Transcripts For CSPAN2 Capitol Hill Hearings 20130913

To how you will address these persons and their homeownership that has been acquired . Bootup and the unsophisticated borrowers . Im talking about those that happen to have high networks. Okay. High net worth lows. Yes, sir. It generally is an area of great concern. The jumbo loans are being offered now in the market, surprisingly, and i think borrowers generally take care of themselves and we have no problem with any that im aware of. Is there a requirement for counseling High Net Worth . I am not familiar with that. Thank you. The time of the german has expired and we recognize the gentleman from wisconsin. Thank you, director chairman and i want to focus on the data that we have touched on a little bit today. I want to give you an opportunity on how Many Americans we are collecting Financial Data from. How Many Americans they are collecting Financial Data on. I want to answer several different times. Okay. It is not the way to the question seems to ask. You have a number . Okay, we have some complaint data. Okay, so im going to bring it here, how Many Americans . We do not collect directly for Many Americans directly. Okay. We work with the institutions to understand how Many Americans are collecting the through third parties. Okay. We oversee approximately 110 large banks and a few Credit Unions. They have significant that is my question for you. It is not the way the work is done. It is like asking me if what is a the response, which is not quite the same thing. Lets go to credit cards. How many actual credit cards are you collecting . Credit card debt . Three different ways, one would be they make consumer complaints. Mr. Cordray i think america wants to know a number of how many you are collecting. You are giving me an explanation, but how many records does the cfpb collect for data . We do not collect any data from individuals about their credit card accounts, other than those who come to our consumer response functions. We are required to go to convert issuers to comply with the law, and we need to look at their institutions and practices to see if they are complying. Some of them have not. You monitor your credit card accounts . The monitor for your agency the credit card accounts . That is the third. There is Market Monitoring. On the Market Monitoring as we have indicated before and we have indicated to you, we are gathering sample data i still have time on the clock. Serve, in Senate Banking you are asking these questions. And you come today illprepared to give us numbers on the number of americans that have a Financial Transactions on national tv. I would like to give you expositions on how this works the. This is the transparency that you have promised. Okay, again, what we are doing in support here the time belongs to the german of wisconsin. If youre not going to give me a direct number, im fine with that and so on. Well talk about Financial Institutions. Will you give me the name of the Financial Institution for which you collect Financial Data, will you give me those names . What we are collecting and need to correct the premise of the question okay. Will you talk about how to comply with the law . Because they havent always complied with the law. There are 110 large institutions. The claim, mr. Director, is not being met. The American People do not know what the cfpb is doing. If you look at another agency, it is called the nsa. They collect american phone records and america has said that im all right having information about my phone records go to government. But i am outraged when the federal government takes information from them. And use it to protect consumers and uses it for the Financial Data that they have said that its okay for the Financial Institution to have. You are taking it and not giving them any transparency about the information and how much you are taking and from who you are taken from. That is incredibly frustrating. Why dont you just level with us . We have asked you these questions over and over again. You come in and you stonewall, but never does america get answered. If you want to make a speech, i appreciate that. There is no comparison between nsa and the nsa and the cfpb. Oh, no, there is. 60 Million Consumers have benefited from what we are doing. The numbers of consumers that have the data collections. They are 110 banks. I can name the number of them. Okay . We are looking at credit card matters with Jpmorgan Chase and bank of america and capital one and quicker matters with discover and american express. We are making sure that every single one of them are complying with the law. The time of the gentleman has expired. Chernow recognizes the gentleman from minnesota, mr. Ellison. Thank you, director cordray. Congratulations on your confirmation. And thank you also on behalf of so Many Americans who have benefited from the good work of your agency. Many of the funds have been directly refunded to consumers due to your work. And i think the questions that people want answered have been addressed. And they are pretty happy about the work you are doing in the proclamations in the name of americans. For example, the members of the United States military that fun at 6. 5 million for excepted problems. They are americans and they are glad that they got their money back. I have a close relative who is an 18yearold listed member of the army and every time he walks up by the agency, i dont want him to get financially caught up in because of your work, he is less likely to be. Also capital one paid about 210 million because they engaged in deceptive credit card practices and they have a little bit left that before. Also they have more than for private Mortgage Insurance Companies for legislative kickbacks. I do not begrudge my colleagues at all for asking questions and concerns to themselves to find out what congress is all about. But i just dont want it to be lost that literally millions of americans have been refunded because of their good work and i dont claim that they could work better. But i do believe that we got to an awkward start. As we have contemplated. There is no such thing as a republican or democrat consumer fraud. It happens all over this country, all the time, and no matter how you vote in the last election or how you plan to vote, if you are given full measured for your dollars, then the cfpb is well justified and i thank you for the work that you are doing. I would just also like to note that there are issues that we would like to inquire about. I would like to get to one of them. One of the things im concerned about is the credit invisible, these are folks that have come to our attention where cell phone records and utility bills were counted and maybe some of these people might be credit invisible and i could improve their lives and reduce the cost of purchases and even employment, which might change your good credit score, people might require that. Could you