We hope the numbers of would grow. There are 16 airports operating through this program. Thank you for your time. Dan, it theave author. About the book and other issues concerning politics. We are taking a look at this. We will look at the governor. We will have an interview with the courier journal. This takes place. Then they will also talk about the fancy political picnic that takes part in kentucky. This is the chairman of the nga. He will join us at 9 00. Begins at 7 00 in the morning. The summer meeting takes place again in milwaukee. The activity is set to start shortly. D kumar sees on cspan starting momentarily. Eu can see these on cspan starting momentarily. We are live this morning on cspan. We are here at the wisconsin sensor a couple of blocks west of the Milwaukee River appeared governors are gathering here throughout a week and. Livell breed bringing you coverage. They are supposed to start a couple of minutes ago. They are getting things together. We will be hearing from the governors about infrastructure. Anthony fox will be on the panel as well as the as the chair of the house transportation committee. We are going to be taking your calls after that and then a true 30 p. M. Eastern panel. We will be talking about how states are integrating into the local economy. Awill have a panel bowl cannot 12 15 p. M. We will be joining the governors tomorrow at 12 15 p. M. By thears gathering governor of delaware. They will be here this morning. Years nga nga,s scott walker. This is in his home state. Neil abercrombie of hawaii took place in the healthcare panel. If you miss you can find it online. Govnors are gathering. Well also hear from the the chair of the house transportation committee. He will be speaking after the presentation. At 2 30 p. M. Eastern the roundtablell hold a on states immigrating into the Global Economy and them one last panel on cyber security. Then tonight the u. S. Senate candidates will be at the fancy farm picnic. E will show you that tonights just waiting for the governors to get underway here with their first panel of the day on infrastructure. Infrastructure. Back ask everyone in the sit. Please seat please take your seats around the table. Thank you. We will be hearing about infrastructure this morning on this first session. Anthony fox is expected to speak as well as the chair of the house transportation committee, bill shuster. E will take this another session this evening about states integrating into the Global Economy. I am the governor of south dakota and the National Resources committee. It is my pleasure to chair this meeting this morning. I hope everyone enjoys their night at Harley Davidson as much as i did. Paint ont leave much the asphalt. That is the good part. Hank you for arranging that it was a great time. I am glad to see my friend. It will be 125 years since south dakota and north dakota became states. Both north dakota and south dakota will be celebrating our 125th anniversary this year. I want to take this opportunity in the celebrations from anniversaries. You always have this. And south dakota we went to our shores and department and they aeated a 125 and size of circle with ribbons off. Logo. Ated our loca north dakota has offered to take suggestions for their one 25th year i have a suggestion. Wife drafted up for me i do not like being ambushed. I found it at walgreens. It is in the form of a tshirt but i think it can be reduced and put on nice materials. It says south dakota, carrying north dakota since 1989. [laughter] if you will please step forward. This calls for direct retaliation immediately. Were going to develop a t shirt tshirt and wait until ours. Til you see hour i will not be needing that. Im nothing to do but call the meeting to order. There is the Economic Resource committee. Unfortunately, some governors are unable to join us. I am honored to be joined by governor jay nixon is a member of the Commerce Committee to help facilitate this session. Avid is here to my left he leads after the National Resources committee. Please leave after them if you want copies. I want to remind everyone to please pitcher phones on vibrate. I will do that myself. Thank you. Today were going to hear from two distinct panelists. They will be invited to ask questions. Lets get started. Infrastructure is in many ways a back own. Connectionnd the between roads and privilege, locks, dams, and they serve. This annex us. This requires a National Commitment. We are here today to review National Policy on infrastructure both in terms of surface transportation and our Water Resources and have intergovernmental partnerships to meet the needs of our modern economy. This is by no means an easy task. They recently gave the United States infrastructure a d rating. They warned that if Investments Continue to lag behind current needs, the u. S. Economy could face 122 really 120 trillion in lost jobs. Uncertainty at the federal level has only exacerbated this deficit. Our states are finding new and innovative ways to address the challenges we face. Other states have advanced public write it harder ships to complement funding. This is not negate the need for this. Upon fruitful intergovernmental partnerships on sharedrate resources. That is why the Commerce Committee has been dedicated to the task of preserving innovative funding including tools like Public Private partnerships. And safeguarding tax exempt bonds. It is totally in the purview of the federal government. The waterhorized by Resource Development act. They require meaningful engagement with the federal entities that drive project approval and maintenance. This unique relationship was a driving force between be Natural Resources committee. A guides them to the Water Resources act. The principles outlined the recommendations for a federal state partnership and Water Resources development. Forllmark is our call increased coordination. Particularly in the states where projects are located. This has not been authorized since 2000 and 2007. It is my hope that congress can finish the work of passing a bill that moves forward with the project authorizations and modernizes the core relationship with governors. A National Commitment to bring this into a state of good repair with not only strengthen our competitiveness but will help us meet the goals of reduced congestion and the environmental sustainability. I would like to turn things over to governor next and for his remarks. Thank you. Thank you for your leadership this year. Of the finer all work theyre doing. Thank you for the incredible hot tablets he. It is the best beer state. The second best beer states. Excuse me. We can do a lot of things here. I get my picture taken with a miller beer it is the most dangerous thing that could occur. He is taking care of me. Really workt though, doesnt it . Anyway. The joint session was an important one. Ive got the mark microphone. We have been busy. Thisll be a great opportunity to explore the challenges that that lie ahead. Were trying to show you helpful get along. Know you feel that way we want businesses to go back to your brother and washington, dc dc how we can argue about things as important as were and do so in a positive vein for our country . We share the concerns for the state of our infrastructure. We agree that partnerships are exchanging important. E are ready to do that were doing a lot of things. We have a nation six largest highway system. This has been identified as a key part of our Strategic Plan for the future. It is all connect it. Not justindustry does use new vehicles over the road but by a rail. This is often transferred to why an integrated solution is essential. This cannot be fixed with a one time investment. We reduce this by a half a billion. We have completed the largest bridge Improvement Plan in our history. Just last week had had the opportunity to stand on the deck of a new bridge over the mississippi river, 16 feet board to go. I could watch this go down the nations greatest river. Theas an awesome view. People that we serve know that we need to build the next great bridges and maintain the futures that all americans drive on. Were tremendously honored. We want to hear from our first guest here, congressman bill shuster. He oversees house action on all the transportation including maritime, highway, mass transit, and railroad. Obeying hiss is ninth Congressional District and has searched on the committee since his first election to congress in 2000 one. Welcome. Thank you very much. Great examplet that i can take back to washington as to how the parties can Work Together. We need a good example. I really appreciate the opportunity to be here. At every state i have been to this is my first visit to wisconsin. Penn state is going to prevail this year. I look at a couple of other governors. Thosek forward to engagements. It is an opportunity for me to engage with governors. Have traveled around the country, seeing what other states are doing the federal government should be looking to you to get the ideas that you are implementing. Example ofur putting those dollars into infrastructure. It is something we need to do more and more at the federal level. The federal government needs to be assisting. The best thing is to get out of your way seek in these forward. And traveled the country salt time and time again how states can move things very quickly. Government makes projects cost more. That is not what we want to do. I will talk about the funding. Time is money. If we can reduce these objects by half or a quarter, that saves money. Her state and sell the crosstown expressway. It took 15 years to build 680 million. 10 from inflation alone is or 12 . A tremendous savings we can use to invest in that. He could understand the save, Transportation System. All of us working together from the local and federal government making this what it has been throughout our history. We can continue to make those investments and make sure the stakeholders are involved as we move forward with policies that are able to drive the system. Transportation is important. When i come into a room like this and they look over the crowd, everybody here has today affected by the Transportation System. In louisiana talking to a manufacturer of our masuda goals, he told me were the most important things was getting those things from the market. He stopped. I can pull this out. I said im in the transportation business. We are all in a transportation business. We have to get the serial in the milk out in the morning. She was touched by the system. It will cost more for the milk. T impacts us all good progress. I think there are some very good reforms. We are still slowly getting the information. Secretary fox will be here later today. I am encouraged. We had dinner the other night. I didnt know was several republicans. We had a great conversation. I look forward to it i did. It is always a positive thing. Sometimes you have to leave politics at the door and get things done. Im sure you will appreciate with the signature has to say. They gave us a poor grade. We are at a point where we have got to figure out how to do this anyway that keeps us competitive in the world. There is a federal role. Working with the state and the local governments. When you look after our our history, it is lost on some folk that the articles of confederation failed for a lot of reasons. The breaking point was the transportation issue. They cannot navigate the Potomac River and into the ohio territory. They realize if we are not able to move our goods and connect our nation we are not going to be a nation. When they went back to draw up the constitution, they talk about commerce and establishing the roads. He said something that is lost sometimes in the debate. That is government should provide three things for the will, security, maintain justice and maintain security. That is good for all of the people. As he moved forward and as we have moved forward through this country, whether it is the Transcontinental Railroad or the highway system, those were all significant works that brought this country together that made this country which i we had it is the giant today. We had a Transportation System that has physically connected this nation. We need to me forward with something. It needs to be on a bipartisan basis. That have beens bipartisan. Transportation is one of them. We are making sure we give you more flexibility. It is essential. Our committee has mentioned the development act. Ready to mark it up in september and has an floor action in october. The senate has artie passed their version of it. Weve learned a lot from watching the senate to go through that. We worked closely. We met with members of congress on both sides of the aisle. We have a bipartisan project that puts the number on the committee and said committee. When a number of stakeholders. I cannot distinguish between a republican and democrat because they have the same kind of complaints about not having bringing themr having more influence in the process. That is a big reason we are able to have that. There are significant reforms. I think the state will be encouraged by what they have to say. It is about trade and jobs. Certainly you are going to get locks. N you a rebuilding jobs. Are shortterm if you look at the trade in the next few years it will double and then double again. These are good jobs for americans. They cannot export their goods if it is not an efficient system. It will not be competitive. This is a jobs bill. On thets hard deadlines time and cost of studies. They do not pass it up the line. We have concurrent reviews. Were she mining the review process. Tll be a responsible though we are authorizing programs that have been authorized over the past 40 or 50 years. They will not continue to build this massive backlog. Were looking at some of the smaller underserved perks. We need to make the investmentt. It maximizes the ability to contribute their own funds. Miami has had their money in the do this for about three or four years. Have theot authorization. This extensibility. People want to put this into the mix. It can accelerate things. First word that has no air marks. There are projects in it. This would be the first word. Thisll have a new process. States states will be involved early on in this. There is a lot of positive things in the senate bill. After they passed the word there will be the corps of engineers. The congress has to authorize these projects. This is one of the things i am adamant about. The word is on its way. This is very difficult to do. I believe there needs to be a passage to rail system. There are some that may not be a great ideas but there are places we need to focus on to get it done. I do not live long in the northeast quarter quarter were. That makes it should be the place the focus is that we own the lines there. The other thing is you have 18 of our population living on 3 of our land mass where it there to get them. Y we need toething take a serious look at. The most congested airspace is above the north these core door. 70 of all that are delayed or ofceled occur because interaction with the northeast corridor. Bringing the private sector to her in. The ridershipn, has grown. There is a significant reforms that needs to take place in the operation. We will continue to work across the aisle. It is made up of several state. Especially if they are putting their money into the system. When we have a divided we are figuring out the solutions together. We will be working on reauthorization of map 2001 matt 21. How do we find it . We need to consider everything that is out there. These dollars in we are looking at that. I know the house is committed to doingeform. They are looking at these types of rings. The senate is committed to doing tax reform. Encouraging our brother and over there to move on a lot of these tax reforms. Know aviation oversight is important to many of your states. I think they are finally right size. As he me forward we need figure out a policy to encourage the Airline Industry to continue to work i make these investments. Money. Not take theyre making the profits to jive that back in without government support. Finally, i come to you today to ask for your help. Certainly i cannot do it alone. Not only learn from what you do but to help us engage your constituencies to the importance of this. Everyone one of you mentioned infrastructure. It is the act phone of