 3,000. You have that, youre not going to hit it. It can be very jarring. If you are someone who, when i bring up the political side, it is just kind of your theory on whether we should be helping the less fortunate of not, which is the idea of the Affordable Care act, provides care to people that cant have it or havent been able to have it and cant afford it. So, were looking a lot at high deduct i believe plans, as the next big project were working on. Because it is going to be, i think the big story of the next year. Host so Affordable Care act, has it caused employer plans to higher . That was a very inarticulate question. Host but i know what you mean. Theres a lot of blaming and scapegoating of the federal government in the law going on. Its difficult to prove but certainly this past year there were not so many costs that Companies Really could legitimately, regularly say sorry folks, your plan is going to cost you more because of the Affordable Care act. That was very convenient in a lot of cases. However they are going to have these cadillac plans, the really good plans that provide so much and so little out of the pocket cost to employee s, employees are going to be penalized in a few years. So they are gradually going to these higher plans so were all going to have to get used to that paying much more out of pocket and having sent deductables for family members. So its the future. Host jim is in bay city, michigan, employer pranrovided. Hi jim. Caller good morning, steve. Im 91yearold senior thats been a very good insurance with the company, but i got a daughter and her husband thats paying horrible, horrible deductable. No way in heck they can afford t. This new plan coming up, i suppose will be higher than ever. Thank you. Host lets go to amy who is enrolled in the Affordable Care act. Caller i think its great. They wouldnt even pay for the testing for a life threatening condition i had. It took me two years to pay off the tests that they turned down. Today, today im getting medication that will save my life under the Affordable Care act. Host what was your experience signing up . Caller it was easy as cake. Im in seattle, i get to see the best doctors in town. There was someone at a local Medical Clinic that helped me sign up, it took me under an hour. It was easy. Host are you on medicaid xpansion or in a private plan . Caller i guess its Medicaid Expansion, its Washington State. Host Washington State. Is there any cost to you . Caller there is not. Theyre literally saving my life. I have a life threatening condition that would have killed me in five years and today im getting medication for it. Host thank you jam. Jane odonnell. Caller those are the stories that are heartening to hear and the administration wants to hear more of. That seems to be the lines the issues drawn those are the issues that are drawn down. Theirople who are having lives saved or a getting medication for preexisting conditions. That can really bankrupt people. It has done a lot of good. Washington state is running its own state exchange. Have some ofeem to the issues as, say, maryland. The state exchanges did tend to have more success. So much is being done for the federal exchange. Im not expecting to wake up and have it implode. There will be some problems. There are some fixes that will probably come in 46 weeks. Im doing a story in a company that does have handle some of the exchanges. Upgrades should allow handling all of the people. We will write a running story. It is kind of like gearing up for black friday. s calling inon from west virginia. Caller good morning. Wife now has the Affordable Care act. She had no insurance for eight years. Medicare. She has great coverage. You cant just look at the surface. Youve got to look at the whole thing and see what money you can get extra. You cant do it by just going online and seeing the policies. Youve got to fill the information out and then they will tell you how much you are going to pay. Guest people could be windowshopping today on healthcare. Gov. You might have sticker shock like you do in a car dealership, but you need to realize that if your income is below a certain level, you could get substantial subsidies. Pointimportant to make a to be a dont want payment buyer when you are buying a car. You dont want to buy by the premium. If you need prescription drugs condition, the insurance will consider whether paying 300 or 400 per month, so that you do not have to pay outofpocket. It can be budget busting. The whole idea is for people to not have to go into debt. Host this is a tweet. It is probably because i have not brought it up. Jonathan gruber, rich weinstein. They are talking about hearings on capitol hill. Mr. Gruber is speaking on those hearings. It is is it a sideshow . Guest i think it is going to be a sideshow. I try to ignore that part of it. I do think it has become this kind of dramatic, theatrical sideshow when it really is important to focus on what you can afford. Up, but can get caught you need to focus on, you need to have insurance by february 15 or you will be paying more at tax time. Host this is another tweet. Very much so. We will see employers contributing to those more. Is so much that many of us have not had to Pay Attention to, myself included, because we have not had to pay outofpocket. It really is something that people need to consider when they have these plans. It is kind of like free money. Host hosea is calling from new mexico. Jose is calling from new mexico. Caller i believe i speak for probably the majority of the American People, millions, hundreds of millions of when i saynd myself that we are disgusted with dr. Gruber calling us stupid. He just proved that a phd can be stupid. I think the results of the election we had proved that the American People are not stupid. Want gruber and these other idiots thinking that we are. I hope the aca is dismantled. Republicans to planld some sort of a self that works for all americans, whether you are poor, middle class, wealthy, whatever. We do need a safety net. That is what medicare and medicaid is for. In a country like america, we should have that. The middle class is being severely hurt. They are paying a lot of money. Old saying, you can keep your plan, you can keep your doctor. That is not happening for the middle class. I just hope that the new congress, the republicans can fix the aca in a way that is fair for everybody. Host all right. Guest i do think it is important to remember that we thataying for these people people dont think we should be paying for when they go to the hospital anyway. The emergency room has to treat people or stabilize them. Such a large portion of the American Public are not insured, are not getting health care, it is still costing taxpayers a lot of money. There are uncompensated care costs that hospitals have. I respect the callers opinion. Everyoneunlikely from i talk to that the law is going to get dismantled. Health care costs have just been skyrocketing. Suit those guys agree that something has to be done. It is very unlikely that that is going to happen. The New York Times has been putting together a series of articles on the aca with the question, is it working . They look at several different areas. As Health Care Spending slowed down . Medicare expansion, the effect on the Health Care Industry. They talk about the percentage of uninsured people. They say that the number of uninsured americans has fallen by about 25 or about 8 million to 11 Million People. You have reported on the Health Care Industry. About thea little bit rural hospitals. What about the Health Care Industry overall . It needs more people to be insured and it is going to help the industry more. A huge primary care doctor shortage. We need more doctors to be treating all of these people. It does help the hospitals, the more people that are insured. We have a graph on the front page today about where the money comes from generally. So much of it is either from government sources or they call it self pay. Hospitals often kind of smirk because so few people can pay. That goes into the bad debt that the hospitals have. They need as many people as possible to have insurance. This chart,ing to rural hospitals are getting 45 of the funding from medicare and another 14 from medicaid and other government 1. 5 . Well over half of their income. It is higher for rural hospitals because of the poverty in a lot of these areas. Urban hospitals are very similar. In washington dc, i bet it is almost the same. The people that are private pay until thee, deductibles become insurmountable, are generally paying their bills. The bad debt is not quite as bad. Host are more private Companies Getting into the exchanges . You have seen a little bit of a trend that some people find alarming where companies are letting people go, we are not going to have insurance. Wereies are saying, going to go to the exchanges. Speaking, Companies Want to get out of the business of insurance. They will have private exchanges that they can outsource that type of work. The government is very happy that employed people are having to go to the exchanges. That is not something they were banking on. Host are more healthcare Companies Getting into the Affordable Care act business . Participating . Guest for their employers . Ost for the competition on the business side, or more companies saying, i want a piece of that action . Guest definitely. You see a lot of new entrants. Medicaid companies are getting into insurance. There is quite a bit going on. There is a company that i am working on a profile of. Saw this andle thought they were going to get into the business of setting up exchanges. Software companies. There was a lot of growth in this area. Get into software or health care, those are the growth industries. Host dave is in maine. Caller i would like to ask a question about this. It seems to me the Affordable Care act blurs the lines between consumers and conscriptions. This was nots into good enough, now we have gone to coercing and exporting the public trust government passed out of legislation. I would like to comment on this because you are a consumer reporter. It seems that consumerism is an act would take on freely and not being forced to participate. Guest it becomes kind of a political issue. We had to pass laws to make people wear their seat belts. Im a reporter, not a political analyst or opinion writer. Peopleis a matter of probably would not do it unless they were required. The government increases they have to believe the penalty to get people to