talk a little bit about how you see this issue and if anything, what the cfpb is doing about it or might do about it. Thank you, congressman. There are a lot of people who make a lot of payments in their lives and they dont seem to get much credit for when it comes to positives shown up in their Credit Report or boosting your credit score. We are very interested and we have been studying the impact of remittances. Some people are very persistent on how that could affect scores, rent payments and utility payments and the like, there is such an interesting pilots as to how we can do this better. Up until now, the credit tended to reflect only certain types of credit not to be as common among low and moderate income americans. Something of the market. So it is a good line of inquiry and something that we have to work with. The bipartisan bill that we have is the Technical Assistance on it. We would like to help people improve their financial outlook. I want to encourage you to go after the student loan, and this is a big deal. You mentioned the overhang on individual students and families. This is expecting them to do so when they. The chernow recognizes mr. Stivers. Thank you, mr. Chairman. I want to congratulate you, cordray, on your appointment. My question is about being a transparency, you are congratulated for your transparency, i want to talk about three things. One is the ig and some information on advisory panels and activities. With regard to your Inspector General, giving a brief answer, theyre kind of yes or no questions. Is the Inspector Generals wholly dedicated to cfpb . Yes or no . We share an Inspector General at the Federal Reserve. Is your Inspector General Senate Confirmed . Actually do not know the answer offhand. The answer is no. I didnt mean to answer a question for you. Fair enough. Given what the representative has talked about earlier with regard to ideas, i dont want to comment on either of those particular possible conflicts, but i believe an independent Senate Confirms that the ig is important because of the challenges with regard to having a budget that is not part of the normal process and then not having a void that only preserves the right, you know, the minority view in and giving a voice to that. Giving those things, its really important that we have separate igs so that we can keep it separate. If you could give me brief you could give me brief comments, i dont you could give me grief, tomato and issue sideways with the current. Two things, we have an id, that we share with the feds. Its very strong in the staff and they have been working to improve operations. Whatever congress devises is the numerous audits to the mandatory testimony in the senate making. You set up one for Community Banks. Thats great. Because you are essentially the sole federal regulator and the primary federal regulator for nonbank Financial Institutions, and because you can potentially regulate amount the business is referred to earlier. It would be great if you would try to set up ab advisory panel. It even if you set up with one with diverse interest. We talked about credit bureau. You have Student Loans and other financing agency. If you set up one for nonbank Financial Institutions. Even though there would be desperate interests. It would be great to have the input and feedback. I guess its more of an urging than anything. I would ask you to asker that. Consider. That i have one more thing to talk about. Thats fine. I responded to the letter. We have the see the daytoday. We are constantly dealing with the nonbank folks. We have examination authorization. We are seeing them daytoday. That felt different to me. Maybe if we talk about it. In multiple sources. They talked about. Sometime the activity you do the activity you might not like whether its specific car loan or online lending. If they are producting that consumers demand. Your activity can result in credit application that hurts borrowers. Im concerned about that. I want to focus on one piece. Do you think its froapt have nonwritten guidance that basically try to force businesses not have a banking relationship without any due process . Thing is happening. Im not understanding. Its not you. Its the fdic. Twisting some banks arm saying dont the particular type of company. They are following state law, should that happen . Shouldnt we make sure that you stated earlier. If people following up a lot t not a problem. People are looking in to and may be obviously a distinction between the Financial Institution whether the online lender is following the law. And what they know about each other. Those are the complexities we are trying to work through. The time has expired. The we recognize the gentlelady from ohio. Thank you. Thank you mr. Cordray for being here. Let me join others in congratulating you on the conformation. And also receiving the bipartisan accolades prior to your conformation when your credential credentials. I have three questions also. If you are aware the ag in ohio has taken an extremely aggressive approach to scrutinizing the reporting company for failing to investigate and correct and essential we all know how important Credit Reports are. He went so m uch o on rrd and drew attention from National Media saying that were breaking the law. Mr. Chairman, if i need to enter to the record. Without objection. A that happened in august around the last week of august. Let my say i appreciated your Immediate Response to that coming out with your release in strong words holding them accountable. I want to thank for that. Also, before i ask my two questions to allow you enough time to answer. One is to say i appreciate your deliberate detail and somewhat historical answers. Because there are at least a dozens of us woo are not here july 21st of 2011 when your agency went in to effect doddfrank. And if bemove forward. A lot of my colleagues on the other side of the aisle have wanted us to t very much appreciated that you help educate us on where we were. Secondly, had you had the opportunity to be here before when we were going through some of those questions and issues i think we would have been better served. Unfortunately you were not invited. I appreciate your bipartisan responses to some of the questions. Let me move forward for the financial literacy. As you know, the many changes we made in ohio to your leadership. I would like to go on in the record a bipartisan support to say i would like to join mr. Stivers working with you on financial literacy. I think as we look at our young folk they are the democratic engine to the future for financial growth. My question i can answer is on as you heard repeatedly on this side of the aisle our Ranking Member define we the opportunity work true that break even most recently had the opportunity to have a minitown hall meeting. Having a big interest in what happened with Small Businesses and Small Business owner can you help us. When we talk about women and minority