the economy. We are needing you to help explain to them the importance of moving a transportation bill. It is good for the business. It is to advocate for the transportation bill. Working with groups like that, there is another one that has been formed in washington. Mary peters who is here at us today has an very much an advocate of americas Infrastructure Alliance that ,as an funded by the airlines water transportation, put this together to form the alliance to advocate and put the American People. You do not understand the importance of the waterway system. Making sure the American People understand that is important. It is a big effort. Were all going to need to pitch in and make sure we are involved in this for. An absolutely Critical Role in moving this agenda forward. Congress needs to hear from you. I believe we can have success. We will be able to do what is necessary to keep this country in a competitive state. If you have places like brazil they want to drive down the. Ost these are the kind that competitive situations that are occurring out there. They have signed a deal that they will not go through the panama canal. The world is getting smaller. We have to remain competitive. Area. K this is a vital i appreciate the opportunity. Thank you very much. [no audio] [applause] thank you very much. Lets open up to questions. Thank you very much for joining us. I to officially welcome you to the home of the last three years champions. I am sure we will have fun with that as well. I do not even mention the 45th super bowl. We appreciate your being here. We appreciate your commitment. And rotationat advocate. He has a harley in washington. It all revolves around harley one way or another. First off, he mentioned the inks on highway 31 to enter state. Isunderstand transportation not just about transportation. In our state we think about transportation. E think about agriculture. E think about manufacturing we think about all of the core industries. Even the things about beer, oftentimes it is not just about competing among brands. It is about competing to see which grew grew reaching get a arbor. Er on the the zoo interchange is just on the way. Area. O have a great we have a transit center. Oneave the airport which is of the fastestgrowing airports in the past decade. S toe are all vital link our data. I appreciate the focus. These are one of the few areas where you do that. This is really outstanding. Thank you. I would like to properly was auce a governor she former chairman of the National Governors association. It is from north dakota. , please stand. Thank you. Its good to see you. I guess less is saved apologies. I just want to thank you for being here. Just one question about how this will progress. There are times when politics entered into the debate. It has been delayed. In a state like ours were we have had several Natural Disasters in the last few years, we are in tremendous need of getting some flood protection objects moving forward. We desperately need a couple of projects to be authorized. We can get through the political challenges. One little problem for us with couplel is there are a of situations where we do need a reconnaissance study and to look at the entire roberval a chain. Nice to be analyzed by the court of engineers. The answer to us that there is no such thing as a new project. One easy way of holding down spending as to never authorize anything new. It is not really progressive when it comes to managing the nations infrastructure. I hope that somehow, someway there can be such a thing as a studyasibi occasionally for a new project. Cautiously optimistic. They have moved this along the way. We watched the bill go through. Able toident we will be move this into confidence. Great thirst and hunger to get this bill. Is tof what i want to do start on the next bill. We should be going through and looking what this brings us and through a process. Every year if we have to be. I know there are studies out there that need to be done, especially after you have a Natural Disaster with the flooding. Our goal is to not only get this out but to get this on the next word of though. Thank you. Thank you for being with us. It is good to see you again. I think most of us recognize how important the interstate freeway system has been. We came together as a country and connected ourselves for better accessibility. It helps our economy. It has been a godsend. They use federal dollars to do that. They made the, unnecessary regulations. Is attached to the utilization of the money. They can build better roads for less money. They suggested they could do or 25 less money. We understand the need for a count ability and oversight. Are we over regulating to point that it has cost us money. Ive talked to every smart person i can in the United States and around the world to get a number to put on that. Just on interest alone it would be 8 or 10 . They were a mile apart. We are using state and local. Oney only it is completed when we were there. The other bridge was identical. Going to cost between 1. 21 . 3 million. They are still going through this. They are chine to get the federal agencies to get this. It can be problematic. Youre absolutely right. It was enlightening to me. This putting a lot of resources into the structure. Let us help you understand some of the challenges we face. They have a hearing and say give us your suggestion. We had hearings and roundtable discussions. We could get there and put into it. They are more formal. This has been very helpful to us. Thank you. My former colleague. We appreciate you coming to join us in a couple things i want to mention. A couple of things i see on the backside. There are rules and regulations. There are the projects. It is getting a bill. This is the time it takes to get those studies done. They do not have the money to do this on some Major Projects for Economic Development. There have been studies that have been done around the lake. Into this new one. Some flexibility would occur. You can encourage them to work. They can create jobs and investments versus taking two years. Sees one of the things i on the back side of it. I appreciate this. This may have happened during the time when you have it here. A barge hit it. We were able to work years ago to create teams and get some waivers. It has some leewayhroughome ivers highway administration. To be done faster. Anytime we can allow the states flexibility the better for all of us. , i know youbreak work very hard when youre on these rates. There are these big jet negotiations. Theyre talking about shutting down the federal government. It creates insurgency in the states. There is a delay making decisions about creating new jobs. The insurgency that you have in washington. It is the local economies. Is thethe things uncertainty does not allow us to plan out in our hiring practices and building practices, not knowing whether the money will be there. This is something i here for my constituents all the time. It is a big problem. As far as streamlining map 21, we did. We did that. They are trying to streamline this. They are constantly dredging those rivers. They had to do a threeyear study. They have quadrupled over the last couple of years. It has to be maddening to you when you see your precious tax dollars in squandered on endless studies. You have representatives. Feel free to contact us. Us if we can be of help. Think we are going to have to move along. We have another guest speaker that we need to give respect to. We have let the question go on a little bit beyond our allocated time. I appreciate your understanding. Thank you, mr. Secretary, mr. Chairman, for being present. Thank you all for your good questions. We appreciate your presence. [applause] p me with. Too many things i need good morning. Our second speaker will be the honorable anthony foxx, secretary of the department of transportation. He was sworn in july 2, 2013. He served as the mayor of charlotte from 2009 to 2013. He served two thomas on the Charlotte City council. This is a lively, bipartisan strong group. I cannot want to take more time in to your introduction. Secretary foxx, i want to thank you for honoring us with your presence. Thank you, governor. I want to thank the National Governors association, the chairs in particular. I also want to pay respects to the home state governor, governor walker. Thank you for hosting this wonderful group. I also want to thank governor governor daugaard governor governor daugaard for posting this event. Event. Ing this you know that transportation is more than the asphalt we pay for the train to rebuild. Transportation is a bridge to the opportunity. Is the highwayinsurance it is a highway that insures that a mom gets our kids home safely. It is the freight or the cargo ship that exports American Goods around the world. Transportation moves america forward. Highways,ild bridges, transit systems, airports, and ports, we are putting our people to work in helping businesses expand. Most importantly, we are giving the next generation the tools to compete. Gatea look of the golden bridge or the hoover dam or the Transcontinental Railroads. These are stumbles of americas grit and innovation. Those things were not built by us. They were built by previous generations and have been bequeathed to us. To anothere bequeath generation . The generations before us believe in a Better Future for the next generation. While finding is tight, i believe we can still build a great things as a country. President o answer obamas call to give the middle class a better bargain. We can ensure that the rungs on the the ladder of opportunity are not so far apart. This is the challenge of our regeneration and we must work lines,r across political across state, federal, local lines to address it. As secretary of transportation, my priority is to make our Transportation System the safest and most efficient in the world. We will continue to work hard so that americans feel safe when they get into a car, get on a bus, board a plane or get on a bicycle. We will be working with our partners to get more from what we have so that taxpayers can trust us to make smart investments. Efficiency enough is not going to get us to prosperity. Over the long term, we have got to be more creative. E have got to Work Together as you know, we have a lot of options in our toolbox and even more options we need to put on the table. We have seen how publicprivate partnerships can kickstart important projects, such as the ork district in minnesota. Inre has been 48 billion Infrastructure Investment across america in places like illinois, california, and texas the we have seen our Financing Loan Program helped denver, colorado finance their railroads station. Those projects would not have been possible without leadership that the state and local level. Frankly, governors can make it happen. Factor. The x you are the difference between a tahrir rating road and a 21st century highway that is road and a 21st century highway that is safe and efficient. I can tell you after meeting with members of congress on both sides of the aisle, they agree. The hard part is agreeing on a. Ay to fund these needs. 21 was a good start. It provided states with 8 years of funding. 2 years states with of funding. It gave people a better value money byr mining institutionalizing best practices and allowing them to work faster and smarter. Expires next september. We are facing longterm deficits. The way we have been doing business is not sustainable. I do not have to tell you. Many are already looking at innovative ways to find your own transportation needs. This year, half of all state legislatures have considered or approved measures dealing with transportation funding. 14 states have discussed raising their fuel taxes. Several have moved to protect transportation funding from fundingraided from being raided for general expenses. Citizens have come together to figure out commonsense ways to address our transportation needs. Governomall in of maryland. They found they were driving on roads that were congested and deteriorated and its cost maryland residents 6. 20 billion a year. Longeste has the average daily commute in america and his constituents could not afford more time spent in traffic. Thanks to his leadership, maryland will be able to a invest 4 billion in infrastructure over the next six years. In all of these states, we are not looking at infrastructure and through a partisan lands. They are looking at crowded ands, congested highways train stations. They are lookingt potholes and bridges that are so old they could qualify for medicarthey as that need 21st century infrastructure to grow. When it comes to transportation, everything we do has a impact and requires local cooperation. I know that from experience. I worked with republicans and democrats as a mayor to address these challenges facing our cities. Time after time, we put aside our differences to do what was right for our constituents. I know that you do the same in your states. Today, i am reaching out to you. I want to hear your ideas and know how you would prioritize projects in your states. How you organize transportation needs. The American People are counting on all was to lead and make critical investments to move this country forward. I believe we can start by answering president obamas called for another bargained for the middleclass. His proposal would invest 50 billion in our nations infrastructure with 40 billion target for the areas of greatest need. Leverage private sector investments to help communities take on infrastructure for the 21st century. That is what we need to build a strong america. As we work to make the president s vision a reality, i hope what we do will serve as an example of how our congress can come together to help our nations infrastructure. Lets come together. Less and less in the future. Lets build transportation that works and is second to none. I am happy to answer your questions. Thank you. [applause] thank you, mr. Secretary. Lets open it up for questions. Governor . Thank you for comment, mr. Secretary. At local level and the state level in illinois, we have invested 14 billion for transportation. Artful way is 12 billion. Is 12 billion. Doing highspeed rail from chicago to st. Louis. We are grateful to you in the president for your commitment to transportation. Just recently, we are just about finished with a bridge from east st. Louis to st. Louis called the stan musial memorial bridge. We would like you to come and you can see all of america from that bridge. It was done with a 26 minority work force. We worked with the federal government and it is a good symbol of what you just said. We have to make sure america knows that when we invest in infrastructure and bridges, we are putting people to work in helping our businesses expand. I will try to make it. It sounds like a good thing to do. I was in st. Louis yesterday. To your point, i was there to break ground on a project. It is of incredible importance to st. Louis. They are capping a freeway that sits in the downtown area and the st. Louis arch. We put 20 million into getting that done. A 380 million public and private investment to get the work done. What it points out is what you just said. When we make the investment, it does have a return on investment and it improves communities. It improves mobility and it makes people safer. I look forward to being there. That thed note project would allow you to what all the way to the train station to the stadium to watch the cardinals play. It is an unbelievably transform into a project that would not have been possible. Those of you who have been to the arch, we have literally dropped the highway and build a park over the top of it. It is going to be dramatic. We are coming up on the 50th anniversary of the arch. The cooperation between the park service and the state of illinois and everybody is incredible, the amount of private dollars that have been small amount of federal and state dollars. Thank you very much. Governor walter . I have a question. Is not with us right now. He will be with us to launch a different discussion. Governor quinn and i just had a groundbreaking for a similar issue, the river crossing. Lines,y crossing state but across the st. Clair river. 