do this. If the government is paying for these people to get health care anyway and is is it is often when it is too late. The cost of treating things early as opposed to two late huge difference. It is going to save the government a lot of money and they have to force people to the extent of making it too expensive at some point to not do it. Host jamie and michigan. Caller we are very satisfied with the aca. Our son and daughterinlaw finally have insurance. They dont have to worry if they have to go to the hospital or see a doctor. Im on medicare. My husband is on medicare. We still have the same doctors. We can go to any specialist without referral. Our grandson is totally disabled. Now he is on insurance. These people calling in, they dont know what they are talking about. Cspan when they were putting through the aca. Most of the amendments that the republicans are talking about now, they are the ones that put them in. I watched a meeting with president obama, i watched day and night when it was being made. Republicans why the want to take the insurance away from these people now. Thank you and have a good day. Guest i dont know that the republicans want to take the insurance away. But they want to try something different. We will see what they come up with. Said, these caller kinds of cases, her disabled grandson, that is why the law is in place, to help people like that. Seem to a lot of people to be the american way to let people like that go without health care. Others may disagree. That is what the authors of the law want to to do. We have heard that the majority of americans want obamacare to be repealed. Here are three gallup polls that have come out. More willing to defy obamacare rule about 35 of uninsured people in the u. S. Would rather pay a fine than buy coverage. According to another poll, newly insured through the exchanges give the coverage good marks according to this gallup poll. Overall, not just the Affordable Care act, but the Overall Health care system, here is another poll. Americans satisfied with how the Health Care System works for them, two out of three or satisfied. It comes down to what your personal situation is. I guess i was more of a risk taker when i was younger. There is a certain percentage of people and they are willing to say i am willing to take a chance because they are young and healthy. I have never gone without health care and i cannot imagine doing so. The options are going to be a lot smaller for where you were going to go to get health care. The federal clinics are going to be cut back. If you want to pay out of pocket at an urgent care center, that is fine. It is interesting to see how contradictory and divided it is. Practitioners going to become more Nurse Practitioners going to become more . Guest oh yes. Physician assistants is one of the top jobs. Because of the shortage of primary care doctors, there is going to be such a need for these kind of people, particularly in rural areas, but just anywhere. For basic things. Host have you noodle the round on healthcare. Gov to see about buying . Guest i browsed around and it is a lot more userfriendly this year. I tried last year and i could not get on at the beginning. It is not orbitz or any of these other sites where we buy Airline Tickets or anything like that. It is starting to get better. This is such an important decision and you need to be able and see if the doctors. Nd hospitals so many of these people have never had insurance. They dont understand that there is often costsharing involved. Host jayne odonnell, frontpage piece this morning in usa today on rural hospitals. Thanks for being with us. Left,e about 45 minutes the house is coming in at 9 00 a. M. We are going to look at the Economic Impact of the Affordable Care act with two economists who have different perspectives on this issue. We are going to return our phone lines to our regular broken down by political affiliations. We will get back into your calls in just a few minutes. Yesterday, nancy pelosi also spoke about health care and the Affordable Care act. [video clip] clearaker boehner made it how vocal the new congress will be on health care. They are talking about possibly having hearings and talking to mr. Gruber. How does your side engage on this issue in a different way . Does it give you more opportunity . Gave an interesting set of observations. When that you skipped is that mr. Grubers comments are a year old and he has backtracked from most of them. That is really important. He is not even advocating the position that he said. I dont know who he is. He did not help write our bill. With all the respect to your question, you have a person who was not writing a bill commenting on what we were thinking when we were writing withdrawing some of the statements that he made. Lets put them aside. To your further question, which with orimportant, without him, the republicans will try to undermine the Affordable Care act. We recognize that. Is that 9. 5 Million People will have access to health care who did not have it before or have it in the manner in which they have it now and ont does not count all those the expansion of medicaid. We are very proud of it. We approach it with great pride and a clear message to people who have that access to quality Affordable Health care, who have the liberty to keep the job they have or change jobs were started business, that this is not going to be taken away from them. Or have a a woman preexisting medical condition or you were being discriminated orinst in getting insurance if youre graduating from college, no longer will you be put off your parents insurance. No longer will you be discriminated against or charged astronomical rates. What thege is really legislation has meant in the lives of the American People. Clearly, there has been a tremendous amount of misrepresentation about it. You saw in the campaign, there was less use of it as a Campaign Issue because the proof of the pudding is in the policies that people now have the protections, the patients writes that are now there rights that are now there. Washington journal continues. Host our conversation about the Affordable Care act continues. The second Enrollment Period continues tomorrow and goes through february 15. We are going to talk about some of the economic aspects of the Affordable Care act. Here are the numbers on the screen. We want to have you as a part of this conversation. 202 5853880, democrats. 202 5853881, republicans. Ndependents, 202 5853882 at the university of chicagos casey mulligan, a professor in economics. Joining us on our set in washington is henry aaron of the Brookings Institution, and Economics Studies senior fellow and has covered health care for a long time. Professor mulligan, i want to start with you in chicago. The white house said that here are some of the goals of the Affordable Care act. , put more money in familys pockets. Number two, help slow the growth of health care costs. Reduce longterm deficit. Improve health and make workers more productive. Reduce job lock and encourage mobility and entrepreneurship. Finally, improve Financial Security in the face of illness. Casey mulligan, in your view, has the Affordable Care act achieved those goals . You asked me in the present tense. A lot of the provisions that the white house intended to achieve those goals have not come into play at. The cadillac tax. They intend that to help reduce the cost and that is not coming in until 2018. It is probably fairer to them, will it ever achieve those goals . There are a bunch of goals you mentioned. Some of them, no, it will do the opposite. The productivity example. There are so many taxes in this law. Different workers, different sectors. It is going to cause people to do business differently than they do it now. Tax andl do it for subsidy reasons, not for Good Business reasons to make the adjustments. That is going to be a loss in productivity. Be 6,000 perwill year per worker who gets insured because of the loss law. I give an example here in chicago. Our lowly cubs changed the way they do business with their grounds crew. Not for Good Business reasons, but to save on taxes or penalties or whatever you want to call them. They were not able to handle 15 minutes of heavy rain and you lost half of the ballgame. That is a loss in productivity, a loss in value to the customer. Those kind of things are happening all over the economy and will happen even greater amounts when the lawfully kicks in. That is a big loss. They have it backwards to say that they are enhancing productivity. One can look at the price side of what the law is doing or the benefit side. Law is toive of this enable people who previously did not have access to Health Insurance and hence suffered needless illnesses to have better access and that will improve their productivity. And thismployers is wellestablished among deciding hownd up much they want to pay workers overall. If they are paying more in the way of Health Insurance, there will be a little less wage, but there is no evidence that the overall impact on the demand for labor by employers should be materially affected. But there is a more fundamental point really. This argument that the tradeoff is between efficiency and compassion has been going on for 200 years, ever since the english poorhouse, when critics complained that if homeless mothers were given shelter and food and her children were similarly supported that somehow it would induce bad behavior on the part of the lower classes. We have is a Compassionate Society here and in all other developed countries struck a balance between providing support for those who need it and the kinds of incentives to which professor mulligan drew attention. There is a tradeoff. I think the tradeoff that the law strikes making sure that people have adequate insurance, giving them the option if they choose not to buy it, not to buy it, and pay a tax instead, that is their call. It improves the options that are available for people to be able to achieve a fair balance between their needs and the incentives of society and that it requests for economic efficiency. Guest im glad we agree there is a tradeoff. The white house to be killed study. Due a detailed there have a Positive Side effect to the tradeoff they do not mention the trade off. At the end of the day, we made reach the right point in the tradeoff, but im very worried that we do not discuss the cost part. ,here is a large employment tax the economic equivalent of an employment tax that is not discussed anywhere. Not in the white house, not a brookings, not at rand, no one is discussing it except in my book about the economic side effects of the lot. It is a huge tax. On mica andory laura smith from long beach california. 