and federal contracts of how you proposed to help us increase those numbers and make a difference. Yes, thank you for that question. Thank you for your comments. On the office of minority and women inclusion, which is what he represent. Im pleased to develop a deep respect. Whom you met the other day. The former commissioner of the eoc and thoughtful about the work were doing for the area. Theres three areas of work, first is, hiring practice of the different federal agency. Second, is contracting with the federal agencies. We have been mindful of that and made changes of our Human Capital and procurement processes to reflect the input. Third is the issue of diversity in the Financial Services industry i. T. Which is a broader issue. There are no tools given to the agency to affect that. It feels to to me thats going to a cooperative effort back and forth between the agency and the industry on the front. Were just working to, i think, finalizing a memo of understanding with standard within the next month or two. Maybe one month. And well move forward from there. Were mindful of our publications here. We take them seriously. I think its going to be interesting and important work. Thank you, mr. Chairman, i actually yield back my time. [laughter] the gentlelady from ohio setting a fine standards. The chair recognize the gentleman from pennsylvania. Thank you, mr. Chairman. Congratulations, director cordray on your conformation. Recent survey from the independent reveals that more than 10 of the Community Banks are indicating theyre not going to out of the mortgage lending business due to the how cousin the fact that the communityback the banks will be exiting the american access to credits . First of all, im not familiar with the survey. Ly now look for it. Icba . Yes. It would be unfortunate, in my mind, if Community Bankers who have been making loans typical according a responsible underwriting model that is safe and sound and often performed extremely well even during the worst economic crisis of our lifetime. Stop making mortgages because they have anxiety around the rules that i think is not justified. The smaller bank, as i said we have a special provision to cover them so they make loans and keep them in portfolio. They are kved mortgages with a safe harbor for litigation. It would be a bad business decision if they torp leave that money on the table and not make it. I think its important you reach tout them. They need to know. Some of them need know it yet. If i could talk about transparency issues. We are coming up on the anniversary with the death of president kennedy. One of the things ive heard about the administration was the Public Service. You look at some of his words, let the Public Service be a rode and lively career. Let every man and woman who works in any area of our National Government in any branch and level be to be say with pride and honor if in future year. I serve the u. S. Government. We remember ask not what your country can do for you. Ask what you can do for your country. President kennedy told the American People to ask of those Public Service the same to hold them to the same high standards of strength and sacrifice we ask of the American People. There was an ad on the american bankers website advertising employment. Not satisfied with your daytoday . Why not give Public Service a try . Take your private sec skill and put them to good use. Make a difference. Without comprising. Premium salary, and benefits. Now hiring all level of our supervisor team. The 741 staffers, 61 that make six figure salary. 111 make more than 179,000. 56 employees make more than 199,000. And 14 make more than 227,000. Which is how much does the cfpb bay bonuses in addition to the salary . First of all. Do they pay the people who are making these six figure and higher salaries bonuses . Yes or no . So, we have had limited supplement tal pay adjustment. It would be a bonus . I dont consider it a bonus. Do you know when they make at the department of justice. I know they are on a different pay schedule than the independent Banking Agency. I dont know what they make. The people who had the top enforcement jobs at the department of justice make more on the upside . And i believe many of our people would be making on the outside. They are making more than the attorney apt the department of the justice. Different people make different amount at different level. Do you know the top salary at the commission are making . The federal Banking Agency are at the different pay skill scale. One thing i want to know. The statute requires us law of the land we are frowned follow we are to have a say pay scale exrabl to the Federal Reserve. Last i checked on the statistic we are 1 lower average salary. What is your salary . Im willing to do that. Do you support legislation that sets the guidelines for the Salvation Army the cfpb . Congress set the guideline. They specifically provided in our statute that the other federal Banking Agency we would be on a pay scale. Would yo oppose legislation be comparable. Again, i dont know what level youre talking about. Apples to apple comparison. Im happy to talk about pay if thats an issue for you. We are trying carefully. The time of the gentleman has expired. I want to pick up on the line of inquiry mainly the relative layer Regulatory Burden on small institution. I actually dont think its rock science. I think its small institutions run on people. Big institutions run on processes, and fairly understandably cfpb regulatory approach is geared to process. So given what you are had said earlier about there being a lack of copiability on the part of Smaller Banks and Credit Unions to contribute to the economic crater we experience is there anything else that you can do that would ease that Regulatory Burden to enable them to continue to be a part of the rich fabric of Financial Institutions that offer services to consumers . Indeed, is there anything you can even say that would ep i think virtually everyone on the committee feel better that you were get this. In deed if you want to take today to announce the new initiative. Please, feel free. Thank, congressman. I think there are things. I have never worked in a big Financial Institution. Its not my background. Friem a im i commute from there. You go above and beyond. We do that because we want to serve the country and take pride in having a role in helping lead this country. N term of the smaller bank, they are the backbone of the economy in many part of america. We have a unique small Banking System in the country that is not replicated in europe, or most countries around the world. A banker official tell me recently in china they were curious how can they set up a Banking System 7,000 or 10,000 smawm banks. Its not easily done. It requires decades and decades of work. Its important for us to preserve that system, because i know in many small town if the local bank is not credit union is not