30year process, getting the approval to do that bridge, which is 60 years past its expectancy. Its expectancy. We will let you know about the Ribbon Cutting for that. You talked about economic impact. A question for you that you do not have to answer now. In addition to hosting all of these wonderful governors, i andat to be experimental aviation association. It started in 1953 in the wisconsin. Visitors for00,000 one week in wisconsin. It becomes the busiest air Traffic Control center in the world. It has about 110 million in impact in that region. Air traffices with control components, they picked up most of the costs, about 500,000 of that. There is an economic impact. Here, i would ask if you would take a look at that. For them, it is a major impact. There are eaa chapters all across america. It is an incredibly important component. It has a huge economic impact. Thank you very much. Hello to you, mr. Secretary. Aloha. I just had an opportunity to say hello to my friends, bill shuster my friend, bill shuster. You are a friend of ray lahood. I bring that up to say that the governor and myself and people have distinctray philosophical orientations as members of congress. I think i can say without reservation that we are pretty missionoriented, particularly the transportation committee. We maye arrived have had Different Reasons and different motivations for voting the way we did. We move in the end to get the vote done on the basis of the project in the proposals that were in front of us. Because i forward would like to know from you, in the wake of chairman rogers skepticism probably the wrong word that the spending goals, while they may have had their difficulties and challenges getting past in thereof authorization, has been a lot of fighting over the numbers there has not been a lot of fighting over the numbers once they are agreed to. There were numbers within that sequestration figure that had been agreed to. I understand what has taken place is that even though there was an agreement, hands were shaking, deals were made. I do not say that in a pejorative sense. Some of the members in the Congress Wants to cut it further even though there has already been an agreement. My question to you is, are you aware of what this is . I assume other governors here are doing what we are doing. I have the Sequestration Task force. Nonpartisan. I have business, labor, nonprofit, Construction Companies in it. Paving companies, everything in it. I was working under the assumption that sequestration was sequestration and we would not weep bitter teras about it. If they are going to 0 tears about it. If they are going to change the numbers, it is really going to mess us up. Thehave any idea that if sequestration numbers change, what are they going to change. I am trying to put my budget together. I am not want to argue or throw darts or rocks at anybody. I just want to know what the numbers are. Question,ou for the governor. , whol refer to be chairman is on the legislative branch in terms of what the internal discussions and working have been. My understanding is that on the house side, in the process of working through what had been previously agreed upon budget they started to move a they areugh, concerned about the impact of those caps. What i have heard and read is that they will come back in the fall and see if they can come back to the table with something on the house side. A similar exercise occurred on the senate side. Beyondate bill was sequestration lovells. Was the senate bill beyond sequestration levels. We, at the department, felt better about the senate bill. Sequestration is a blunt instrument. Pham and arithmetic perspective, an places the with from arithmetic perspective, it places caps and makes it difficult for us to accomplish the goals we have for our country across a variety of fronts. A growingere is sense that there is a need to relook at it. You do not have any idea of what the numbers are or some of the projects. I can live with it. With i am saying to you is that the situation is obviously very fluid. Happen toartment, we be ready for just about anything. Thank you, mr. Secretary. We are honored to have you with us. Most governors recognize how important transportation is to their success in their states. Elected official, you understand that. It is Economic Development and the ability to expand economically. Havee state of utah, we stepped up our commitment to transportation in a significant way. We have put 500 more state money into state highways, roads, and into a augmenting the state system. We just completed 15 miles of interstate 15, expanding the lanes. Pacity, hov we did it all without federal dollars. We are trying to put our resources where we think they need to be in the infrastructure and road building. I would like to ask you the same question i asked chairman bill shuster. I had a group of contractors i met with a few months back. The build a lot of roads in western part of the United States. In their laments to me was the fact that they believe regulations coming to the federal from the federal government are burdensome and counterproductive and the there are too many Strings Attached to the federal dollars and it is inhibiting them from building roads in the most efficient and effective way possible. They said they could build roads better for 25 less if there is regulation reform. I would like to have you respond to that issue and if that is something that is being addressed in your area of responsibility. Do we have too many regulations getting in the way of effective, efficient, and costeffective Road Construction . That is a great question. Thank you for asking it. I havethe first acts taken as transportation secretary is a notice of rule making that pertains to truckers. Right now, if a truck driver is running a route, they have to inspectthey picked the vehicle d have to do it again when they return it. They are required to submit a piece of paper each time they do that. We have found that 95 of the time there is no problem with the vehicle. The paper work is being submitted to say there is no problem with the vehicle. We have made its proposed rule that eliminates the need to file that piece of paper. There will still be an inspection, but we do not need to be told the vehicle is ok if it is ok. We expect that rule will save the Trucking Industry 1. 70 billion. Say to you at the outset is that i am interested in ways that we can streamline and make more efficient our Transportation System as long as we are not compromising safety. Ofm interested in your list any potential changes to our rules, regulations that you think will help us make the system more efficient. Ofave been talking to a few your colleagues, governor malloy in connecticut, who has a big bridge project that is coming in budget andlion under ahead of schedule. In transportation, time is money. If we can speed things along, i want us to do it. We have an internal initiative and map 21 allows us to look at streamlining in a big way. If you have ideas about regulation, i am interesting in partnering with you the buti am interested in partnering with you to make things run better i am is interested in partnering with you to make things run better. Thank you forfoxx, joining us. I am glad you have experience working for a political subdivision. It is a good perspective for you to bring to your job. Question is on the problem of certainty of funding for states. In north dakota, we need more transportation money just like everybody else. Even a bigger problem for us is the sixth month authorization, the six month funding periods clouds us a lot of problems where construction season cause us a lot of problems with the construction season is extremely seasonal. Can you work with congress to try to create more predictability of the cash flow . Or at least a 12 month period or at least some kind of base certainty with the possibility of some enhancement later. Projects with a federal share of less we know that money absolutely, for sure is forthcoming. The way it has been going in the last few years, we literally have to wait until the last set be sure we have the money for a bid. The more lead time we give these contractors, the better the business that we get. All of us money if we had some sense for at least a 12 month period of what is coming. Thank you for the comment, governor. I could not agree with you more. There is a substantial need for all of our stakeholders in the Transportation Industry for ofgterm look outs in terms budgeting and Funding Availability and instability within the system. Also say to that is we have to see transportation in the context of what is happening globally, which is that the while i think American Workers are the best workers in the world, while i think we have the best infrastructure in the world, we have a world that is quickly trying to catch up to us. We cannot afford to wait to create the 21st century infrastructure that is going to make this country continue to achieve our goals economically. I havent strong belief that there is a bipartisan understanding of that i have a strong belief that there is a bipartisan bipartisan understanding of that. It is so important, not only to us, but also important to our children that we figure out a way forward that helps this country compete. We appreciate the historic nature of your appearance here in your first significant address. We appreciate the symbolism and the reality of that relationship. Also your comments in talking historically of the things we have done over the last 100 years. The primary message of funding fundings a method of our roads, from healed taxes. Field taxes. Tenurebeginning of your as the secretary of transportation and as you look at states and you begin your tenure, what sort of longerterm advice to you have about the discussion we need to have about what the form of the income line is . We not only talk about timing, but we invented a system where cars got 10 miles a gallon and now they get 40. We have the Trucking Industry that is getting ready to switch to natural gas. Right sit where you are now, what advice to you have for us about helping to lead a National Discussion about how we transition the funding models into the future the same Way Technology is shifting the way people moving to the future. It is a great question. A couple of points. We are seeing activity in the state and local governments already today. You go through measures and fuel taxes, there are taxes that have been under discussion. We want to understand what the sentiment is at the local and state levels as it relates to these different alternatives. There is no question that we have a structural funding problem. The magnitude of it is not lost on me. We have also got some shorter term fiscal issues that also need to get undressed. Dressed. We will be looking across a range of different options. We will be looking to congress a lot on this. You can have the greatest idea in the world. If it has no chance of making it through, it is almost moot. I think we have got a lot of work to do with capitol hill on this question. We are seeing in states and local government a lot of things that are encouraging in terms of leadership being willing to step forward, and also citizens actually getting it and supporting some of the measures put out there in the states. Thank you, mr. Secretary for being with us and speaking so clearly to the issue. Forso want to thank you coming to connecticut as your first visit as secretary. I have been in government a long time, as a parttimer, a full time, a mayor, a governor. I have never seen an environment sustained as long as this one. Although we might reasonably expect different monetary policies and Interest Rates will go up, they will probably go up in historical terms relatively slowly. At least before they get back to the norms. There seems to be this incredible disconnect. Sayalk about what people could save money if we change rules and regulations. Every governor has had that discussion. What clearly is missing i know the chairman mention this this lack of inflation in construction is an Incredible Opportunity that we have and that we are absolutely missing taking advantage of. You referenced a 2. 50 billion project that has been underway for a number of years that is well in excess of 2 million under budget and ahead of time. We can get the resources on the spot that we need to complete the project. The environment is so incredibly progovernment at the moment. The question i have not for you, but for my fellow governors are we doing everything we can to see common sense prevail on the issue of transportation in this nation . Democratic and republican congressman come back from trips to china and elsewhere and marvel at the state of the infrastructure in the countries they visited, marvel at how fast trains move in china, marvel at the rate in which new train stations are built. In a financial in climate where we could bring those projects online in connecticut and in all our states a reasonable Cost Effective way, we are squandering our opportunity. Is anything else we could do to be heard on this issue . Bipartisan voice that is so seldom heard in washington on this issue . Does anyone care to respond to that . You want a response, governor . Mentioned common sense. I do not know if that is something that is always in the political arena, unfortunately. In utah, we have increased of spending by 500 . Opportunity. The fortunately, we have been in a fiscal position to do that. We have limitations in our volume capacity. We do 85 of that. If we have an emergency where we have to borrow money, we can do that. We use cash and carry and we also have Road Construction that has binding needs. We are taking advantage of what you said. Has bonding needs. Helping standpoint of the private sector do what they do, they need to get to point a to point b. If they cannot do that, they will find somewhere else to grow their businesses. Ways, doing it in prudent which is kind of the utah way. I want to add another point on this question of how we pay for infrastructure. Two other points to get back to the governors question. We have to look at the cost structure of projects themselves. The way we build projects in old country is like an pipe. We do not often go back and reflect on how we can make that process moves faster. There are modular pieces that have allowed entire bridges to be in place over a weekend. It ou say that a day, when you save a day, it saves money. We can also look at ways we can make the pipeline move faster by working with the Construction Industry. Is the Public Private partnership opportunities. You all know as well as anyone contour and that kind of partnership can be. We are seeing projects across this country that are being put seeingr and we are experimentation with infrastructure banks acrosecoun. That is another piece of the equation. I would only put an asterisk by public by the private partnership by saying this. The be projects that will not be good candidates for publicprivate partnerships because they do not spin off or do not have the pottial to spin off revenues. I do not wante irrational exuberance about them. They are a critical piece of th. If there are ways we can make them happen, we should be doing it. Thank you for being here. We appreciate you joining us for your first meeting. You have been a former mayor so you know the challenges of infrastructure projects. One thing i want to bring to your attention is that we are a Bipartisan Group that has democrat and republican governors and we actually had an red tapeape nga committee. There were recommendations for ways that we think we can improve the nations infrastructure, the timeliness and Cost Effectiveness. We have different categories from the faa to nasa to trucks come across the Mexican Border to the federal highway endangeredion to species, Environmental Issues we have to face, funding issues. We have followed the suggestions from our governors as to how we can help with the red tape to make things more efficient within the Transportation System. I would like to give this to you. I hope he will consider them. I would definitely consider them. Other questions . We are close to of a scheduled game. I want to thank secretary foxx for making this his first public appearance, or public presentation come to the governors. Thank you, sir. [applause] thank you. Padillas governor birthday today. Happy birthday to you, governor. Is there any further business . If not, the meeting is adjourned. Thank