60s. Re in their mike had a district manager job. The law said, look, we have big subsidies for you. Npr was celebrating the big subsidies. What they didnt mention is that mr. Smith had to get out of the job to get access to the subsidies. Really a penalty. Look, mr. Smith, you want to make great contribution to Economic Activity . We are going to pull Something Back from you. As soon as you stop making your contribution, here are your goodies. I may agree at the end of the day that balance has been achieved, but how do we know we achieve the balance unless we discuss it . Jonathan gruber never discussed the employment tax. Lets have the discussion and quantify it and compare it to the benefits and use arithmetic and numbers. Guest since we are going by anecdote, let me go back to the Chicago Baseball Team example. I sat on the committee to study the economics of baseball several years ago. Mulligan,ure mr. Professor mulligan, that the owners of the chicago team could have afforded to pay their groundskeepers more. That was not an effect of the Affordable Care act. That was an excuse for the management to try to lower their and there was nothing in the economics of the situation that required the sacrifice of the game that he described. Aaron and casey mulligan. Sys calling in from plainview, new york. Caller good morning. I have been listening to your conversation. I have several comments to make. Curve isall, the cost supposedly going down, but i think that is in effect a very high deductibles. To what iording looked up, is between 3000 and 6,000 per person. They are not really able to Access Health care unless it becomes catastrophic, in which case the plague would act as catastrophic insurance because you have to pay 3000 to 6,000 outofpocket, plus your monthly premium. It becomes prohibitive. I dont know why they call it the Affordable Care act. It is only affordable to the lower, middle, and lower classes. The middle and the upper classes have subsidized them. If it was so great, why didnt the government try to get out of it themselves . And then when they could not get out of it and were forced to take obamacare, they somehow finagled subsidies for themselves, even though their incomes are well above the parameters for subsidies which end at 4000 . Host we are going to leave it there. Guest let me start with the second part. The things i do when i am not here is sit on the executive board of the d. C. Health exchange. Basically, what the federal Government Employees are doing is getting an employmentbased Insurance Plan through the d. C. Health exchange. As with other companies in which the employer pays a portion of the premium, that is also applying here in the case of federal employees. There is no really any special deal and there is no separate subsidy for employees. They are simply buying Health Insurance, buying coverage through the d. C. Health exchange. Curve, therest always has been a tradeoff between paying high premiums and having low outofpocket expenses when you use health care or paying lower premiums and having to pay more up front, in the form of deductibles or some form of cost sharing at the time you use the services. That tradeoff was not repealed by the Affordable Care act. And this goes back to the Bush Administration and the medicare expansion act have been encouraged to move in the direction of high did a double plans. Whether that is a good thing is something that is quite controversial. Personally, i would go for a high deductible plan myself. But not everybody has the same tastes or risks that i have and might prefer more complete coverage of they want it. Now, as in the past, they can get it by paying higher premiums. Those are the gold or platinum plans under the Health Insurance exchange. I agree with the basic that one of the ways to bend the cost curve is to ask people to have more skin in the game and pay more when they make those visits. That is a kind of tradeoff. The other way i like to look at the cost curve is not in terms of inflation rates and health are, but how many hours does family have to work to pay for the health care that is received . The growth rate in that has not fallen at all. People are making less per hour. The growth rate of their wages has not been so great. Previous trend in terms of how many hours you have to work to pay for health care has continued at the same rapid pace that it has been for a while. Host a tweet to the washington journal. Guest im not sure what aspect of sustaining. Yes, we could sustain. We can have a society with less free stuff rather than more. It is sustainable. Maybe it is not desirable and it has winners and losers, but you could do it and our economy would be bigger now and more people would be working. Work would be creating more value in the marketplace if we had stayed with the old system. But it has its costs. Host susan is calling in from the suburbs and virginia. In virginia. Caller good morning. This is an interesting conversation and i had to get up and call. I was on thement, internet for two or three days and it kept crashing. Plan, iup buying a needed a really good plan because i am a prior heart patient. The cost now with having an individual plan in Northern Virginia because i had to use the federal exchange is over 1000 per month. I cannot, for the life of me, understand why we could not get to buy into better drug costs , which i think big pharma has a hand in here. And then the Insurance Industry is giving me the option of one ppo and Everything Else was hmo. Hmo, in the past, i had such a horrible experience because of my heart, they botched it, unfortunately. I dont know at this point what i am going to do. I see the cost going up and up. Host what would you like to see done . What the would like gentleman said here. Financial transparency. You have got to get into these and let the consumer and the reporters look at all the details. Without the details, you cannot make a good decision. Guest let me first point out that under the prior system, it was sustainable. The caller would have faced medical underwriting from Insurance Companies and premiums that likely were even higher than those she now finds so distressing. And very possibly, she would have been denied coverage altogether or, if granted coverage, she could have been given some services and then the Insurance Company could have elected to cancel coverage altogether. Federalw, through the exchanges and state exchanges, there is a menu of four grade levels of plans, ranging from pretty comprehensive coverage and that carries i premiums. , you can have plans that have high detectables and be a few thousand dollars per year and higher charges when you use services, until you have paid a certain amount outofpocket. At that point, everything is covered under all the plans. The premiums are much lower for that kind of plan. That is a tradeoff. That is a fact of life because there is a simple iron law. The Insurance Companies who are writing your coverage have to collect enough money overall to stay in business. That means transferring funds tom those who are healthy those who are sick. Mostu are paying everything in the way of health care, they are going to charge higher premiums. Host robert is calling in from illinois. Caller yes sir. I have a few comments. Hard and soft manipulation. Tonsparent in regards getting elected by saying we will provide you health care to the masses. Whenever you engage in that kind of behavior, people love free stuff and free health care. Everything is not too free. Is ifuth of the matter Insurance Companies were not so greedy and regard to preexisting conditions, they would never have been able to engage in getting elected on the platform. Everybody should be transparent in regard to corporations and ties to big form a cynical companies in order to get elected. The only beneficiary to the aca is the pharmaceutical companies. In chicago, illinois, we have a bunch of them. The fact that everybody is required to pay for health care is ok, but when it gets to the point when the working poor and the middle class are paying for andybody and the rich again the pharmaceutical companies are making billions and billions of dollars. Host casey mulligan, university of chicago. Callersoth the mentioned that they want to see some transparency and see the costs and benefits laid out. I agree with that. I am pessimistic. The New York Times does not mention the tax that a pointed out. It is the single biggest tax. The dont mention it. Why not question it why not . Maybe they think that the law is a good law and it is not a good idea to shine a light on its costs because others who are not as smart will exaggerate those costs. Im pessimistic that we will see it. Get very little coverage. I really appreciate being invited today. I think that is a permanent state of affairs. Casey mulligan is the author of the book side effects. He did a study for the mercators center on the Affordable Care act and the economics of parttime work. Henry aaron has been with the Brookings Institution since 1968. How many of those years have you studied health care . 