providing that credit. Bigger banks dwoabt. It i was taken by your initial comment. Larger institutions tend to work on processes. Smaller institution on persons who often exercise a lot of discretion and judgment. The way they dpers historically has been sound and responsible and deserves our respect and admiration. Were trying to figure out where to make special exemption. We will continue to do that. I meet regularly with them to hear from them state institution, state association level, individual institution level, the icba, and credit union groups, and also our advisory counsel. Its something that i mean for this agency to be able to point to as a success not a failure. I appreciate your input to help this. Please hear us. Its universal. Maybe quickly on the qm. I have a sense you are had gone back and done a retrospective analysis how many loans made in the last few years would have been enabled or allowed under the qm. Im actually more curious, especially given the decision on qrm as to whether or not you have gone back and done any analysis retrospectively on how many loans would . Rot been allowed in the years of the a runup to the crater, and whether or not you think that would have helped us materially help us avoid bursting the bubble by having fewer people place in loan for which they probably shouldnt have been. Yeah. So two points. First, your question is, you know, how can we dont monitor how the Mortgage Market may be affect bid the rule and make sure were not having the affect that the kind mr. Chairman referenced. We have to have dated information. Theres no substitute for it. Cut us off having information we wont a good job. Youll justly criticize for us that. In term of the issue in particular, the qrm is a rule we are not involved in writing. There seems to be a growing proposal by the other agencies to conform that significantly to the qualified mortgage rule which i would assume is a compliment to the rule. We dont work with the other agencies to help them get it right in their judgment. Its not our rule. Not their rule. Were happy to work with them. Time of the gentleman has expired. The chair recognizes the gentleman from south carolina. Thank you, mr. Cordray, looking over the report something jumped out which was the section regard amount of money you asked for Federal Reserve for the First Quarter of the year. December 31st. You asked transfer of Federal Reserve for 136d 13 6. 2 million. It said you only spent 89. 5. What did do you with the extra . We make quarrelly request. I know what you do. Im not trying to cut you off. I want to have a conversation. Im not going give speech. What did you do with the extra . What im saying you need to look tat over time. Some quarters were aking for more because we spent more before. Some were asking for less because we spent less before. Its an ongoing. I think [inaudible conversations] thats why i went look at 2011 and 2012 in leading up for the request for 2013. In 2011 you asked for 161 and spent 123 d. Before so by calculations going back to the beginning of your existence you asked for roughly 135 million more than you spent. I want to know where the money is going. Let me say a couple of things. I first of all, i hope you understand theres a challenge to creating a new agency out of nothing. We had no agency, no personnel, no structure in anything in july of 2010. We are about three years old now. We have had something of a pattern in the early phase of the bureau of spending. In part because we anticipated hiring trajectory. Start to line up more closely. I think theyre beginning to line up more closely. The other people i want to mention. I dont have a second and Third Quarter numbers. How closely did they line up for the most recent request . The other piece i want to get on the table is were leasing a building that is apparently in need of substantial renovation. I understand that. We had timing issues we asked funds for that and the renovation wasnt to be proceed yet. Some of the numbers have looked larger than they turn out to be. Section 1017 which give you if anybody thought your ask was unreasonable who could make the challenge . I think we subject to oversight by the congress. The only oversight is the cap set every year. Im asking has your Inspector General asked you about the relationship between the size of your request and the size of expenditure . Were subject to gao audit every year. Were subject to an additional outside audit every year. Its law of the land. Dont care about that. Has anybody ask . I think its been asked several times and in the hearings asked before. Because people want to make sure, just as you are legitimately and validly asking now how is our spending natching up with the budget. And the reason i ask, mr. Cordray, the money comes from the fed. Money that could go to the deficit that you are sitting on. My clal collation is roughly 135 million plus interest. Again, there has been some underspend issue around hiring trajectory and timing of the building renovation that will smooth over time. As for us, we are like every other Banking Agency. But we have a hard cap on our budget. Which others do not have. Are you operating on a specific plan . Soon the building renovation i would rather spend zero dollars. I have to look forward to that. I want to fall on something brief. My understanding you have primary authority over the larger and some secondary authority over the smaller. Less than institutions less than 10 billion. Tell me, sir, how you handle your rulemaking Oversight Authority differently for the small institutions versus the large ones . And the specific example im interested in. Theres the prohibition on financing Credit Insurance premiums which understand tell me how you treat the two institutions differently in the particular circumstance. So, the institutions are treated dlircht differently in part under the law. We dont have any authority to exam any institutions with the 10 billion or less. We dont have any Examination Team go. Its a in term of how we write our rules adds i indicated in several respect we try to take in to account carefully of the smaller creditor ander that particular needs and the fact few employees cant bare the same complaint as 200,000 employee institutions as some of the larger ones are or even larger. In term of other things that something were trying to be careful about all the time. Thats why we have a credit union and advisory download help time of the gentle mab has expired. The chair recognizes the gentleman from colorado. Thank you, mr. Chairman. Mr. Cordray, ebbing anymorety and perseverance are the two words that come to mind. I appreciate the fact you have been very mellow under certain crossexaminings and being here as long as you have. Have three point. The first is the tight using the word optional. I just suggest that you remain that document be silent. If youre fortunately not enough to need a lender. You dont want some