you. Here at the National GovernorsAssociation Meeting being held in milwaukee, the host is Governor Scott walker. The north dakota governor and the south dakota governor opened the session with some jokes back and forth before delving into the bigger issue, and for structure. The federal governments role, a partnership between states. What about your states infrastructure, whether it is roads and bridges or interest internet connectivity, power lines. Our numbers are up on your screen. We have a lot of callers on the line. We will get right to it with maryland. Baltimore, thanderard ater my name is derard. Improving. Ructure is the governor has taken an interest in how our infrastructure will look in the next 20 to 50 years. From observing the meeting of the governors, it is fascinating how all of the governors came together and they were asking questions. It seems as if they were working in a cohesive effort. It looked very bipartisan in how they were very cooperative. One of the things that has fascinated me is that the governors can Work Together like this even though they come from so many different spectrums of ideology. In washington, d. C. , it seems like nothing is done and there is no cooperation. With regard to the effort structure in my state, it is good. Infrastructure nationally, the leadership in d. C. Can take a good example of how the governors Work Together in this session to drive what needs to be done to improve infrastructure in our country. You are right outside d. C. Question you are right outside d. C. How do you think d. C. And maryland Work Together . They Work Together ok. I live in baltimore but i went to school in richmond. Acommuted up and down 95 lot. The region Work Together well but i do not believe it worked together well enough. The competition we have is good. In the areas of education and trying to Work Together in areas of education and crime we have lots of crime that jump state borders and state lines. We need improvement in those areas. Overall, it is ok. We need some improvement in some areas. A lot of that improvement has to do with politics. When we moved beyond parlance partisan politics, we can Work Together better as a region and as a country. Thanks. Theave someone calling on independent line. Go ahead. Thank you for cspan. I was surprised to see at a time when a lot of cities are having trouble with having enough money to spend on things that they need, some of the governors were talking about building more bridges. Years, i have seen two larger bridges collapsed. Perhaps we should start reducing the number of bridges we have our taking some down and giving Small Businesses a chance to grow and new businesses a chance to start up. I do not think they were going about spending their money the right way. We are doing ok here. We have had two bridges built in the area. I am surprise that they did that. I did not think there was a need for it. How would that help Small Businesses . If you have two bridges, it reduces the ecs the ease people have going to the larger store. Instead of going to walmart, there would be a mom and pop store people could go to. The effortat about structure in your state . The infrastructure needs to be updated. What i see here is the cooperation of these governors. It is nice to see the experienced these people want to put together to Work Together. Spirit see here is the of working together in the experience needed to do that and actually governing something. The next time someone wants to be president , maybe they should become a governor first so they can put forward a balanced budget, a foreignpolicy, a jobs program, somebody who has actually done something in government. That would really make a difference in this country. We are watching the governors and their staff wrapped up this first session on infrastructure, talking about infrastructure in different states and how the federal government can help. On theyork, you are independent line. What about infrastructure in new york . We need a lot done. I live in a rural area. There is not enough money. Patchingconstantly them. Our power line is over 60 years old. The winter and spring if there is a storm, we lose power. I am glad all of these governors are talking and cooperating. They need to talk to their representatives. They do not do anything. They put through bills they know will not go anywhere. Havebody knows if we people working on a power grid and on a road and building bridges, there would be jobs for people. Those people have to eat. They have to put gas in their cars. They have to buy equipment. Everybody would benefit. Up in washington they sit there and they go, lets repeal obamacare again. That 40 times. These governors want to get something done, they need to talk to the people they are representing in the state. The article in the hill talks about americas deteriorating infrastructure. The average household loses 3000 jobs 3,000 a year from asdges, power lines, Water Infrastructure becomes less efficient. The American Society of Civil Engineers giving the u. S. A d plus on infrastructure. We will move on and take david s call. You are in vermont. What is infrastructure like for you. I can hear your tv in the background. Withyour tv and go ahead your question. Yes, maam. I know the country does need roads and bridges. Of ohio, theyate are about to build a b by portsmouth that i believe is a waste of money because portsmouth he is that traffic to come within its limits. It does not need to go around or bypass portsmouth. A Welfare Community now. We need traffic to come into our town, pl jobs and so forth. I cannot see bypassing portsmouth can her placing on that money for 16 miles of road. We will get a call from seth in california on the independent line. What is infrastructure like for you . We have crumbling roads. We have leaking sewers systems. We have water lines that are busting all the time. We are dismantling our electricity in the canyon. Our power rates are going up. Our gas is 4. 15 a gallon. We are a mess in california. We are being dismantled by the environmentalism. I suggest we have a national tax for illegal aliens. Thank you. Anne is joining us from pittsburgh. Is it pittsburgh, california . Yes, it is. What i have to say is that we have a lot of American People are out of work at this time. Theow that it is draining welfare system, the Social Security system, or whatever. A lot of them are really willing to work. By the materials first and see how much money you have buy the materials first and see how much money you have to pay people for hundred dollars a four hundred dollars a on food stamps. Enough people are unemployed who are willing to work for less money in america. Why not utilize them . They are just walking the streets receiving money. At what the needs of america are. They need to be fixed. The bridges. On the floor of the senate this week, kentucky senator rand paul proposed cutting randaid cutting off aid to egypt. That amendment was ultimately defeated. That happened this week. You can look back at his comments online. We will move to leonard in florida on the republican line. Go ahead. Yes. Congress need to get their act together. There are infrastructure needs, especially in our state of florida. We have a lot of bridges and those types of things. Our roads are in disrepair. Therer last caller said, happens to be a number of people unemployed. Said they are drawing money. A lot of them are not getting any money. They may be getting food stamps. Their Unemployment Compensation has run out. We do have an infrastructure needs. Wastingans, instead of time talking about voting 40 times to get rid of obamacare, which is already something that is needed, they need to try to get that act together and look at getting money to these states to improve our infrastructure needs. Thank you very much for accepting my call. The next call is joseph calling us from ohio on the democrats line. . Ow is the infrastructure and taxing people. It is like theyre fighting over the busing. They are thinking of getting rid of all their strivers and farming it out to cincinnati. That is kind of stupid. Our infrastructure is falling apart. Everything is under construction around here. For there working are still people who do not have jobs that want jobs. I think they need to get their act together incident being all high and mighty in think they can do anything they want. They need to think about the people. Calls. K you for the if we do not get your phone us on facebook. The conversation continues there. Us. With a lot of interesting conversations happening at this meeting. We will be live again at 2 30 p. M. Eastern time for a conversation with the governors about the local economy. Tonight were going to take you to be fancy farm event in kentucky. The u. S. Candidate will be speaking. Just heard from the governors about infrastructure. Investing in infrastructure was a topic on capitol hill this week. Off paul propose cutting aid to egypt and investing that in american cities. His amendment was defeated. The topic of u. S. Foreign aid to egypt came up during the interview. Lets look at what he had to say about the age. Did a to take place in egypt . Why is that . Is that too wishywashy . The white house has said it is not a queucoup. We cand agreed to agree to disagree. He replaced it by the military. I am just a smalltown lawyer for minds. What we had from vermont. What we have done now in the foreign operations bill, remember we are dealing with some money, provided certain steps to being taken to democracy, and the next part will be allowed if the steps for takinen. Not going to suddenly come back as president. The reality is the military in charge of a certain area does not mean that we have to say you are in port into us here is a blank check. If you want the money you have to follow some specific steps toward the freedom of press and that part of the world here at and a restoration of democracy. A round form policy. I am sorry im curious if you see to close one, mo . This would have been close today. They bring them into our federal courts. Come back from where they are never escape. With senator leahy tomorrow. That is sunday at 10 00 p. M. You can tune in right here on c span. What are the milestone years of first ladies their history . Mrs. Would certainly say adams, the first to live in the white house. A very capable lady. On a more social side, Dolly Madison and the drama of the burning of the house. Then you have other first ladies were there really arent many first ladies. Would take it up from there to harriet lane. Everyone would remember some of thatld pil people clearing saying it was the grandest white house that ever happens. More with William Seale sunday night at eight. Cspan is partnering with Kaiser Health news for discussions about the new Health Care Law. We will take a look at the first portion of the conversation wa which lasted about an hour. This is on the federal Health Care Law and what it means to you. We kick it out today with a series with Kaiser Health news. We are joined by three that will help guide us. First up we have mary agnes. Thank you for joining us. Both have in guest before. Thank you for being here. We are dividing up the lines. 202. An call us at if you are in farther west it is 202, 585, re881. Take us back. What were the original goals of the law. Convert them to make it cover more than it currently does . Newhere are several benefits that have been added. We are talking about things like Preventative Care, looking at screenings for mammograms over 40. Those are available without deductibles. Several million Adult Children are now in their Parents Health insurance plan. There are no more life limits on coverage. As someone on your home had cancer, there is no lifetime limit. Seniors have seen their cost to go down with his closing of the doughnut hole. Several of those are already up and running. What do we know so far . There are concerns that adding additional benefits will increase the cost of Health Care Coverage. Some of the new bids coming in starts october 1. These are either run by the federal government or the state or partner. Some of these are a bit lower than originally anticipated. This continues to emerge. If we look into more detail about some of the elements, these are for people that currently have insurance plans. Children areadult covered up to age 26. Closing the doughnut hole is also here. It is significant. Has time the doughnut hole s with a lot. Ole this will be phased down to having seniors just cover 25 of their costs. Fixedf them were on income. Many do not have large incomes to begin with. Were also seeing things like coverage cannot be covered except in cases of fraud. This had been a problem several years ago. Cap look worn your was a a problem. You would file a claim. Then you would not have the ,overage anymore if you live then they could cancel. If you do not do that research ands or no longer allowed. The Insurance Companies had internal departments that were set up to actually find errors in peoples applications. You might be getting very high priced cancer treatment. They would see they get actually had acne acne when you were 16 you had not failed have not noted that and they say you do not give us your complete medical picture. We have a couple of profile cases are people were in the middle of treatment and lost their coverage. California banned that with the state law. We saw news a couple of weeks ago that they do blade implementing businesses having to ensure their employees. Why was that significant . Guest it was significant because it was a delay in one of the major pillars of the law, which is the idea that we want to get everyone to get insured. One pillar is expanding medicaid for poor folks. Another is the individual mandate that everybody over a certain income has to have Health Insurance. The other pillar is that employers are obligated, 15 employees are obligated employers are obligated with 50 employees to insure their employees. The delay was seen as a setback by republicans, who keep arguing it is very difficult to implement this law. It was seen as a source of relief by a lot of employers. One of the things going on with this law remember it was passed in 2010. It was suppsoed to be, that gives us four years. Whats going on now is the time to get new rules out are squeezed. Rules are still coming out even as we are sitting re employers were trying to figure out how they were going to comply with the law. The administration decided, we will give them a years break. We can all take a breather and figure out we are going to do this. Guest i was at a seminar by an Insurance Broker in california. This room was full of employers that were athar plastic about this. There was this list of dates, by october 1 you had to give a piece of paper to every single employee letting them know what their benefits are going to be. They were worried they have to update their Computer System because many of these employers i were talking to do not have i was talking to did not have a Computer System that would track at the level they needed to. Now they need to buy a 100 thousand dollar Computer System on top of all of these added costs to the system. A week later he was released he has more time. Guest we are part of the kaiser our stories do run and partners throughout the country. The editorial independence element of it means that the newsroom works like all of the newsrooms we have worked in throughout our careers. Host let us go to the phone lines, you are on the phone. Caller i have been made off since 2009. Since then, it was from findingt time work and a lot of areas. I am thinking employers i just found work within the last 35 days. What i am finding is a lot of employers are trying to avoid giving fulltime hours coming even though the demands of the work is fulltime work. They are actually going to the point where they are writing people up if they are going over there hours, trying to meet the demands of their customers. Is that fair . What can you do to report it . I think americans should do the american thing. If you have fulltime if you have parttime workers doing fulltime work, they should get benefits just the same. They are trying to hide under this 30 ball this 30 hour barrier. I wanted to see if someone could comment on that. Host what reporting heavy done on this topic . Guest quite a bit. Two points