1980, afterrted in a stint in government were i was given a job because what i knew about welfare and social security. In the course of my two years in government service, i realized that Health Care Policy was the emerging issue and the most important domestic, social policy issue that the nation would be facing and i think events have proven that inside correct. Ost paul is an arkansas is that arkansas or alaska . Caller you always get it mixed up. Ak is alaska. Host we are even. [laughter] caller i asked her economics , couldor mr. Mulligan you define fascism . My followup with liberty. Here is the issue. Medicare. M on 68 years old, im on medicare. Everyone i think a unique health care and we are going to force you to take health care. Do you want it or not . President obama has said, ive got the pen. Fascism is a situation where everybody, whoever is in power, whatever they say goes as law. That is based on roman law. Our government, we based our government on commonlaw, which is a bicameral system and where the people have a say in the situation. Host we appreciate that. You have given us a little bit of that philosophy and titus into the Affordable Care act. Areer why so many people rejecting the Affordable Care act is that we are being forced without any say, we are being forced to buy this policy. Host lets begin with casey mulligan. Im not an expert on politics. I know that plays in. I wish i had more expertise. I would like to see the political process be more competitive. We have too many districts that are either all republican are all democrat and they virtually have nothing to choose from. Is alack of competition problem. Im not sure how it feeds into health care, but i sure it does. Ly agree complete with professor mulligan about the lack of competitive districts. We have an elected congress that can be voted out of office. As many democratic incumbents recently discovered. If you dont like the law, elect people to change it. That is called democracy, not fascism. Host leonard in ohio. Caller good morning. Reagan saidident that insurance and everything would go down. Now, we have the Affordable Care say is ah some people give me from the government. I would like to ask your guests, what is the difference between a person receiving welfare and the whole state receiving welfare . Virginia,inas, florida, georgia, alabama, mississippi, arkansas, texas or welfare states. Could you explain to me what is a welfare state . Host henry aaron . Can answernot sure i that question directly. There is something about all of the states thats a gentleman mentioned. They have elected to make a very bad deal for the citizens of their own states. Support fromused the rest of the United States for expanding health care for poor residents of their own state. That strikes me as a poor decision. In the case of virginia, where i looked up the numbers, we are looking at a state that is turning done 2 billion per year in steady money. The enrollments have leveled off. Funds would come from other states to support local residents. How thet clear to me legislature in the state of electoraten face the and say, we are turning done money and other states to help us support your neighbors. The law does have built into it at the state level some perverse incentives. They are inviting individual states to take out of the federal treasury. America pays for that. Surprisingly, a number of states have declined to take a bite out of the federal treasury. The rest of america ought to thank them, not criticize them. In charleston, south carolina. Caller very interesting show. I have a short statement and one question. Real easyeasy is for people on obamacare to make the statement that they love it, they like it, they like everything about it. That is because most of them are not paying for it. Now you get to the people who are paying the bill. I am 67. I have worked on my life, paid my taxes. My question is if obamas amnesty plan goes through and we add 46,000,000 more people to our country, i would think that the majority of those people would not have money to pay for the Affordable Care act and they too will get a subsidy and the people that is paying the bills, the subsidies, how can you expect the 50 of people in this country paying the bills and the other 50 are sitting on their behind . Something is getting to a boiling point. The country is already bankrupt, they just dont put it in words. This is causing a horrific rift between two sections of people. Everybody is that their throats and we have mr. Obama to thank for it. I understand the frustration, but with all do respect, i think you have things backwards. People who are here without documentation are receiving free care. ,hen they go into a hospital the hospital is legally required to provide care for them. The kind of measures that are reported to be under consideration by the administration would enable those people to take regular employment and earn more than they are now able to do because they are not allowed effectively into many kinds of jobs. I think the measures that are now under consideration would actually help deal with the problem which troubles you, the last caller. I do understand the frustration. You dont like to have freeloaders in the country. But i think the measures that the administration is considering would help ameliorate and reduce the magnitude of the problem that troubles you. Host william is in virginia. Caller i would like to ask the guys as they have any opinion on Insurance Companies. And they doinesses it by actuarial analysis. Is there any way, any better way than what we have going on now where you could bend a business with a systemnce like they have in canada or something where everything is supposedly free . Some thoughts on that. Thank you. The caller is right. Part of the Insurance Business is actuarial analysis. Another big part of the Insurance Business is regulation. The regulations are not new. They are increasing over time. That hurts the value that customers get out of their insurance. Of those employees have to be devoted to understanding regulation, leveraging regulation to their advantage, lobbying. I would like to see a lot less regulated Insurance Industry, at least the part of the Insurance Industry that would be unregulated and people could deal with. That would save a lot of resources. Something like 35 of insurance is overhead. Costs thate types of every Insurance Plan owner has to pay for. They are really not necessary as a matter of technology. Know the collar wanted to if there are alternative ways to pay for Health Benefits and pointed to the example in canada. There certainly are. The United States has one particular kind of arrangement under which private Insurance Companies provide most of the coverage. Casey mulligan and i disagree about whether the Insurance Industry is desirable or essential for the industry to function reasonably well. There is no question that we could, if we wished, have a different kind of system. The canadians as do, a system organized by the state, but officially under a national law that requires a degree of uniformity. It pays through most of health care through taxation and provides services at lower price , at least hospital services, at the time the people made them. A lot of other countries do that. Oo these systems have advantages and disadvantages. There is one thing in common across the world. Unless something really horrendous changes, we evolve, we change gradually. That is why for all its flaws and complexities, the Affordable Care act actually builds on the system that we had. It is an incremental change. It did not sweep out the whole Health Care System and replace it with a National Health service as in great britain. It did not sweep away employmentbased coverage and , as everybody a voucher senator mccain suggested during his president ial campaign. It builds on our system, which happens to be the most complicated in the world. Surprise, the reform is complicated. It annoys a lot of people, it annoys me. I think there are things that can be done better. But if we were not going to have a revolution in the healthcare system, we had to build on what was there before. It is a very complicated system. The various disturbances that people are expressing frustrations are a product of that decision. Sense that theny nation is disposed for revolutionary change, either toward vouchers or toward a national tax finance system. Was barely tolerated politically, the reform that we had. We are going to try to make it work. I think it will work eventually. It will take time, money, patients, and i think we will be better off for it, but it is not going to be a smooth, bump list trip. Mpless trip. Host casey mulligan, what would you recommend . Guest i would recommend a tax credit for people who dont get Health Insurance through their job. That would build on the old system, which had texted actions for people who did get it through the job. I would roll back some of the regulations in the Insurance Industry, such as competing across state lines. It is hard to know exactly what that would achieve, but i think the market surprises you. I would do that. Something needs to be done about preexisting conditions. You dont need to have a huge redistribution to deal with produced or brooding preexisting conditions. I think that is one of the big things that came up in this law. Jim is in hamilton, montana. Caller yes, good morning. I was calling in to say the same thing. We get billions and billions and billions of dollars away. Why cant it be free . Pharmaceutical bills 32 . 32 to . 87 of powder per pill. They are making 10 or 20 of pill. That is beyond greed. Care, weup the health are going to have more fairness for the corporations and what they are charging their customers. But it should be free for everybody. Host casey mulligan. Free . Free stuff is a path to a real small economy. People create value so they can earn profit or a wager what have you. That goes for the workers. They work so they can get health care and schooling and vacations. The pharmaceutical companies as well. They need to make money on their successful drugs because they have a great number of drugs that are not successful and they still have to pay the scientist s and pay for the fda trials and so on. They need to earn a profit. You take away the profit and you are not going to have new drugs. There will be people who died because a new drug was not there for them because we were demonizing the inventors. For a long time and i think with some justification, people have been upset at the way in which Insurance Company executives have behaved. Some Insurance Companies have engaged in what i would regard as really deplorable behavior and stonewalling certain practices. Fundamentally, professor mulligan is correct. Selling a product, insurance in this case. They have to receive enough money to cover costs. They have every incentive to try to hone down those costs. That is where regulation comes in. In some cases, companies have engaged in practices in order to hold down costs that the American Public to floors. You make a big claim, your insurance gets canceled. You happen to have had an illness in the past the past, we you really exorbitant premiums. This kinds of practices marks the reputation of the Insurance Industry. Some bad actors have engaged in at. Some of the behaviors have been driven by competition and the need for making a profit. An industryates intelligently, and i would be the first to say not all regulation is done intelligently , if one does it intelligently, the nation ends up gaining a lot. It gets a better product and at a reasonable price. Unfortunately, we are out of time. Thank you very much. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] [captions Copyright National cable satellite corp. 2014] this weekend, 48 hours of books on cspan two on book tv. You will see forest johnson, the mayor of london, george w. Bush talking about 41. John mccain talking about 13 soldiers and next weekend, live for the 17th year in a row, but bookll be at the miami fair. Lots of call in opportunities. Two full days of live coverage. The 17th year in a row. Weekend,over the American History tv, 48 hours of American History on cspan 3 beginning saturday at 8 00 a. M. Saturday, live on talking war world war i and thee is in session. The speaker pro tempore the house will be in order. The chair lays before the house a communication from the speaker. The clerk the speakers room, washington, d. C. , november 14, 2014. I hereby appoint the honorable Virginia Foxx to act as speaker pro tempore on this day. Signed, john a. Boehner, speaker of the house of representatives. The speaker pro tempore the prayer will be offered by our chaplain, father conroy. Chaplain conroy let us pray. Eternal god, we give you thanks for giving us another day. We come to the end of a week during which some members of this peoples house have come to finish their service in the congress and others have come to prepare for their opportunity to serve this great nation. It is a time of tremendous transition, a time fraught with trepidation and some uncertainty. Send your spirit of peace and calm that all might have confidence in your faithfulness to us and that no matter what lies ahead your grace is abundantly available. Bless the members of this assembly and us all that we would be worthy of the call we have been given as americans. Help us all to be truly thankful and appropriately generous in our response. May all that is done this day be for your greater honor and glory. Amen. The speaker pro tempore the chair has examined the journal of the last days proceedings and announces to the house her approval thereof. Pursuant to clause 1 of rule 1 the journal stands approved. The pledge of allegiance will be led by the gentlewoman from florida, ms. Roslehtinen. Ms. Roslehtinen if the visitors would join the members in the pledge to our flag. I pledge allegiance to the flag of the United States of america and to the republic for which it stands, one nation under god, indivisible, with liberty and justice for all. The speaker pro tempore the chair will entertain up to five requests for oneminute speeches on each side of the aisle. For what purpose does the gentlewoman from florida seek recognition . Ms. Roslehtinen i ask unanimous consent to address the house for one minute and to revise and extend my remarks. The speaker pro tempore without objection, the gentlewoman is recognized for one minute. Ms. Roslehtinen thank you so much, madam speaker. As we approach the november 24 iran nuclear deadline, we should all be reminded that iran is a u. S. Designated state sponsor of terrorism. Iran continues to violate multiple u. N. Security council resolutions, and the regime continues to advance its Ballistic Missile program, a program that has only one purpose, to launch a nuclear weapon. Iran is one of the worlds worst human rights violators and under the socalled moderate rouhani has been executing people in record numbers. Yet, we recently found out that president obama sent a secret letter to irans Supreme Leader last month. The Supreme Leader responded by releasing a plan to destroy our closest friend and ally, the democratic jewish state of israel. The Iranian Regime cannot be trusted. Yet, this administration continues to push for a nuclear deal that threatens our u. S. National security interests. Madam speaker, we must not allow any deal to be finalized that we view is not in the interest of the United States of america. Thank you, madam speaker. I yield back. The speaker pro tempore the gentlewoman yields back. For what purpose does the gentleman from new york seek recognition . I ask unanimous consent to address the house for one minute. The speaker pro tempore without objection, the gentleman is recognized for one minute. Mr. Higgins madam speaker, today i rise to stand with the american postal workers in buffalo, new york, and across the country who today will rally to send a message, stop delaying americas mail. Since 2012, 141 Mail Processing plants have closed. 82 more across 37 states are scheduled to either close are be consolidated beginning in january. The erosion of Service Standards is not only bad for customers, u. S. Businesses and hardworking postal workers, but it is a step backward in a delivery industry. Today the Postal Service board of governors holds their last Public Meeting of freen. I urge them to re 2014. I urge them to reverse course of the trademark reputation of the United States Postal Service. I you were the house to bring i urge the house to bring up the Postal Service protection act up for a vote. This removes the pension prefund obligation, shipping operations in the lease of surplus facility space while maintaining saturday delivery. I yield back the balance of my time. The speaker pro tempore the gentleman yields back. For what purpose does the gentleman from minnesota seek recognition . I ask permission for one minute and permission to revise and extend my remarks. The speaker pro tempore without objection, the gentleman is recognized for one minute. Madam speaker, members of the house, money and negative advertising in the last election cycle has clearly established the need for us to change the way we do politics here in america. Mr. Nolan putting an end to it this negative advertising is so essential. Its not only polluting the airwaves on tv but it is denigrating the candidates, it is corrupting the Public Policy process and its dangerously diminishing peoples confidence in the system. I was greatly heartened two years ago to see the spirit of bipartisanship that came with all the new members of the congress. Im seeing it again, but until we change the way we do our politics, its not going to be realized. We need a compliment, putting an end to all this money by outside special interests and their negative advertising and complement that with a change in way we do business, open rules, where every chance gets to be heard and voted on. Thats how bipartisanship works. Thats how things get done. Thats essential for compromise and thats where we need to go to restore peoples confidence in our system here in america. Thank you, mr. Speaker. The speaker pro tempore the gentlemans time has expired. Pursuant to clause 12a of rule 1, the chair declares the house in recess subject to the call of the chair. We will have live coverage here on cspan. We will also have live coverage coming up in about 20 minutes or so. Defense secretary chuck hagel will talk about the nuclear his comments and nine 30. Tomorrow marks the beginning of your two of the open enrollment through the insurance marketplace. We talked about that this morning. T newspaper. Open enrollment begins tomorrow. Is it going to be ready . Are the cites going to be ready . I think its going to be as ready as it possibly can be. All the works been done, were all waiting to see and im sure folks in the government are nervous, but probably not as nervous as they were last year because theres been so much more testing, its incredible. Its weeks and weeks compared to 10 days. March 23, 2010 that the president signed the a. C. A. Whats the consensus on its success . Its still pretty divided. Certainly listening to your callers and talking to people regularly, people are pretty divided. Its very politically polarized as you well know. You tend to hear from people who are unhappy more than you hear from people who are happy. Ive heard from a certain number of people that even if theyre unheam with certain aspects of finding the doctor they want in a plan they can afford, thats a big concern. But some people are getting here that they never could have gotten. So i do hear with a fair number of people with advanced stage cancers who would be bankrupt if it wasnt for the law. I do tend to hear more about people who are paying out of pocket. New republican majority, both house and senate, hows that going to affect the a. C. A. . Guest you didnt hear as much on the campaign trail, it wasnt the big hot button issue that some expected maybe a year ago that it was expected it would be. What im hearing is that there isnt going to be the mood, or even the its not likely to be repeeled. Theyre probably going to be changes made. Probably changes that everyone would agree should be made, certain loopholes closed. But youll be hearing a sell about it but i dont think its the priority that it once was. Supreme court, whats going to happen up there . Goodness, i certainly dont know that. But i would tell con seemers, even though the Supreme Court will look at whether the subsidaries are in fact legal if youre a state that didnt set up your own exchange, everythings going to go as it is now. No matter what the Supreme Court does, consumers shouldnt do anything different. They should still, what is it about 80 of people are eligible for subsidaries that buy on the government exchanges. So people should still pursue those subsidaries. Host is that the only case on health care that the Supreme Court is going to hear in the next session . Guest im not a Supreme Court reporter thats the only one im aware of. Thats the big one. Host before we go back to calls, want to point this out, the u. S. A. Today has devoted a page and a half to your story this morning. And its on rural hospitals. Rural hospitals in critical condition, this is the front page of u. S. A. Today this morning. Is this because of the a. C. A. . Guest well, some of them say its a little bit of the last straw. It certainly isnt because of the a. C. A. Rural hospitals have been in decline for a number of years, but its been a accumulation of things, the death spiral theyve been in. One of the hospitals, i went to richland, georgia, right up the street from plains, georgia. Their little hospital there, the Electronic Health records were kind of the last straw, which are required under the Affordable Care act. But largely, the populations that theyre serving, theyre serving very poor populations that are on medicare or medicaid, and of course georgias one of the states that didnt expand medicaid, expansion of medicaid would make a big difference, but wouldnt save a lot of these hospitals. Host and you have a chart in here over some of the hospitals that are closing. Lets show this. Is it centered down in the south . Guest it certainly does seem to