Hazardous Waste going across the property. I would suggest get rid of the option. On qualified mortgages, i think that the bureau is kind of a data limb ma here with the 43 dote income ratio. And the potential those loans remain either with the credit union or the small bank or the original Mortgage Lender because they cannot be sold in the secondary market. Which will then really reduce their liquidity and whey fear is that lower income borderers will be red lined. Theres a potential for discrimination at the same time trying to have legitimate underwriting criteria in place. I ask your bureau look that the closely. Ive had a number of complaint from small banks, credit union and others they feel like theyre in an impossible position. I think its important us. We made a commitment to monitor the effect of the mortgage rule as we go. If there is gse reform or other significant change in the market. We have to think about how affect the application of the rule. That again i want to stress it again. Thats why having the information and data about what is actually going on in the Mortgage Market is so critical to us being able to do that successfully and making sure things arent going off the rail. We are required to review the rule within five years in the law and consider updating or changing them as appropriate once we have more experience with them. We wont be able to do that if we dont have the information necessary to have i want you to have the data. You needed data to be able to do it right. You better watch it closely from the get go. I think its going to be a problem. Fair enough. Third thing, its the subject not come up yet today. Is marijuana in banking. And the reason i bring it up, is that in your position, and you also sit on fdic board or one of the other boards we have two states that allow for adult use of marijuana being washington and colorado. And twenty states that have medical marijuana. 22 states out of the 50 where there is some use of marijuana. Under the banking regulation wills its credit union or bank. The ability to provide Financial Services has been asked by some. If thats a consequence, everything goes to cash. When its cash, so you Public Safety problems. I think you were attorney general and your role you could see that. People are going to be more subject to robbery, obviously fraud. You cant follow the money from a tax point of view or any kind of audit trail kind of point of view. This matter came up before the Senate Judiciary a couple of dais ago the attorney general in their office has said we understand theres a banking issue here. We have sent you a letter on the subject. We would like for you to really be on it. We think its a Public Safety issue. We have 22 states. Something that has to be addressed. With that i yield the bans of my time to the rehabbing member. Do you apt brief statement. When you raise the issue of marijuana in banking. I was surprised but i recall the letter i saw. From ohio were not one of the states. Friend and center in my mind. The Law Enforcement piece would be. Yep. To the Ranking Member. I was hoping i would have a little bit more time. I think you have been so rudely interpreted on any number of issue you didnt have time to respond. I dont have any time to really give you. So well get with you to make sure that you get that information. I want to say i understand the member. This is overstieght. I take it very seriously. Its important to me. I understand the member feel strongly about certain issues. Sometime t not easy to give a simple answer to a question about complicated matter. I hope people can understand that. I know it can be frustrated. Thats not my intention or purpose. Im happy to work with you to see you have the oversight you want and need. The time for the gentleman from colorado expired. The chair recognizes the gentleman from new mexico. Thank you, mr. Cordray. Congratulation and condolences on your conformation. [laughter] i represent the mexico 50 of the loan for housing for trailer house. When your agency if they are misused they follow down. And for our five years any prospect of changing that . Thank you, congressman. This was an issue we worked hard under certain area. We come from an area of ohio i consider rural. Across the road. I come understand rural means Something Different from my experience. That would bring up the second point. This is the mexico. Thats right. We have 2Million People in the same side geographically as northeast 55 Million People live in that area. If you look over here in the corner here. Thats luna county about 2500 square miles which makes it larger than rhode island and delaware. Its got 25,000 people. Which means we have eight people per square mile. In new york, for instance, you have 27,000 people per square mile being treated the same here. Theres one road north and south one road east and west. In the one town its right in the middle. And being treated so that the definition of rural and underserved somehow doesnt play out. The county right here goes over the arizona border. Its got six people per square mile, and they are not declared rural in your definition. We put a twoyear moratorium on that. This will not be a problem for anybody in the county. We pulled it back. Anything done no. For two years we completely solved this problem. No lender has to worry about it for anything. Im asking about the loan made during the twoyear period. That extend. Any loan they make they make is not a problem. We pulled it back. Thats not my question. We consider it and redo the definition a way more aligned. We are happy to talk to you and your staff. Thats back off the table and reconsidered. Not a problem for people. The prevailing direction in the Committee Room on may 21st then she came in on july 10th to visit personally with. We havent heard any answers, i mean, i know you had time. But this is now dating back to may and july and still no answers on these things. Understand when you declare that banks will be okay. They hold thing in the port follow you. Understand that the portfolio for the average bank in the mexico is ownership days nap means question lend money for trailer houses for 70 days. We have to wait until those pay off. So when you treat the area of the west the same way you treat wall street, understand you have a war on the poor going on. That is who suffers. Access to credit and access to being able to borrow money to get in some used trailer house the one size fits all has been dissed a venn teenage use to us there in the poor rural areas. Some of the counties in mexico got 14,000 percapitaincome. As your make rule. It would have been nice to get the answer now. We have a good dialogue on the great thing. You gave high praise to un counity ba elling me telling me they are going to shut down and go out of business. Thats what im hearing across the state. With your high praise for them, understand that your rules are probably the one choke off the