to be made here. One is if your employer is asking you to work more than 30 hours a week and not paying you, or not paying you for any hours you are putting in that is against the law. You are not supposed to do that. It has been known to happen every now and then. You should talk to your supervisor about it. If you do not get any satisfaction, you can talk to the Illinois Labor department. The other points to be made is the big one, which is you know something that is a bit of a trend going on here. The number of parttime jobs has been growing. This is giving something of a talking point to republicans. They claimed the growth in part time jobs and the relative lack of growth in fulltime jobs they blame it on obamacare. As you mentioned obamacare revives coverage for larger employers and employees working over 30 hours a week. This gives incentives to employers to keep employees under 30 hours per week. The mandate we just talked about is giving some employers sometime tooth sometime to rethink this. The question is will this continue . The economists claim the poor the growth of parttime jobs there is something going on with globalization. A lot of republicans are blaming it on the Affordable Care act. We are going to be watching in the job numbers in the coming months to see exactly what is going on. Host here is a story jake hancock filed for kaiser news. We will talk about what this means for businesses and employees. Jonathan is from phoenix, arizona. Go ahead. Caller i want is a call about age in which it covers, say your parents will cover you. I believe it was 26 . I do not understand why the age limit is so high. Try to pay your own health care. These kits that are growing up to be accountable on accountable for what they want unaccountable for what they want, now they wont be accountable to get up and there own jobs and their own economy going. I am 17 and i grew up with different values. I want to know what you guys ought about it. Do you agree or disagree to affect that this age limit is so high . Host do you have a game plan for when you turn 18 . Do you plan to continue your education or get into the workforce . Caller i plan to get a secondary education. It might be difficult for me to afford my own health care. That is part of life. I am going to stroll with that. I am going to find my own way. I will be happy to participate. Host take us through what this cutoff means and why it is significant. Guest so many Young Americans were getting out of college with the economic slowdown and were having difficulties either getting a job or finding a job with coverage. That is why this provision was created. It helps millions of Young Americans get covered. I think the callers concerns are ones that have been echoed on capitol hill, that this adds an unnecessary expense. The health lot does have special and larger deductible plans. It is a good policy when it is time to go into the Health Insurance world. There will be options for younger fulks. Younger fulks. This was a backstop for those getting out of college that need coverage. Many parents as well as little children out of college are happy to have it. Guest there was a story a couple of months ago i did a story on, asking the obvious question, does having Health Insurance protect you from catastrophic financial problems . What they found out was it does. They looked at in number of things that would send you to the hospital, bar none. Situations where you would not have a choice. Before this provision was implemented and after, what they found was 147 million in compensated care for the hospital is now being paid out by Insurance Companies. There were a lot of legitimate economic reasons. Students who are graduating that were not able to get jobs with Health Insurance, whoever wants to phase one of these illnesses would have gone to the hospital. They would have been sued for claims or the hospital would have had to claim uncompensated care. Host republicans push for killing obamacare funding, this is gaining some support among conservative republicans. As we look at a recent poll by cbs, 39 of those holes say repeal the obamacare act. 67 said expand or keep it. What do you think in terms of the fight . Guest it continues and is very intense. House of representatives will have the 40th vote to repeal all or part of the healthcare law. This will look into defunding the Internal Revenue service in having implementation efforts in the healthcare law. I think republicans see a lot of good things for them. Despite the fact that democrats kept the senate and white house in the november elections, republicans feel that the law is not good for individuals and employers. They are very motivated to he funding it, not only the standalone measures but as we look toward the continuing resolution, the bill that will fund the government beyond september 30, they plan to act on the foot on the Health Care Law. Host our next caller is jonathan in New Hampshire. Good morning. Caller good morning. I had a couple of questions. I have had quite a bit of confusion on some of the information. With regards to the Medicare Advantage, is that going to be did salt dissolved . My confusion is which of the two are they going to continue . Guest Medicare Advantage reimbursements is being reduced overtime. They are trying to equalize with the government pays for beneficiary and traditional services. The program will remain. You talk about supplemental coverage, that is used most often for a variety of policies. Neither one of those programs are going away. Guest i would add that a lot people have been predicting a decline in in Medicare Advantage coverage because of the funding we let the funding reductions. You are seen that anywhere in the Insurance Industry. These plants are only getting more popular, despite the reimbursement reductions. Host david in new jersey, hello. Caller good morning. I have been unemployed for two years and i have been uninsured for that same. Of time. I do not want to bash the program but it seems kind of clandestine. They do not want to publish the numbers, they talk about this gold, silver, bronze package theyre going to have. It is very hard for the consumer to wrap their hands for it wrap their hands around it. I am hoping for the best. I am going to pay the 240 premium every month but they are offering for this basic clan. I am only doing that because i do not have a lot of confidence in the Affordable Care act. I am not in the position to even afford this. I was a high income earner for the last couple of years. Now the basicake they should insurance now. I dont know if anyone wants to add to that. Guest a couple thoughts. Yes it is really complicated. However, in a few months, if everything works close to the way it is supposed to, a lot of things will become clearer. New Jerseys Health exchange these Online Marketplaces were anyone like you is supposed to go on and sign up for coverage if the software is designed right you will be able to go on their and actually get a really clear idea of what your choices are, what the tradeoffs are, the plants, and what the plans are going to cost. Those open october 1. People like you have until march 31 and march 31 of next year to comply with the mandate. One other quick tip, go online and Google Obamacare subsidy calculator. This is something our colleagues at the foundation put together. It is a great tool that will show you not only what coverage is available but what kind of subsidy you are going to get based on your income to help base help pay those new premiums. If youre unemployed you will most certainly qualify for a subsidy. It should give you more information than you have now. Host one question i have is should he wait . Guest that is a great question. If you have not signed a contract already, wait until october. It is when the subsidies become available. They are not available now. If you bought the plan already you are doing the responsible thing by being insured. You will get Financial Health if you wait a little bit. Host the calculators you are talking about was from the Kaiser Family foundation. It is a way to plug in information and find out some results. We have seen some tweets come in especially on this question of young people and their Health Insurance. Jan says for young people who are not on their Parents Health insurance, they are still facing having to get insurance, whether or not they have a job in the coming months. Mary agnes carey, take us through dons question about why 100 of people are supposed to get covered. Guest younger people tend to be healthier and insurance is the balance for us. You need younger people to balance it out in the risk pool. To jays point, looking at subsidies that might be available, not only with what your premium and copay is, you can get a lot of Financial Assistance to get coverage and get into Health Insurance system. It is part of the nature of insurance. If this is where the individual mandate comes in this is where the individual mandate comes in. Look at what this will be. Or 1 of taxable income, what ever is greater. Why is whatever greater in significant detail . 95 is not a big deal but 1 maybe higher. Bronx, new york. Caller good morning. I want to thank what he is done for our community and nation. It was so useful for our family. As a human being and a nation we are claiming to respect human rights in different parts of this world, i want to add this. President obama. If you are caring for our buddies in this country, we want to care about this in different places. Host our guests are answering your questions about the law. We will turn out to look at the insurance marketplace. Here are some new phone lines. If you have insurance you can ll us at 20258. If you lack insurance it is 202 5853881. Good morning. Caller we have about 30 employees. We could easily higher 20 or 30 move but we will not do it because of obama care. It is one of the largest hospitals in america. We just laid off it is one of the largest hospitals in america. We just laid off the reasons that he did not institute his policies simply because there were elections coming up in november. That is ready much it. I apologize. She said people that do not get insurance if they get hurt they are going to be responsible. If they do not have the money and there are d getting subsidies, they do not care if they are responsible. Theres nobody to get. It looks like we are already paying for these people to start with. A change in the system is the same way i look at it. Guest there are lot of antidotes about employer saying there holding off hiring. I suspect a lot of it is because of uncertainty surrounding the law. I think i met this one man down and brownsville who works full time in the shipyard. He is uninsured. What he did about the bill. He said i still have it. They try to buy a house or a loan. That will be on his record. This idea that you can somehow go to the emergency room and walk away is somewhat of a fallacy. There are hundreds of billions of dollars of care. The price to the individual and family is not one of just a clean slate. Host good morning. Caller my question is this. To me, this is strictly healthcare that has to do with big Company Money and Insurance Companies. Did any of you people see the hourlong special on Public Television where they compare healthcare cost from this country to other countries in the world . Did anybody see that . It will open your eyes. Politicians is just greed and money. My brother had an mri about two years ago, 1300. If he can back it will be 2000 for a facial mri. Any other country he went to wouldve cost of 91. A doctor visit in this country walk in with 15 and you can see doctor. It is not matter what kind of insurance you have. Some countries have a limit on how much money a doctor can make per year. When he hit that limit he is working for free. I want to know why it is that this country, with the politicians and Insurance Companies who do not care about the elderly or the kids, why is it that this country has to have this kind of a healthcare deal . Guest it is an accident of history. It is true that when other countries are looking at any economist when you asked them if you would design it the way the United States, most people would say no. Taiwan was facing a situation where they have many uninsured people. They looked at Different Health systems and they came to the United States and left immediately. It is not one that is seen as a model by any stretch or any country. It is an accident of history. During world war ii companies were not allowed to increase salaries for workers. In order to create enticements to keep workers they started offering Health Insurance. It worked its way into the American Healthcare system and it is how we have been set up for 46 years. I do not think theres anybody who would say this is a perfect system. It is one that has been built on. Guest politically it is pretty invulnerable. Congress democrats said they wanted universal Health Care Coverage. As the political possibility that made it happen. It is very complex. You go to people in different parts of the system and asked them where they should come out and they always point to somebody else. That is the big problem. How do you get people to agree to take what needs to be about a 20 cost to even begin to match what other developed countries are paying. Host we are visited by three guests this morning. They have a partnership with Kaiser Health news. J hancock, lets talk more about the exchanges for the marketplaces. What are they . Guest marketplaces is the new term. Exchanges was this policy term. They are trying to rebrand them. They think that is more descriptive of where they are. They are mainly online places where you can shop for health coverage. You can walk several steps to see where the design of this is. It is not an obvious thing. Starting october 1, youre going to hear more and more about these exchanges opening. You are going to start hearing about this. Based on this individual mandate they can sign up get credited with the subsidies we have been talking about on the spot. Is there going to help consumers sign up or a very complicated process. On the idea that based on this those lackingdate coverage through their go to thewill get creditedn up, with the subsidies we have been talking about on the spot, and they will be injured for health care after. And host some states are choosing to run their own exchanges. Here is a map from the Kaiser Family foundation. Why is it significant that some states like california are doing faitits are faulting it to the federal exchanges . The state has decided they will run their own exchange. It is coming fca een llowing what is going on. You see different kind of models. In california this was considered an active purchaser. When the Legislature Passed a law setting up this exchange they authorized them to run the exchange to negotiate strictly with the Insurance Companies. Went to the unveiling of the a month or two ago. It was like a party. Everybody showed up. There were 100 people there. You felt like you are going to an art show or something. They cut of the rates on the screen and everyone started hollering. They were participating in the california exchange. I think there were about 13. The rates were much lower than what people anticipated. I think were seeing that in maryland. Were seeing that in a couple of r es a coming in a lot lower. California is an active purchaser. Others are saying we will put up the marketplace and build a website and anybody can sell their wares on this. Host what are some states having a harder time getting Insurance Companies marketing their products . Guest mississippi is where there was a wide swath where there would be no insurance options. Humana has stepped in. This is what you have when you have a marketplace. It is something where you have to have customers willing to buy a project. You might make a business decision that that is not a market you want to go into. As long as youre having this delivered through private Health Insurance companies, that is what you are going to get, people making business deals. Host appleby recently filed this. Consumers may not be offered insurance subsidies. Take us up to date with what is happening in mississippi. Guest when he wrote the story there were some blank spots on the map. Host what does that mean . Guest if you were eligible to