be. There is a lot in the south. The south is where theres been the least Medicaid Expansion. There are a lot of these hospitals, its really, ive covered health care over a year, ive been a reporter for a long time. But there are so many issues that go into this. You feel it can be rather depressing and ive covered a lot of depressing things in my career. Theres so much that needs to be done in this air. Theyre not getting the care they need so they certainly need to be getting some Preventive Care and Healthy Lifestyle changes, frankly. Host Jane Odonnell is our guest, u. S. A. Today. Fred is calling from suh city, owa. Caller obama is from an old third world car who operates on socialism. I like capitalism. Hes breaking our country. Host fred, how do you get your insurance . Caller im on medicare and i buy a Supplemental Health care. And im retired. Host can i play devils advocate. You talked about the fact caller you sure cut me off fast, i thought it was my phone call but it seems like you want to control the call, if you cant do that, i guess i have to play by the rules. Host i just want to ask you a question. You talk about the president being a socialist and youre on medicare which is government funded. Do you see any connection or any conflict in that statement . Caller yes, thats true. But you can take that. Im not advocating anything about it at all. Rather to continue on this path, go ahead and take my medicare because our countrys doing down the tube. Its just a matter of time before the whole Financial System collapses, and you want us to pay for this Affordable Care act by sacrificing our military and cutting it back to dards in the ii stan most dangerous time that anybody could live at. Host ok, thank you fred. Any reaction to his call . Guest i will say as an observer of this issue, i find that it is interesting because you brought up the point that comes up for me a lot is a lot of the people that are the biggest opponents of the federal government involved in health care often do get so many entight ltments and so much of their livelihood is dependent on the government. An interesting case, im in Northern Virginia but you go out to rural virginia, its largely republican signs but a lot of federal entitlements. Host have the cost of the a. C. A. Been in line with whats predicted . Have they been higher, lower . Guest i think theyve pretty much been in line. It will take a lot to see what the Health Care Savings are. Youre not going to see the savings of these people that werent getting care, are not getting care. I think its on track so far. Host 36 billion according to a congressional budget office, net cost in 2014, the expected cost 1. 38 5 to 2024, trillion. Sweetie is in covington, georgia. Hi sweetie. Caller hi, good morning, im glad you took my call. Im going to try to be as nice as i can to our government. The Affordable Care act, i dont need to use it, ive been in business many years, but as a grandmother i have children that do not have jobs and theyre not able to get insurance and theyre refusing to even use the social Service System because theyre saying there are people that are worse off than them. With the Affordable Care act in my opinion, its already successful, because the calls that i heard, i do have a heart for people that never had insurance and now you have insurance, thats an excellent thing. But the whole thing with the Affordable Care act in america, if we continue to break down the person at the top, whos staff to be using his to get america balanced, youre always making references to who the forefathers were. Tell the congress they are the forefathers. The forefathers before did what they had to do. Since they had such an excellent vision, thats why were still tapping into those sources today. Host all right, Jane Odonnell. Anything you want to add to what sweetie had to say . Guest im a little confused, i wasnt exactly sure who she was mad at, but it was interesting to me that she was from georgia because i did spend so much time in georgia. I do wonder if her grandchildren arent able to get jobs, how she would feel about Medicaid Expansions that a lot of people feel it would make such a difference in that state, especially if theyre not willing to use social services. Talk about rural hospitals closing, but the cost to any hospitals that have to continue under law to take these people who arent getting health care, otherwise when they finally do have that hernia or the heart attack or diagnose of cancer they go to the Emergency Rooms and these hospitals are getting less money from the government to care for them. Host what is the resistance to Medicaid Expansion by some of the governors in the country . Host they just say its going to cost them. Sure now the federal government will help them out but in two or three years, theyre going to have to pay, what is it like 10 , and that could be backbreaking and their states are already struggling so much to stay afloat. That is the case. There is so much unemployment and so many businesses closes in a lot of these states that you can understand that point. But it does seem to spend much of next year working on a series of Medicaid Expansion. It will be interesting to see, even where we are right in the middle of maryland and virginia, one that did and one that didnt. It will be interesting to see what the affects are because these people are not getting, the states that didnt get expand arent getting any better and theyre going to need health care at some point. Host when is that series coming out . Guest in a fellowship so ill be working on that, investigating it and learning more about it. Host laila tweets in, how many doctors, clinics hospitals arent accepting obama care . Guest i dont have numbers, there are no good numbers on that, but i did talk to a few people that had a devil of a time finding a doctor who would take their plan. The provider lists are often inaccurate. Theres one man suing Anthem Blue Cross because he must have called 40 doctors and it was either an error or the numbers didnt work or they simply wouldnt take it. So there are some complaints theyre not getting the reimbursements under the Affordable Care act plan as they do under private insurance. Host speaking of numbers, this is from h. H. S. , they say that 10. 3 Million People gained Health Insurance under the Affordable Care act. 32 million still lack coverage. Political reports via h. H. S. That 9. 9 million expected to enroll by the end of 2015. You said its really hard to get good numbers, ive got a headline over here from september that says 7. 3 million have enrolled. Why is it so hard to get good numbers . Guest i did see a report that the 9. 9 million is supposedly the net and your 7. 3 is the net, so either eight or 8. 1 signed up, but then a lot of these people wound up not paying the premiums, which is another problem the doctors have. They dont know whether the persons paying their premiums so they actually treat their parkes and then there becomes a fight with the Insurance Company, they have to least cover part, i think its a month of a cost and on Insurance Companies. For three months you have this 90 day grace period where you an get free insurance. Host when h. H. S. Reports 10. 3 million signed up, does that include the 19 to 26yearolds who stay on their parents plan, Medicaid Expansion . Guest it has to because it is only 7. 3. I think its the people that got in there under their parents. But the 9. 9 is including, thats the net. So that is one of the reasons it seems like such a conservative estimate is because they were saying ok, a certain percentage, maybe another million or two, probably wont pay their premiums. O theyre estimating that now. Host is it tough to get numbers out of h. H. S. . Guest its tough to get everything out of h. H. S. Again ive only covered them for a year, but ive covered federal agencies and this is a tough administration. Host hi alex. Caller good morning. First ive been around the a. C. A. For a year and i get a great subsidary in new york and im happy with it. Just had a couple of comments. Peter, you read from the wall street journal about how many people lack a basic understanding of how they can reenroll. Then you roll that clip of Mitch Mcconnell saying people hate it. How can people hate it if for example they dont even know they can change their policy, like that. That level of ignorance, half of them really say they hate it. My second point it seems like a psychology. I was a School Teacher and i resented to have to get insurance, i always had to be a School Teacher and do something i didnt really like. Now i can do what i want to do and not be tied to my employer for my Health Insurance. Host how much do you pay a much . Caller yeah, i pay around 100 a month for my premium and receive a subsidary of little over 200 a month. And i have a bronze plan. Host are you employed . Do you have a full time job . Caller im self employed. Host ok. Caller and yeah. Host anything else you would like to add . Caller well, i wanted to ask your guest, the psychology of it, it seems im more liberateded. The gentleman from iowa who calls and hates obama, yet hes on medicare. What a great thing to be in our old age and not have to be consumed with this fear of going into hundreds of thousands of debt to get your hip replaced or your heart fixed. Its a wonderful thing. I dont know why people are so afraid of it. I wonder if your lovely guest could tell us. Guest it does seem to be politically motivated, generally. Psychology, some people, whether i was in georgia or no matter where i was, there is a certain, you know, knee jerk reaction or kind of gut feeling. I shouldnt have to, i, meaning as a taxpayer, shouldnt have to pay for these people who cant pay for themselves. But, you know, i think when a lot of people see the subsidaries they can get and if they are indeed successful getting doctors, i think they would probably agree with the caller, where i found more complaints are the people who are more middle class arent getting subsidaries because as individual insurance, it isnt cheap to buy insurance on the exchange, or through just generally speaking it was never cheap. So they tend to get kind of upset and people, people, my company and other companies who are seeing they have higher and higher deductable plans get pretty upset and companies will often blame the Affordable Care act. Sometimes that prickles down. Host in the wall street journal, this democrat is giving up on obama care, nonprofit, professional and former Hospital Insurance