bank. No one from wall street is ever going come mexico and lend money for a trailer house. Well name point to retoast mexico Community Bankers association and get the word through them. I dont they smaller lenders should be making a decision to get out of this market. I think its a bad decision. Bad business decision. I want to make sure they understand that some of these anxieties are not in fact accurate. And were working to continue to address. It was not done correctly by us. We full back and rethink it. Were avoiding creating that problem. There are or things you tbroing our attention. Well listen to those as well. The time of the gentleman has expired. Recognize the gentleman from illinois. Thank you, mr. Chairman. Thank you, director. Appreciate you being here. A question about i know its a challenge in government have good staff and keep good staff. I guess it was a little while ago. The american banker said there was turnover expected. The sheer number of senior officials leaving worries bankers. They wonder who will fill the vacancy and how the new management will treat the industry. I think theres a concern of number of people leaving. Your organization. The cfpb and concern taking the positions. The other thing that im concerned about is expertise and not having a background in the industry. I also know there was a in twelve how satisfy with the training of the only 28. 8 . One of the quote i heard from the bankers very frustrating when ive in the business for decades. And somebody playing hack i can sack is regulating my bank. I have some question. Playing game on the quad two years ago now is a regulator over my bank. Thats a concern ive heard over and over again. I wonder if you could respond. Theresst theres reporting off base. There are people who have come and go from time to time and when they go they are replaced were finding they are equal quality and as good or better. We get hundred of resumes for every opening. Weve actually been able to recruit effectively. What im hearing its not the case or the perception of the people being regulated. I have another question. I know youre working on mortgage rulemaking. The merging of mortgage disclosure to one document. It was the proposed rule over 1,000 pages and effect everyone involved in purchase home buyers, lenders, realtors. As i understand it given how much Technical Work getting everyones system updated and ready. I would like to think it would be impossible have it implemented before january 14th. Is that true . The rule of the one of the special mortgage rule. I wonder what efforts youre doing taking to minimize the cost on the rule on Small Businesses. Yeah. Thank you for the question. Just as youre hearing about it were also hearing about if. We try to think about exactly what purpose that serves and. Obviously the point i know is to create some uniformity so there is more comparison an analysis of the market. Whether its needs to be done now. My time is just about over. I hope you look at costbenefit analysis that doesnt happen enough in this. And have any impact on Small Businesses. Thank you, chairman. I yield back. The time is expired. The chair recognizes the gentle mab from florida. Thank you. I want to talk about to you pay done loan or advanced product. How do you feel about those particular products . Payday loans . Yes. As we all theres different way of providing it for tight loans. They are mechanism for credit that they find necessary to meet particular situations. They are often a very high cost loan, and we did it white paper we put out in the spring that analyzed the market pretty carefully. The details of the data that you use losed for that. Have you released any yet . We published the paper. The data. Upon which the paper relies. The data it you collected. Theres not a privacy act. What privilege do you assert. Business information. There may be trade secret issues there. It was provided on confidence. It wouldnt be published. Theres just some concern. Did it take in to consideration just one time user payday loan as opposed to a frequent or repetitive user for payday loan. Did it take in to consideration all states and programs they have. We did, in fact. The website you have on pay loan have particular graphic. Would you take a taxi on as Cross Country trip. It discusses the median loan, payday loan. Medium number of transactions per year is 10. The data based on data from the white paper . I believe so, yes. Dont you think that the integrity of your report the white paper i. T. Is tarnished as a result of not disclosing the data . Look, we cant also disclose data. What we can do analyze and provide the conclusions. Its my understanding youre going refuse to disclose data. Ill have my staff get back to you. Thank you. There are i understand that. You would agree theres a market for payday loan not being made. For lending institutions . If we [inaudible] overregulate the good players they get out of the market. Where is the demand going to go . Most likely offshore. Most likely on the internet. Youre not going to eliminate demand because you eliminate the supply. There are 13 states that bar payday loans. They dont allow lending. Good point. When i was in the legislature in florida we addressed it. We have by far the best regulatory scheme. We address every issue and i would ask you please take a look how we address florida. If i might share. If i can help. The they took the data and analyzed it for florida in particular. Maximum fee is 10 plus a fee. I wish that they could put that on a credit card. Even have to wait after paying that off . The minimum loan inseminate come at a max is 31 days. There is a system that works and it works effectively and i would only ask that you take a look at that and use that as your model. I thank you. And actually that comparison will help us to make judgments about what will work or not work in the country. I just want to point without the data, we cannot have any idea what to do about this product. We have to have that data and florida provided it. It is very helpful to getting this right. All members have been heard. I would like to thank director cordray for his testimony. All members will have five days to submit additional written questions which will be forwarded to the witness. We will ask you again, mr. Director, to please answer fully and promptly. Before the five days pass, we will smell the we need an answer everything that we can. Thank you. The legislators will have five days to submit material including in the record, this meeting has stand adjourned. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] coming up on cspan2, a senate house subcommittee examines dental health costs. Health care amendments are offered on the Energy Efficiency bill, and later, Richard Cordray come in ahead of the Consumer Financial protection bureau, speaks before a House Financial Service committee. We continue to discuss this on her next washington journal. Bill kristol is talking to us about the divided within the Republican Party over u. S. Military strikes. More about syria as well as funding the government and the attempts to repeal the health care law. Our guest is ben bernanke. Washington journal is live every day at 7 00 a. M. On cspan. It is something we discuss domestically and internationally. There are footprints that are left regarding the haters that the one that something is going to occur. One of the reasons that the changes need to be made is the posture has been made and continue to look at this and we need to move to Continuous Monitoring and after that we need to continually look at the precursor or the context that is being set for an attack. A lot of that has to do with analyzing social media. We are never going to it defeat the cyberenemy, whether its a nationstate. We clicked the box and we did everything that congress wanted us to do. There has to be timely and continuous information sharing. Both within the federal government, particularly the dhs and then vertically down to particularly the private sector. After all, the federal government relies upon the private sector. As we come in the Senate Homeland Security Committee looks at where the next homeland threat may come from. Saturday at 10 00 a. M. Eastern on cspan2s booktv. A separate life hidden from family and friends and the story of americas first female rocket scientist, mary sherman morgan. And live on American History tv, commemorating the 50th anniversary of the 15th st. Baptist church bombings. Starting at 11 00 a. M. And throughout the day live from birmingham, alabama. A letter was received on thursday with conditions on the global treaty. And if Cabinet Meeting on thursday, president obama told reporters that he is hopeful that talks on syria between secretary john kerry and his russian counterpart would yield concrete results. Thank you, everyone. Well, obviously we are missing a few members of our cabinet here today, in particular john kerry. He is overseas meeting on a topic that we have been spending a lot of time on over the last several weeks. The situation with syria and how we can make sure that the chemical weapons are not used against the people. I am hopeful that the discussions that secretary kerry has with the foreign minister as well as some of the other players in this can yield a concrete result and i know that he is going to be working very hard over the next several days. Especially to see what the possibilities are there. But even as we have been spending a lot of time on the syria issue, making sure that International Attention is focused on the horrible tragedy that occurred there, it is important to recognize that we have a lot more important stuff to do in this government and the American People are interested in making sure that our kids are getting the kind of education that they deserve and get people back to work. We are dealing properly with a federal budget and the bills are getting paid on time and in every agency, with it running the way it should, making sure that our constituents and the American People are getting a good deal. So we will spend time here today talking about all the efforts that have been made to streamline operations and to cut out waste and improve performance and to improve customer satisfaction. We will focus on specific issues, including managing budget debates over the next several weeks. We have seen some tremendous progress over the last several months and we are confident that starting at the beginning of next month, people start signing up for health care in many cases for the first time. And we will spend time talking about issues like comprehensive immigration reform, that are still part of making sure that america works. So i definitely appreciate the work that everyone has done. Some of the numbers are still relatively new, but thanks to their confirmations and i know that they are hitting the ground running. Thank you very much, everybody. [inaudible conversations] thank you very much, everyone. [inaudible conversations] thank you, thank you. [inaudible conversations] sunday, Vice President biden is the speaker at tom harkins annual steak fry in indianola, iowa. Starting at 3 00 p. M. Eastern on cspan. Coming up next, better access to health care and dental medicine. You can see a live friday at 12 15 p. M. Eastern here on cspan2. It is different than earlier president ial health. They did not try to be selfsufficient. So they did have the access of living there and they said their horses grains and reduce the cost of having horses there. They did have a Lovely Garden that produced everything from corn to strawberries. They had an arbor that had eight different kinds of berries, and greeks and the idea was to reduce the costs of maintaining a property like this. Watch our program on Edith Roosevelt at our website at cspan. Org first ladies, or see it saturday on cspan at 7 00 p. M. Eastern. We continue our series liveness money as we look at first lady helen taft. According to a new study by the ual, more than four out of 10 adults surveyed took trips to the dentist because they lack Health Insurance. Thursday, a Senate Health subcommittee held a hearing on the high cost of dental care. This is one hour and 20 minutes. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] thank youthe hearing of thee subcommittee on primary health and aging is going to begin. And i would like to take this opportunity to thank all of the panelists who are with us today to thank cspan for putting this issue across the country and to thank my colleagues that are coming in and out as well. In the last couple of years, we have had a lot of discussion in our country about a dysfunctional Health Care System in which some 50 Million People have no Health Insurance. We have a crisis in primary care, and despite poor outcomes we spend almost twice as much on personal health care good people of many other countries. And its about the discussion of health care in general, we have forgotten that we pay very little attention to an element of health care that is enormously important to all americans im glad that we can see this. Im glad that cspan is here and everyone is here. This is an issue that needs a lot of discussion. Lester held a hearing on dental care where we learned that in the United States we have a major crisis in terms of health. Specifically oral health. That is middle americans, racial, minorities, pregnant women, those who live in the rural communities, for example, low income kids. So we are trying to prevent cavities and a lower income adult is more than twice as likely to have had all of their teeth removed than an uppermiddleclass at all. All only no all over this country there are kids who are home today and not going to school because they have serious toothaches and we know that this is a major problem. What we also found is that in america today, millions and millions of people