buy in the exchanges in certain counties in mississippi you would have no choice. You would say i qualify. Im eligible for the subsidies. I want to buy in the exchange. Since then the department of health and Human Services in washington as well as mike cheney had been working really hard with the arm twists. One of the larger insurers i believe has agreed to come in and offer a plan in these counties where there might not have been any choice before. There are other states where it is thinner than some others in california. Sarah mentioned it would have 13 in the marketplace. It is not going to be appropriate. South dakota, iowa, they are not going to have any empty counties. Guest all health care is local right . In california and in many other bigger states, you have states broken up in different regions. Insurance companies have to go in and form these partnerships with providers. The providers are very local. A Regional Hospital chain in Southern California building around a network of providers. That would be different where there is mainly one hospital. It is the ability to get an insurance package. It depen o are. Host they ask if you can comment on the number of plans offered in the state marketplace. Will it be sufficient in competition . Lets hear from our callers. Beverly is insured. Hello. Caller i am so glad you are there today. I am so ignorant about insurance. I talked for years. We talked for years in new jersey. We are both covered by blue cross blue shield. I have to go out on me. I cannot finish my term. It did not matter to me. I was covered under his insurance. I lost my when i went out. When he passed away and they informed me now my insurance is not free. I would have to pay. Ok. It did not bother me. Every year my premiums are more and more. They are taken out of my pension check. I have to have insurance so it doesnt matter. I heard president obama saying something about if you are insured and you are paying premiums you will get money back this year or something to that effect. I do not know anything about it. I do not want to upset them. I do not know anything about it. Could you answer that for me . Guest im very sorry for the loss of your husband and having to deal with this. What the president is talking about is the healthcare law is required to spend 80 of your premium dollar on health care benefits. It does to people who buy their own Health Insurance. They may get a check back from there and sure. They are spending at least 80 on premiums. If you do not buy it yourself your employer buys it for you. Your employer may get the money back. That has been confusing for people. I encourage you to look at the exchanges. You might qualify for your actual premium. We will see if you can get a better deal. Guest if i was a late mail and my late 20s i should not have to pay a fine. And a story. Look for cspan. We will go over again the numbers of what you will pay if you do not get insurance. Next are 95 a person or 1 of your taxable income goes up from there. It is two percent of a taxable income or over 300 if you do not pay and then it goes up more. And a story. Look for cspan. We will go over again the numbers of what you will pay if you do not get insurance. Next are 95 a person or 1 of your taxable income goes up from there. It is two percent of a taxable income or over 300 if you do not pay and then it goes up more. It is annually adjusted. Would they come knocking on your door . Guest we tracked through the Revenue Service and it would be your premium. Guest if you do not pay, and the law it is not a criminal offense. No jail time. You cannot be prosecuted. They can, the worst that can happen, is they could garnish her pay check in the future if you owe the penalties. It will be interesting to see how much they have to enforce it. They are the ones that verify your income. They will have a lot of information. The enforcement aspect is one that no one is really concentrating on now. The white house does not want people to concentrate on. Guest this is one reason why the Tax Companies are interested in the Health Care Laws. H r block will step forward and say we will make this part of our tax coverage process. A lot of people they go to the companies are not high income earners. They are working class families here it the idea that these others have said we will sit down and figure out what your subsidy will be in how to apply that proactively so that you could potentially have a lower premium monthtomonth. People are working with one of the companies. They will most likely be asked to talk about the Health Insurance. Host for washington, maryland. And uninsured caller. Caller i have been doing a lot of natural taking care of myself by natural means. I am looking for natural doctors now. A lot of people are so ignorant about healthcare. As one of the main reasons the Health Insurance companies are like that. I would love to see the new healthcare law act work. We need to stop listening to bill oreilly and fox cable. They have state of the art insurance care. We need access to the health care. I do not want to go to the doc for and said our naked and get two minutes worth of a doctors time. 10 of that is going to your actual healthcare. Could we ever come to a time where we would actually have no employers responsible for healthcare . People need to be able to have their own health care. Host lets dive into some of those. Guest there is a lot of interest among republicans. Health insurance should not eat link to your job. It should be something you take with you. That thought is certainly out there. This is very much based on the system. It would not surprise me is several years down the road you solve that rim unemployment. I do not think it will do anything to reduce your weight in the waiting room waiting for your position. You will have morere this is where it is charged and what you have to pay. The frustrations are certainly share by a lot of people. Host why is language important when talking about this . Guest words carry meaning. They carry hidden meanings be on the literal meaning of the word. Obamacare started out as being the pejorative term. It was jean to by opponents. It was used by obamacare. Last year the administration started this as a brand. From some of the groups that are trying to promote the law we saw public ad campaigns having examples of benefits of the law. I use it as a shorthand. While some people still to see this outlier. Host will this be the Affordable Care act . If you like your Health Insurance policy you can keep it. That has proven not to be true. They make this offer. Host michigan is up next. Hi. Caller i want to thank heiser for the count later. Should we wait until october 1 to get her policy in place . The risk pool is going to they are using it. It is something that has been in the headlines. Will this be the Affordable Care act . F you like it you can keep it that has proven not to be true. They cut it at the same time. Healthcare provider, hello. These is also a daily basis. The risk for is going to increase. Here it is it is the price increase of 125 . I think this may be 700. You will not get that until of the year. You will get that every month. I see a prm. Host it is a problem given your income. I think it does make sense. He is eligible for the subsidies. If youre not eligible for subsidies, and we should say right now about subsidies. Subsidies are available for a family of four if you have income up to about 00 change. You can still be eligible for these tax credits with a middle class income. For a Single Person it is about 46,000 and change. Decent middleclass income you were going to be able to go on the exchange and get these tax credits applied. Some of the Sticker Prices you are starting to read about in the newspaper, depending on your income, will not be what you pay in the end. That is a point we need to make. Your point is a good one. If you are a family making 100,000 a year and you do not have health coverage, you might want to go in and talk to a broker or some other source now and look at a plan. In some cases that situation might change in october. A beer r you to lock in now. Host arizona, medicare recipient. Hello. Caller good morning. How are you . Host good. Thank you. Caller i have concerns about the republican people. I guess i can call them people. They always try to diminish government. I am for a strong government. That way we can be governed and accountable. You know, the people that correct the systems that are in them are being held to charged to something. The republicans keep hollering about too much government. We need to enforce the laws that are there such as epa, healthcare, trying to be good citizens. Host do you have any russians questions about how this healthcare law is going to impact your coverage in medicare . Caller yes. Somebody should answer me. I already have health care in medicare. My wife was in the hospital about three or four years ago and i got bills. She was in the hospital twice overnight maybe half a day. I got bills for over 35,000. I paid them. Even though we had medicare and we were eligible for that. I think that was crooked. There was another case where he where i took her to the hospital and i griped over the cost of what i was going to have to pay for being injected with a little bit of juice. I do not know what they call it. Anyway, she was in there about three hours total. I did not get a bill. I was being billed on the spot, 1400. I showed up in the office. I really griped about it. They say ok, you are griping enough. Well put it down to 866. Host negotiating costs. Mary agnes carey. Guest your wife is on medicare . Im concerned about the ability both of y on medicare. I am curious why it was 35,000. If i got a bill like that, i am not on medicare, i would call my Insurance Company and ask right away, cautionary note. Were are talking aboutth snd boring about a piece of paper that comes in the mail to try to explain what you have to pay, you should question that before you pay a bill if you think it is too high. That is my number one thought. Host we are seeing some questions coming in on twitter. What the average person needs is stepbystep instructions with links, etc. It is too confusing. Guest that is what happens when the exchanges open in october. It might help to explain a little bit in more detail what you are likely to see when you go online and try to buy Health Insurance through the local exchange or marketplace. First of all, each state will have a different name. In california it is covers california. Every state will have a different name, but you are going to hear about it. The publicity is just starting. You will see at campaigns even ad campaigns even if you do not know the name. You are going to go on and youll do do several things once youre online. The software is designed intelligently. It will walk you through the decision. One thing you need to do is verify your income. There is supposed to be a link with the irs records. You can put in your Social Security number. You will say you earned asked year. Ast you are eligible for this amount of subsidies. You will see that. Anyou will shop for insuranceh Companies Just like you shop for a plane flight. You will see all of these different choices. The software that is good will help you choose. It will ask your priorities. It will ask you if it is important to keep your current. Current doctor. If it is you, will click yes. You will say who your doctor is. It will steer you toward plans where your doctor is there. What is more important, the lowest absolute cost . You want to pay the lowest premium costs, your answer is yes, you may be able to keep your online doctor. To save costs they are setting up narrow networks. A relatively skinny group of doctors and hospitals that will be available to treat you. In return for that narrow access, the costs are down. They say in return for giving you a higher volume of patients will you cut your costs . That gets passed along to consumers. That is one way it is working to try to get providers and insurers on there to give you the best fee. One thing we should really mention that we have not talked about yet is your hearing a lot now about Sticker Prices. We did one on maryland last friday. The typical Sticker Price you are going to see for the lowest benefit, bronze plan, youre going to have bronze, silver, gold, platinum. A bronze plan will have low premiums, but you will have a relatively high number of co pays and deductibles that goes along with those. When you go on the exchange, one of the things you need to do is not just Pay Attention to the Sticker Price. The typical Sticker Price for the bronze plan will typically be in the 200 or 300 range. In some states we have seen less than 200 a month. It sounds pretty good. I spent 2000 a year for these plan. One thing we need to focus on is looking at your outofpocket costs. Do not look at the upfront premium. Particularly if you have medical issues. If you have a chronic condition, you need to figure out what your total cost is to be for the year and youre going for all of these steps. It ought to show you that. I have test driven through some of the programs. They want to show you the upfront price. They will show you your total cost. Guest will it direct you to your exchange of people go there first . Guest if they are first, it should happen. It is the first one you can go and see what premiums are costing interstate now. I cant imagine that they would not. Guest you mentioned copays. I think it could be as high as 6,300 for individuals and about 12,000 for families. My premium might be a blow but how much am i pay out of pocket throughout of the year. Host we are talking with three correspondence from kaiser news. Coming up next we will have calls from Business Owners, employees, and find out what your questions are. Return for the second part in a moment. We will let you know about the National GovernorsAssociation Meeting will get underway in milwaukee. We will bring you live programming. That will be here on cspan. Also tonight, fancy farms, we take you to that event in kentucky. U. S. Senate candidates will make including senator mcconnell, senator grimes, senatorbevin, and marksberry. The state Department Says it will close 21 embassies and consulates tomorrow. He also issued a Worldwide Travel alert saying current information she just that a qaeda and affiliated organizations continue to plan terrorist attacks both in the region and beyond. They have focused on attacks between now and the end of august. Those embassies are located in the middle east and north africa. Of can check the Department State website for the latest alerts. Ron paul talked about Embassy Closures during a keynote address at the Young Americans for liberty. Take a look. I lean toward optimism, but i am concerned about what other countries have done. They usually people get frightened. They scare people, just like what is going on right now. There will be a lot of acts around the world. We just saved you from all of this grief because we have saved all of these attacks. One of the attacks was a real one. They trap people. These are the lies the government tells. A honesty have government. That is what we need. [cheers and applause] we will show you all of his remarks tomorrow at 6 30 p. M. Eastern right after newsmakers. We will go back to the conversation about the Health Care Law with reporters from kaiser. We are focusing on the Health Care Law and what it means for you. Here to answer your questions arent recourse abundance from. Are from kaiser we are opening up the phone lines. On whetherto based you are a boss or an employee. We are looking at what it means in that workplace. Numbers. The let us begin with a call. We have an employee. Hi, sharon. Caller hello. I have two questions. I have been working since the age of 15. I turn 65 on friday. In 2008, i started getting Social Security disability. A subsidized insurance through the state. It has been great for me. I have been seeing the same doctor for years, including some specialists. But i have to work. Much. Ot get i have been working since i have been able to parttime. If i am not working, i have a health plan ofhe ice. I cannot afford that. I was wondering if the Affordable Care act is going to helpf i , i can still have coverage through the state. You are an employee about to turn 65 . Caller yes. Guest