coordinator currently works as a counselor at a social Service Agency in denver. He writes i voted for president obama again in 2012, then received a cancellation notice from my Health Insurance. This was due to obama care, the so called Affordable Care act. However i couldnt afford anything else. Obama care is a failure for anyone who thinks this is a misprint because no democratic activist would make such a comment, let me add that it is too big, too complicated and too expensive without a public option within its network of exchanges, obama care is a giant blank check to the Insurance Companies that pushed it through congress. Is that accurate in your view . Guest well, im not going to give my opinion, but my thoughts on that are that it has done a fair amount of good. It is fairly complicated. I think its going to take a while and require a lot of adjustment on a lot of people. I hear this a lot, people are still angry about is socalled promise that you can keep your plan. I heard from someone yesterday who said president obama said i could keep my plan and i couldnt. And their rates went up considerably. So you can understand why people are upset if they have very limited income and theyre paying 300 more out of pocket. Host how widespread was people losing their plan . Caller well, it was quite a few people. Millions of people probably. I dont remember the number exactly. But it was quite considerable. Now they may, they did get to keep them for a while but youre going to start to see more people get upset. There will probably be a second wave. Host doug in north carolina, gets employer insurance. Hi doug. Caller good morning, how are you doing today . Just wanted to flake a comment, i was listening to several of the callers, and there was a gentleman on just now talking about the gentleman being dissatisfied with the medicare, medicaid. I worked all my life, since i was 14 years old working in tobacco, in north carolina. Im quite tired of having to take the burden on of everybody else. My deductable went up to 2,000. I went to purchase some meds and usually would have a 10 co pay and now my meds are going to be 120. Host and this is through your employer insurance, doug . Caller yes, sir. Host why do you think the cost has gone up . Caller because this failed plan host that your opinion or have you been told that by the people who run your insurance . Caller no, its my opinion. To me, its and she was making a comment that a lot of these comments may be politically driven. But, to me, its taken away from our individual liberties. By forcing us to do this. Youve got people that will get out and work every day, and are having to take on the burden of everybody elses insurance because they wont get out and work. Im in a business where i see it a lot. People come in and theyre driving vehicles that are worth more than my car, but yet theyre Getting Services from the government. Individuals need to take on responsibility. Weve been put into, i think a lot of people are being put into a nanny state and being dependent and made to be dependent on the government. Where i came from, you get out, you work hard, and you pay your way through life. Host thats doug in north carolina. Jane odonnell. Guest he did sum up some of what ive been saying. He makes a very good point. I was talking to a colleague who has the same kind of thing where theyre paying out of pocket, hes paying out of pocket for Prescription Medications until he hits his deductable, which was 3,000. You have that, youre not going to hit it. It can be very jarring. If you are someone who, when i bring up the political side, it is just kind of your theory on whether we should be helping the less fortunate of not, which is the idea of the Affordable Care act, provides care to people that cant have it or havent been able to have it and cant afford it. So, were looking a lot at high deduct i believe plans, as the next big project were working on. Because it is going to be, i think the big story of the next year. Host so Affordable Care act, has it caused employer plans to higher . That was a very inarticulate question. Host but i know what you mean. Theres a lot of blaming and scapegoating of the federal government in the law going on. Its difficult to prove but certainly this past year there were not so many costs that Companies Really could legitimately, regularly say sorry folks, your plan is going to cost you more because of the Affordable Care act. That was very convenient in a lot of cases. However they are caller it took me two years to pay off the test. I am getting medication that will save my life under the Affordable Care act. What was your experience signing up . Easy as cake grid there is someone who helped me sign up. Are you on medication expansion . Medicaid guess it is expansion. Washington state. Is there any cost to you . Caller there is not. They are literally saving my life. Today, im getting medication for it. Host thank you. Those are the stories that are heartening to hear. The administration wants people to hear more of that. That does seem to be the lines that the issues are drawn down. Someone orwho know are having their lives saved. Insurance Companies Use to be able to say, we cannot cover you because you have cancer and that can bankrupt people. It has done a lot of good and it is good that it has done that. So Washington State has been running its own exchange and they do not see to have the issues that maybe maryland had. Guest maryland, we live here. But the state exchanges did have more success than that federal exchange did. So much has been put into the federal exchange. That there will be problems, there are some fixes that will probably come in. Im doing a story on the company that does handle some of the exchanges and that is fairly standard, do an upgrade or it everything may not be available, every functionality, that it should be able to handle all the people who are going to lock on tomorrow. Host re working because enrollment is going to start . Guest yes. The woman who is next to me covers black friday and it is kind of like that. Middleton is calling in from west virginia. Caller good morning. My wife, she now has the Affordable Care act. She had no insurance for eight years. When i retired for my job, my Insurance Company do not give me any either. But i was on medicare before it became law. Ghmark. Blue cross, hi she has great coverage. She paid less than a hundred dollars last year. People need to research this. Cant just look at the surface. You have to look at the whole thing and see what money you can get extra. You cant do it by yougoing to mindonline. Have to fill out the information and they will tell you how much that you are going to pay. Good he makes a very point. People can window shop and you might have sticker sh ock. But you have to realize, if your income is below the federal poverty limit, you can get extensive subsidiaries. It is important to make the you dontagain, want to be a payment buyer when youre buying a car. You do not want to buy by the premium. If you need prescription drugs, be sure to look at the deductible and consider whether paying 300 or 400 a month, rather than 100 so you do not have to pay outofpocket is important to consider. It can be budget busting and the the thingthingand about this is to have people not go host why no mention of probably because i have not started. Is it going to be a sideshow or central . Guest i think it is going to be a sideshow. I try to kind of ignore that part of it because i do think dramatic,comes this theatrical sideshow might really is important if youre a consumer to focus on what you can afford and what you canyes you can you cut up and saying, need toister shown having insurance bites every 15th, or youre going to more at tax time. Good morning. Followingis year, revelations about troubling in ourand poor morale Nations Nuclear forces, i ordered reviews of our entire. Scanning therise air force and navy systems. Examine the to health of the Nuclear Enterprise. Oversight Mission Performance and funding. This morning with me here on the who have individuals played a particularly important but in these reviews. Probably most importantly, they had the responsibility to carry out the recommendations that came from these reviews and i believe you know that after i leave this morning, the deputy willtary and others here stay on the stage and answer more specific questions. Ank you,g to thinkth admiral for what you have done as vice chief of Naval Operations because your component is critical to this. Thank you for your continued leadership at goit ist isnt to aspect. Gral we are going to go to the air force base in north dakota and wilson,day. General thank you for what you do with your forces and your team. These individuals as well as other leaders have all been integral to what we are doing and the internal review part of visited alliewers many ofoperations and the key support facilities. The interviewed hundreds. Review team leaders from the external review part of this are with us this morning. I want to particularly thank admiral harvey and general for your leadership. Madeleine headed up the internal general welch and general harvey headed up the external. For all of your teams, we are grateful. Today, i am announcing the thelts of those reviews, actions that the dod has already taken to Carry Forward and carry out the recommendations of those reviews. And the actions that we are the process of taking to address the ensure thend assure safety of Americas Nuclear deterrent. I went to be clear about the importance of the Nuclear Mission and the role in defending our nation. It plays a Critical Role in assuring u. S. Safety. It is the dods highest parity mission. No other capability we have is more important. Our Nuclear Triad deters attacks on the u. S. And our allies and partners. Fromevents adversaries escalating. It provides the means for Effective Response should deterrence fail. Consistent with president obamas guidance, our policy is to reduce the role of Nuclear Weapons in our nations Security Strategy and seek peace and security in a World Without Nuclear Weapons. We will continue to do both that does not diminish our responsibilities. As the president has made clear, as long as we have nuclear ensure, we will and must that they are safe, secure, and effective. Dod Senior Leaders and i are in full agreement. We are in full agreement that today, Americas Nuclear deterrent remains safe, secure, and effective. That is thanks to the heroic efforts of the mn, semen, and marines. However, the internal and external reviews show a consistent lack of investment and support for Nuclear Forces over far too many years has left us with too little margin to cope with mounting stresses. The review has found evidence of systematic problems that if not undermine could the safety and effectiveness of the force in the future. This includes manning and skill inefficiencies. The culture of over inspection inspection and followup and accountability by Senior Leadership. The because it is a lack of sustained focus, attention, and resources. It results in a pervasive sense of that a career in the Nuclear Enterprise offers too few opportunities for growth and advancement. My manyhis from conversations. Tohave been taking steps work on the conditions. Some of the recommendations involve changes in organization, policies, and culture. Others require an increase in resources, allocated to the Nuclear Mission. We must address all of the underlying problems. Many begin with the many steps that we have already taken, starting with improving oversight and first i ght group. D the oversi not only from the pentagon but from strategic mandate in nebraska and air force Global Strike command in louisiana. Previous reviews of our Nuclear Enterprise lacked clear followup mechanisms. Recommendations were implement it without the seri follow through to assess that they were implemented effectively. Was a lack of accountability. To fix that, i have directed our track both the status of the actions we are were, the progress making, and the impact on the health of our nuclear force. To know what is working and what is not. They will report every month. They will report to me approximately every 90 days. I will hold all leaders accountable up and down the chain of command to ensure that words are matched with actions. We must change the cultural perception of that Nuclear Enterprise, which has particularly suffered in the air force. We must restore the prestige and the brightestt minds. That is why i have granted that air force authority to elevate double Strike Command to a nt. Rstar billa billet. They will no longer be outranked by their nonclear counterparts. James, who hasry been a trend as leader, personally awarded the first Nuclear Deterrent service tols, and new medal recognize the contributions they make to american security. Permeatechange must down to the individual. Man knowing how much we value them and their service. We already have started to match needed leadership with investments. Establishedlast year we established a program. Urgentess the most shortfalls in programs, equipment, and manning. Some of it will fund incentive pay for Critical Nuclear scientists. The air force has exempted 4000 airman from manpower reductions. 1100 billetsover efforts mustour be sustained. The dod will soon finish updating and standardizing how we conduct inspections and elevate our personal across the Nuclear Enterprise, eliminating micromanagement, redundancies, and administrative burdens that overtax the force and harm the mission. The navy is reducing administrative distractions and plan to hire more than 2500 shipyards,public weapons facilities, and reactor training systems. Meanwhile, the air force is planning construction to improve weapons storage facilities. Helicopters and revamp how it trains and manages the nuclear force. Elevating andare reinforcing the Nuclear Mission, including in the budget requests they are preparing for fiscal year 2016. We will to make billions of dollars of additional investment in the Nuclear Enterprise in the next five years. This new funding, which will be detailed in our budget submission next year, will be critical in continuing upkeep and security while addressing shortfalls that undermined morale in the nuclear force. There is much more wins to do muchng up to ourthere is more we need to do leading up to our modernization. Traveled to wyoming to wyoming and montana. I visited Kirtland Air Force and theew mexico and air force base in omaha. I met with sailors at the uss tennessee in kings bay georgia. Right after this press conference, we will leave for the air force base in north cruise andpeak with support teams that are now stationed there. Message to them and to their colleagues is simple. Nuclear enterprise is foundational to Americas National security and the resources and attention commit to the new air force must reflect that. We need our best people in this enterprise. I will not take a couple of questions before we leave and as i said, this team answeray behind and further questions that you may have. Rita . You talk about accountability. Several years ago, they fired people and similar reviews. Where is the accountability for the failure to improve and take the steps that were needed over has been quite well and steps have not been taken to see what hasis needed. What is the youre talking about billions of dollars. Kenny narrow that downcan you that down . The budget issue, let me address it this way. We will get specifics on how much and where and all of that toour budget that we present congress. Futuree next five years, werefiscal years, looking at a 10 increase over each of those years. 15 billione spend to 16 billion on our Nuclear Enterprise. If that gives you some kind of range. On the accountability issue, there has been already accountability in a number of instances in specific areas as we are Holding People accountable. There will be more. As i said, thinkn my remarks, and i in backgrounds most of you received yesterday, this is also a process as we work our way as weh accountability, restructured. I go back to a comment i made. I know secretary james feel strongly about this. All our leaders do. Accountability is key to everything. It is critical. Andcould have the structure process and resources but if you do not have accountability, it will unwind. Who is holding responsible positions, and by the way this cuts across lines, it is not just the Nuclear Enterprise, it is all the institution,who hold responsible positions, are accountable and will be held accountable and we will continue to make adjustments where we need to make them. David . We are told one of the things that the panels found was situation in which there was one toy of a wrench needed attach warheads to the muscles. Missiles at50 three bases. And if it is, how did they manage with just one wrench. It is true. David, it is indicative, of whatepth and width has happened over the last few years. As i said in my statement, a lack of focus, little attention to some of it wasntific areas, just resources. Partly, it is cultural. People taking the eyethier eye off the ball. It is important to note that this did not affect the safety of the weapon. About delivery platforms as opposed to nuclear war heads. Point is exactly right. It is refined in and indicative of a system that has been allowed to kind of slowly back down hill. As a result of the intense reviews, internal and external, is kinds of things come out. How did they do it . They did it by federal expressing the one each base. There were creative and inventive and they made it work. Hat is not the way to do it we now have a wrench for each location and theyre going to have two for each location. One followup question. Everyone is asking. What happened to your cheek . Well, i had an incident with the cabinet door. I know it is not an exciting story. Depends on the audience as to what i tell people. I thought over the years, it is always better to tell the truth. That is what happened. I engaged the corner of the cabinet in my kitchen and it did not not well for me. But it is going to be all right, no stitches and it all heels. But i have had more bandages on my face in my career and have been in tougher spots. [laughter] im sorry not to make it more interesting. Melly, general doves happenedsked me what and said it was not interesting. One more question. Over the years, we have heard similar words from your predecessors. Had you conveyed to the American Public that this time will be different . Heard, werehave going to make the internetthe Nuclear Enterprise. Is it because we have been at war and officials have been diverted . How can you explain that this will be different this time . I think it is all the things you mentioned in the number of things i mentioned in my statement. Lets start with what this enterprise has been focused on mainly for the last 13 years. Two large grantors. Wars. Nd when you have that situation, when america has been at war and had large numbers of troops commitments in those two wars, when a nation is at war, that is a focus. That is not the only reason, i think, that this is Nuclear Enterprise has been allowed to it isownhill little bit. Not paying attention where we should have in some areas. Upon whom weple, paths aref career blocked or seen as not conducive and we are young people with a lot of focus and commitment, where they want to go with their lives and commitments, if they see that not as a very attractive way, affect where we are. The good news about this, there has been no nuclear exchange. In the world. That is the whole point of deterrence tiered that is the reason this triad system is so critical for our security. I think there has been a nationallyi think there has been nationally a sense of taking it for granted. So what . There is not going to be a nuclear exchange. The big problem is what is going on in the middle east, africa, al qaeda, that is the threat to america. Yes, that is the threat to america, it still is. We have ball. I eye off the think this is the right time to have this assessment and review. The seriousness of this issue has always been there. I do not think anyone has diminished the seriousness of a nuclear threat. The good news is, there is nothing here that we cannot fix. The good news is, none of this endangereddhas americans are put our security at risk. That is all good news. That if we cannot Pay Attention to this, six this, eventually, it will get to a point where there will be questions about our security. It is not unlike institutions in life and the world. We have so much going on in the world. A convergence of challenges and threats in the world. All you need to do, your Business Records every moment of every day. It is coming at us at once. We have to manage it. We cant lose sight of the longterm. Same time we managed through the crises and we leave through coalitions and other means, but we cannot take our eye off the ball of longerterm issues and challenges to keep this institution strong. It is important