you can go to medicare. Gov or call the number and find out how medicare can do with the current coverage you have. You will be 65 on friday. That would be my first thought for you. The providers youre currently using probably know your state program re well and how it may or may not work with medicare. Hear from arkansas. Hope is selfemployed. Gmoer thank you for taking my call. Offeringtwopart qiowill the ee plans. Number two, my husband is on medicare. Will i be able to get care for him . Go, dbefore we let you have any insurance now yourself . Are you paying for anything out of pocket . I am. yes, im part of a selfemployed land. I paid a premium every month. That gives me currently six visits to any doctor in any network. Of the total charges to the doctor. It has been quite affordable for me right now. That will be ending december 31. I will be shopping on the marketplace. Im really excited about that. Host ok. Great question. I do not know if dental and vision will be in there. Guest dental is only for children. I think if you had a problem with your retina, and medical issue, you might get medical coverage. Not vision coverage. The exchanges might be a good option for the caller. Host you are nodding your head yes. Guest yes. We have been going through the process for the pediatric dental plan. A dull dental is still the mount is the orphan organ. [laughter] the orphanh is organ. Guest separate copays. That hhs ising watching during the implementation. Host if you are self employed with a Small Business, how do you approach this law . Guest i forget that i am a business. I go shopping as a consumer online. That is where the subsidies are likely to be the best. There are two products that will be on the exchanges. One is for individuals and families buying directly from Insurance Companies. The other is for Small Businesses. Small businesses under 50 employees will be able to go buy coverage for their workers on the exchange. It is taking a little bit of time to get ramped up. The idea was that say i run a car repair garage. I had 25 workers. The vision was that i could sign up on the exchange and that my workers could go on and sort of shop in the same way individuals would be able to shop to go through these sources of multiple insurers that we have been talking about. That is not going to happen. That was one of several pieces of the law that was too complicated to get up and going this year. The exchanges for Small Businesses will be in business. There will only likely be one choice for employees when they go on. In other words, you will offer coverage to your employees as Small Businesses have traditionally. You contract with one Insurance Company and that is yours. Host we see the plan choice element has been delayed. As you mentioned, most employees will only have one plan option. By 2015 there will be more of a choice element. Guest that is the idea. The aca is about choice. It is supposed to be about diversity. If everything goes as planned, you will go on and you will have choices that look somewhat similar to what the individual going on the exchange will do. Right now if you are a Small Business that is your pool. When you Insurance Broker tries to sell you a plan, whether it is at the or humana are what ever, that is the affordability act. Everybody is there together. You pool your resources and it gives you better partner. Theyre able to offer a better deal. Guest the employer, the summer camp where the average age is 23, will pay not the same but a similar premium as an employer with an Older Work Force and higher healthcare costs. Host sue is in cleveland, ohio. Caller we have 23 employees. We have always provided medical insurance for them. In the last recent years we have split it where we pay 75 and they pay 25 . Beginning january 1, there is going to be federal fees and taxes on the insurance policy. Theres 18 cents per person insured. 2 or 3 as the market share fee. For a family of four that is like 59 a month. If we switch to the marketplace we will have to pay these federal fees, too . Is it just for private insurance . Host jay hancock. Guest the fees will be leveled on all insurance products. We have not talked about self insurance. This is something that has traditionally been practiced with very large companies. Selfassurance is basically when the employer has enough revenue that they can agree to pay the medical bills directly based on the risk that employees will have very high medical expenses the basic idea is that your employer is paying the bills directly. It contracts with the others to pay the claim. Even employers as small as your company are looking at self insurance. One of the reasons these taxes are not levied on selfassurance is because it is not a licensed insurance rodarte. Product. That is where the rubber hits the road. What is going on is that its is business these are self insuring and they are going out and ensuring from Insurance Brokers to sort of hedge their risk. For example, if you go self insured you can buy insurance that will kick in if any single employer of years has healthcare bills of more than 10,000 you are not be for that afterward. It looks like insurance to you and your employees. Not only do you not pay that tax but you are also exempt from some of the required Health Benefits that the law offers. It is controversial. It too Many Employers do this it shrinks the risk pool we were just talking about. It puts it across everybody. It lets them do this. For firms like yours, it might be an option why it is still a allowed. I would talk to your broker and see what he has to say. Host you can join this conversation by looking for c span on facebook. What exactly does the federal Health Care Law change for people who already have Health Insurance in addition to those without it . Guest you are probably having more Preventative Care with no deductible. When we took our children to the pediatrician, i did not have a copay or deductible for the services i have before. We are talking about more screenings, Blood Pressure for everyone. That is one thing that may be changing for you. If you have an adult child of up to 26 who either does not have a job or an offer of coverage from their employer you could pick that adult child on your Health Insurance policy. The same things we have been talking about with no lifetime limits starting january 1. There will be no annual limits for adults. You cannot be discriminated against for a preexisting medical condition. They are not only treating the subsidies to help people that do not have coverage, if theyre helping people with coverage to have more benefits. What does that due to the price of insurance . Guest we should probably mention that employers and their Insurance Companies are making changes in their coverage and dependent of the Affordable Care act. The hallmark of what is going on are the Consumer Directed Health plans known as High Deductible Health plans. I would bet that a lot of people watching now are seeing this in your workplace. Theyre asking you to pay much higher deductibles, almost as much as 1000 dollars or 2000. There is a philosophical idea behind it. Now that more of the responsibility for payment is on your shoulder and not the Insurance Companies, it is supposed to turn you into a savvy shopper. Youre supposed to start comparing prices. Youre supposed to start calling when you have an expensive procedure coming up. There is a problem there. The transparency of medical prices isnt nearly what it is for airplane tickets. If a doctor says you need an mri test, you have a bad act, prices for mri prices vary hugely. Theyre asking you to shop around. Cost sharing is going on to a much larger degree among employers of all sizes. They were typically used by Small Businesses. The premiums are cheaper and they can afford them. Even the largest employees are having high deductible plans with Health Savings accounts. You put pretax money into these accounts. You use those to pay for out of pocket expenses. This has little to do with the Affordable Care act. It is going on anyway. It is the counterweight to the aca. Everybody focuses on what the Affordable Care act is given to consumers or taxpayer subsidies. Pushingans have been for more consumer input for years. They have been pushing this. What is flying under the radar is that conservatives are Getting Health Care policy. Host the washington journal is launching a series of Kaiser Health news reporters. We watch the federal Health Care Law roll out. Our guests are mary agnes carey, a longtime reporter who has covers a Health Care Law reform. She watched it as it became law on capitol hill. She worked for congressional orderly prior. Jay hancock is a Senior Correspondent for Kaiser Health news. Jay hancock was a longtime reporter for the baltimore sun. We also have sarah varney, who comes to washington for the special show we are doing today. She worked for a long time at kqed public broadcasting in San Francisco and she did Health Care Coverage and has filed for the monthly Magazine Health dialogue. We are taking your calls on the federal Health Care Law. Jean deaux tweets in it is not health care, it is insurance. And simple. Is that a fair assessment, sarah varney . Guest certainly. The primary goal of the Affordable Care act is to ensure millions of people in the United States, and there is a whole bunch of other things the Affordable Care act does. Medicare, trying to reduce inspections, the list goes on and on. Primarily at its core, absolutely, we have 50 million uninsured people and how do we get them insurance . Guest we are talking about Financial Security and peace of mind. By far the largest cause of bankruptcies in recent years, recent decades, its been healthcare costs. One of the reasons behind the aca was that nobody should have to go bankrupt because they get sick. Host you do objective reporting. Is the goal to market Health Care Law or to educate and learn about it . Guest no, the goal is to explain healthcare policy and politics. We cover things other than the aca as well. We write about hospitals, the Insurance Industry, providers, every nook and cranny of the Health Care System we have folks dedicated to that. No doubt the implementation of the law is a great niche for us, but we are not here to promote anything. Host andrew is selfemployed go ahead, andrew. Caller hi, how are you . Your guests are excellent this morning. Thank you all for showing up and being so professional. I am selfemployed. I dont make very much money. Im a handyman, kind of a carpenter, painter, roof repair stuff. I mostly make less than 17,000 a year. Am i going to be put on some kind of total subsidy thing here . If i got insurance outside of this whole obamacare thing, do they then say you dont have to apply, or am i roped into this thing no matter what . Host sarah varney . Guest you are the type of person the exchanges are meant for. You are eligible for a fairly large subsidy im sorry, what state did you say you are in . Guest new york. Guest you are in a state that has expanded medicaid. Up to 138 of the poverty level, 15,000 a year. If you were to be below that, you would qualify for medicaid in the state of new york. But since you are above that, you will go on the exchange, and because of your income you will be eligible for what is most likely the largest subsidy. I have not seen the new york numbers, but in california, obviously another big state with a lot of people, most likely new york will have a fairly robust exchange, we are seeing in some of the markets, we are factoring in the subsidy of 90 a month. In some cases less than that. You are exactly who the exchange is built for, and i think you will see that you would qualify for a fairly large subsidy. Guest we should mention, andrew, that the exchanges are for Medicaid Enrollment as well. If it works as it is supposed to, it shouldnt matter you dont know whether you are eligible, which one you are eligible for, when you go to the website, and you shouldnt have to know. It should steer you in the right direction no matter what the case is based on income numbers and other information you put in. Host Kaiser Family foundation has this map showing which states are running their own exchange is and which are defaulting to the federal government exchange. Federal exchanges are in the lightest color. Those who are doing a partnership are in the midrange blue. Some states have launched ad campaigns to let people know about what is happening in the coming months. Lets take a listen to an ad airing in the state of connecticut. [video clip] now thanks to Access Health connecticut, just about everyone can get Health Insurance and nobody can be denied due to a preexisting condition that you may qualify for a discount on your monthly insurance bill. Use our savings calculator to calculate how much. Access Health Connecticut see how much you might save. Host this is airing in connecticut. Mary agnes carey, who pays for them, and what are they trying to communicate . Guest they are trying to get people interested in the Health Care Law. There are people who oppose the law, who are in favor of the law. One poll i thought was interesting was a Kaiser FamilyFoundation Poll from april, talked about 42 of the people they talked to were unaware that the Affordable Care act was still a law. Connecticut is moving forward with his exchange and wants people to be aware and to get out there and to sign up. If you havent really paid attention to the Affordable Care act, you can tune back in now because you will hear a lot about it in the month ahead. Guest the question of the ad strategy, when you start launching these ads, because we have been to the movies and we see the preview of the new tom cruise film that is not going to come out until next april and you think, how on earth am i supposed to remember that . There is the question of when you start to air these things. We have a lot of callers who go to the website and cannot sign up, because you cannot sign up yet. When should a bulk of the ads hit the airwaves . We should tell people about the law even though theres nothing we can do about it right now. In some states where they have the money and resources, they can get out there early. In california you have not seen a lot of ads just yet, and america, one of the big organizations we can talk about, they are saying we are not going to watch a major ad campaign in the fall either. Host a comment from james on twitter, a question but with implied commentary. Spent onmoney advertising do anything to cure one sick person . Guest no. What it will do is increase the health of these risk pools that we keep talking about. People who are really going to be bombarded by these ads, publicity, if it does the job, are the young invincibles we mentioned earlier. The exchanges open for business the coverage they provide is available january 1, and we all know that people who have medical needs, who have ongoing chronic conditions, and see doctors regularly, are going to be first in line to sign up for these plans. But if they are the only ones who sign up, the premiums you are seeing quoted wont turn out to be realistic. The cost per beneficiary will turn out to be too expensive. This is what has happened again and again and again with attempts to expand Health Insurance in the past. The difference now is we have these mandates that require everybody to be in the pool or pay these penalties could what you will see a lot of his ads targeted at people in their 20s, people in their 30s, to get them in the pool and answer the implied commentary is no, that wont cure anybody, but it will make these exchanges, make these insurance pools sustainable. It will spread the costs around, which is the intent of the act, and make it sustainable. If we see Insurance Professionals call it a death spiral, which is the technical term, adverse selection, when you get too many sick people in the pool, your costs per person go way up and even people who need coverage cannot afford it. The ads are supposed to prevent that from happening. Guest on nprs planet money i sat down with this ad man in new york city, a viral market expert. I was saying to him, just imagine if you have any budget in the world and you have got to get the young people into the pool, how do you do it . He is thinking not just television, but internet advertising, embedded branding in jackass videos on mtv. [laughter] and you look at the geico ads, they are completely wacky. You have flo, the lizard the gecko. Could Health Insurance ads go that way eventually . He seems to think so. Host byron, retired. Hi, byron. Caller thank you, cspan, and thank all you folks. I appreciate it. I have a unique situation. I am a retired federal employee, i recently went on medicare age, but i still work. Im a trucker. And when i am working, i am under the teamsters insurance and at times i am under different locals insurance and i can have up to three insurance plans going. I have my federal and maybe two different teamsters plans. And i am a vietnam veteran so i see the va for agent orange checkups. My question is this how is this going to affect my federal insurance . And i kind of lost my train of thought how is it going to affect my federal insurance . Are my premiums going to go off the chart because my wife and i are on my federal insurance . And also, why is it that when i have the three insurance plans going, nobody wants to pay for anything . [laughter] i am insurance poor at times and i have all this insurance. I would love to be able to take these teamsters plans and say, give this to one of my brothers and sisters. But i cant do that. I am hamstrung in that. I think that the industry is hamstrung in that type of thing, too host byron, stay on the line with us in case our guests have any questions for you. Mary agnes carey. Guest when you file a claim, who is your primary insurer . If you are married to someone and they may say, date of birth, for example, distinguishes who is the primary insurance carrier, who was born first. Whether it is va or caller ok, generally speaking, when i am not working for the teamsters and i dont have enough hours to carry the teamster insurance, i am under blue cross. Va i use for myself when i have to have to checkups for the agent orange. Theres no charge there. When i have enough hours working to pick up the teamster insurance, they become the primary, and if i go to another local at the same time and i pick up enough hours on that insurance, they would then become the primary. I can have blue cross federal, blue cross massachusetts, and cigna in New Hampshire all at the same time, and it is either going to be cigna or blue cross mass if i work for the teamsters. Guest it sounds like you kind of got that down, you know where to go and who your primary payer is, depending on the particular circumstance. The question of what this does to your federal coverage i want to say that open enrollment is this fall for the federal government and you will have to wait and see what their choices are. There is no particular reason why it would change much. But insurers always make decisions whether they want to offer federal employees a pretty vibrant pool. You can see that happening this fall and see what your options are and see what your costs on that would be. But youre definitely right, you would have a lot of insurance and overlap there. Complicated case, very interesting. Guest why taiwan did not choose the United States is a model. Host good morning, kelly. Caller thank you so much for taking my call. Our situation has been a little bit different. My husband was fulltime employed, but paying in the Affordable Care act, my husbands employer moved many of their employees to what i guess you would call 1099. The irs basically forces you to claim as selfemployed. At that time we picked private insurance. However, due to my preexisting condition, no one would cover me. I was just awarded disability, and thank goodness, i received medicare. However, in our town, as i am trying to finally get a doctor, no one there is no doctors that will cover a medicare patient. Those are just basically a few comments. I am having a hard time finding a doctor. My husband, however, his private insurance, his premiums continue to go up and up and up and up and up, to where we finally had to drop it due to me waiting nearly four years trying to get disability. Now that we are trying to look at the Affordable Care act, georgia is a little bit different because they have not wanted to participate in the exchanges. As we look at trying to get him on insurance, it has been a debacle trying to figure it out. Host as our caller kelly mentioned, georgia is defaulting to the federal exchange. Tell us why that is significant and then we can get to her questions, sarah varney. Guest even in states like georgia that are not doing their own state exchange, there are exchanges available and you will be able to go on october 1 to this website. Ow, t on hh , i dont ou get some kif linknd figure out essentially throughout calculate or whether or not you, or your husband, i guess, would qualify for one of these subsidies. It will not be until october 1. Guest i thought her medicare question was interesting. You hear a lot of anecdotal evidence from people maybe they have access to a primary care physician or specialty doctor, but she obviously, this something she may look beyond her hometown where she has coverage to get a physician to take care of her. This is something that as somebody who covers medicare you hear a lot about all the time. Host we will hear from more of our medicaid recipients and also we would like to hear from if you are insured or uninsured. We will change up the phone lines a little bit for the rest of washington journal. Lets get one more Business Owner in on the conversation. Mark is in norfolk, virginia. Hi, mark. Caller good morning, and to all your guests. I have been selfemployed since 1987, and i have seen Health Insurance just skyrocket completely through the roof. As the gentleman who called in from new york who is in the construction business, my business is also linked to the Construction Industry as well. I can tell you and most callers listening will certainly affirm that in most Industries Like construction, we are working off mid1990 pricing as far as labor, while we have watched everything around us like materials and Services Continue exponentially up. I think a big problem i would like to have your guests expound we basically have a new economy, where i think Corporate America has gotten to a point where what used to be good profit in the 60s and 70s has gone on steroids. If you are part of the corporate industrial complex, you can continue to get to push your rates, push or profits, and because you only you could be unaffected. The second part that i have an issue with is the simple fact i think some kind of way, we have got to find a way to be able to connect your academics to what actually physically happens to the people in the undercurrent. That disconnect is further causing an issue in the healthcare industry, and im thinking, why do we need a broker to get me healthcare, if the doctor who is in business is providing my health care, money would be better spent if we could give doctors or other care professionals the wherewithal so they could house their own administrative processes to be able to care for patients. Host lets get a response, starting with the jay hancock, the Insurance Industry and their role. Guest one of many complaints about the u. S. System. One of the reasons why taiwan elected not to implement a u. S. Style system is the administrative costs you are talking about. When the u. S. Implements the Affordable Care act, we will have all these different layers of administrators, managers, supervisors, over and above the caregivers who are there on the ground making people healthy and curing them of disease. We have employers, Insurance Companies, people in washington administering all of this, we will have the exchanges now, we have state exchange organizations, and one of the big arguments about health care and we will continue to hear it in years and i daresay decades to come is why are we spending all this money on the administrative superstructure when we could be spending it on caregiving . As a practical matter, however, it is a moot point. The country has chosen based on the inertia that sarah was talking about, the historical coincidence that we have employerbased healthcare, and the idea is to deal with a system that we have, and the aca was congress answer to that and we will see how it works. You are referring primary to how expensive it is and the cost of the system. There are parts of the aca that are meant to address the cost. We are supposed to start paying providers, doctors, and hospitals to keep people healthy, not to put them through the hospital. We will see if that works or not. Host there is a conversation going on on twitter. Boringfileclerk asked everyoneensuring decrease the cost of health care . It doesnt, it decreases the cost of insurance. Thoughts on that . Guest one of the things critics point to about the Affordable Care act is the rising cost. We are seeing premiums go up on average in individual policies and exchanges we are talking about, probably talking about net increases in the cost. What people forget to talk about is that society is paying for this care anyway. We see enormous amounts of taxpayer costs that go into pay for medicaid, incredible bills and hospitals that write off uncompensated care. People are being taken care of in inoptimal ways and expensive ways. One of the things in the aca is to shift costs inside the system and deliver care more intelligently, and if we can do that people will be healthier and the cost will be better control. Guest how can insurance be used . If you can help reduce the epidemic of childhood obesity, if you can get to someone who is prediabetic as an adult and get them to control their food intake and get exercise and get off certain medications im not saying it is a panacea. There is great debate about what could or could not reduce healthcare cost, but it could change the trajectory of trends were seeing in the market public that are not positive for good health. Guest one of the things that jay is alluding to is the Accountable Care organizations, the new version of an hmo, basically, or a managed care organization. I went and saw one of these in riverside a couple years ago. This is preaca. They took on the risk of all of their patients and form relationships with the local doctor or hospital and a group of specialists and they got money directly to care for these patients. What is interesting is the doctor who leads this is very pragmatic some years i make money, some years i dont make money. The physicians have to be willing to essentially take a pay cut in the years when they have a lot of expenses if the model is going to work, and a lot of physicians are unwilling to do that. Guest one of the positive things that is happening, in my view, is that properly constructed, Accountable Care organizations and similar setups known as patientcentered medical homes are actually increasing compensation for the primary care quarterback doctors who supervise your care at the expense of specialists. The metaidea is to keep people healthy, keep them out of the hospital, lets not focus on doing procedures. The way the system is setup now is people make money for doing procedures, whether they are needed or not. Primary care physicians, who, by the standards of medicine, are underpaid compared to their neurologist or anesthesiologist colleagues, some of the better constructed acos are seeing significant increases in income if they can manage care the way that sarah is talking about and keep people healthy. Host another conversation on twitter. We all went to the er, healthcare would be much more expensive than it is now. Caretance preventive cheapest. James says link me the study that proves preventive cases care saves money. So questions on our twitter feed, and you can tweet in your thoughts by writing cspanwj. Another state that has launched a campaign to raise Public Awareness is oregon. Lets look at oregons latest tv ad. [video clip] the Cold Mountain snow where i am free to be healthy and happy and strong and live long in oregon long live our oregon spirit long live the oregon way to care each one, every daughter and son live long oregon host the oregon ad, sarah varney. Guest i love this ad. Host who is this made for, what is the message it is trying to communicate . Guest i think what we heard from the people who made this ad is they wanted to get out this idea that the Oregon Exchange is for the health of all oregonians, that this is something we are doing together, we are in the same a lot. Much has been written about this ad in that it is very twee and could have come off of the set of portlandia, but it is trying to appeal to a younger demographic, most likely in the urban portland area. I dont know if there are people in eastern rural oregon who identify with the message. I just love the little kids with the cutout trees. It is very creative and does not seem to be selling a product but is trying to sell an idea or feeling about this thing that is coming. Host so, on twitter what are the mechanics of the exchanges . Can you sign it would just internet, phone, and mail . Have to visit the government dr. Office . So at what point, sarah varney, does the Education Campaign turned to here is what you do and here is how you do it . Guest we will see a lot of that at the end of september and certainly by october. Here is the exact website you will go to. You will see a lot of ad campaigns where there is click and point. The ads will get much more specific as we get closer to the launch dates. Host lets hear from scott, uninsured, living in oceanside, california. Caller good morning, and thank you to cspan and your knowledgeable guests. I am 53 years old, uninsured, but also an air force veteran. I recently suffered a Heart Failure and im considered 30 Service Connected disability through my va. My question is, with the new act that is going to take place, would i be required to have insurance as well, even though i have my veteran right now they are taking care of me and the only thing i have to pay for are my medications. Guest you are fine, you are covered. If you have the va system or tricare which fulfills the individual mandate, you have coverage and you are fine. Host the Kaiser Family foundation looks at the status of state actions on the Medicaid Expansion decision. Take us back to the supreme courts decision about the Affordable Care act last year, what they decided about the Medicaid Expansion. Guest that day and every day that followed, everybody was remarking on the decision to uphold the law in general. What did you get a lot of attention right away but rightly now has is the question of whether or not medicaid can be mandatory. I think there is a lot of surprise that this came out of the decision. And now that so many states have chosen actually not to expand medicaid, the way the congress designed the Medicaid Expansion in its it was seen as a carrot dipped in a lot of sugar. The Medicaid Expansion of the threeyear window when the fed picks up the entire tab starts january 1. People are surprised that so many states have not signed on, that it is continuing to be this political question, that if you do the Medicaid Expansion you are somehow endorsing obamacare and president obama, and governor rick perry has sort of made this an issue in texas. It is in his mind untexan. Host so texas is not doing it guest there are 24 states that are expanding, and it is the west coast, the northwest, nevada, arizona, the southwest, and then along the eastern standard board, most of new england, many of the states in the midatlantic. That is about 9 Million People who are currently uninsured you will get insurance through the Medicaid Expansion. States that are not extending, about 21, also about 9 Million People, and this is essentially texas, the most number of uninsured people in the United States, primarily through the this is essentially texas, the most number of uninsured people in the United States, primarily through the midwest, the entire south, the deep south, montana, idaho, miami, and utah. Idaho, wyoming, and utah. There are some states that are still debating michigan, indiana, pennsylvania, a few others. I was thinking, where i want to be on january 1 is the four corners and with one arm in new mexico, another arm in colorado im getting this wrong arizona, new mexico, colorado, utah, and utah is the only one that does not have the Medicaid Expansion. Host there are differences depending on what side of the border you are on