live in towns and cities where it is difficult to access the dental care. We learned that about 70 million lowincome children receive no dental care in 2009. We know that this is a mind blowing statistic that one fourth of adults in the United States, aged 65 and older have lost all of their teeth. What about that . Well, we learned that lowincome adults are almost twice as likely as higher income adult go without a dental checkup in the Previous Year and add dental Health Impacts Overall Health and increases the risk of diabetes, heart disease, and poor outcomes. We learned that they are all of 833,000 visits to Emergency Rooms across the country for preventable dental conditions in 2009, a 60 over 2006. In other words, when people are in agony, and their only alternative is to go into an emergency room which is by the way very expensive dental care and the people in the emergency room are not trained to deal with the dental problems and pain relief and that is how we are spending money on dental care. Im a 60 of kids, ages five to 17 have cavities, aching tooth decay five times more common than asthma at children of this age. Nearly 9500 new dental providers are needed to meet the countrys Current Oral Health needs, however, there are more dentists who are retiring each year than there are dental School Graduates to replace them. They not only have High Economic costs to individuals in our country, and over 100 billion are spent every year on dental services in the United States, over one third of these expenditures are paid out of pocket. Until outofpocket spending a second to spending on prescription drugs. In addition to the billions, billions are lost in the school day and lost Economic Opportunities due to dental pain. Tragically, sometimes people become extremely ill because of oral infections and on occasion, people die because they dont get the oral care that they need. Let me be clear that we are paying for this dental crisis now in an unjust and also somewhere we spend money on those who come to our hospital Emergency Rooms and suffering and people get the care they need before its too late and i believe that making sure that people can get to this effort when they need to will prevent not only a lot of suffering, but at the end of the day, it will save our country money as well. Interestingly enough last year, i asked the people of vermont and people all over the country to send me their stories about problems and we were just blown away by the kind of response that we got. We have 1200 responses. People are never asked to talk about it. And we hear about people that are in pain, it was really quite something. So i think that we have a real problem that needs to be discussed. We have talked about that insurance covers the need. It often pays for a relatively small percentage with insurance, the average benefit the past is just about 1500 per year. We will understand why dental care is so expensive. That 1500 coming to understand that a tire, is not one to do it. People of dental insurance or for four more likely to see a dentist and those who have no coverage at all, more than one out of every four americans do not have any dental insurance, and i see this every day and seniors often come up to us and say why his medicare not covering dental services, and it certainly does not. Im chairman of the veterans administration, and i can tell you that right now this is an issue that we are working on. Except for Service Connected problems, and states can choose whether their Medicaid Program provides coverage for dental care and lowincome americans have no dental benefits or can receive services and it is unacceptable that millions cannot get the care they need to live a healthy life, dentalead e pain and another issue, the stigma of missing teeth. What is that about . What do you think my employer is going to say . And so when you have no teeth in your mouth to my flickr for for head saying that this is a poor person that we dont want in our workplace. This is often the case and the problems are far more acute lower the income. With many people with medicaid, it is almost impossible to find a dentist that will see them. Even if you do have medicaid, it is impossible to find a dentist that will serve you. Only 20 exhibited only a small percentage of them dedicated significant portion of their practice for the underserved. When asked about the high cost of dental care, i am often reminded that most work in small private practice is practices where the overhead is high in dental school is extremely and it is outrageously expensive, hundreds of thousands of dollars in debt. But in a report, the Government Accountability office found wide variations charged by dentists. Eight of 24 common procedures, those charging at the high and charged more than double what those with average these charge. Its a whole other issue as to why the cost is so expensive and the discrepancy the crisis that we see all of the country. There is good news out there and we will hear the good news today. The good news is that we are making progress in expanding where working people can get access to dental care. In federally qualified Health Services, providing more than 4 million americans across the country regardless of their ability. Many work very hard to expand this to the tune of some 12 or 13 billion of money of International Health services they are funded by the government more than 90 have incomes under 200 or below the federal poverty line and other models that we are seeing, and i hope that we can discuss this today, we are having some success with 25,000 people getting their dental care now. We have established schools as well and clinics. And they are working really well in these two locations where kids have taken this Dental Clinic and in some cases the adults are coming in and in some cases we need to talk about that. Later this month, i intend to reintroduce the comprehensive dental reform act, and this bill addresses the dental crisis in america by expanding coverage to people with medicare and medicaid and Veterans Health benefits and the Affordable Care act to increase the number of people with insurance and expanding number of places where people can see care and enhancing the workforce and improving education to respond to the needs of the underserved. This bill will cost a great deal, and we have already included emergency room visits and productivity. The bottom line is we have a crisis in this country in terms of dental care and we are wasting huge amounts of money and it is time to make sure that every american gets the dental care that he or she needs and to make sure that we take care of the kids. We are going to have to make an introduction, please. Estimate by committee staffers. I can stay for a little while. Thats great, thanks to have you. I want to thank you, mr. Chairman, for holding this very important hearing. The longstanding commitment to extending quality affordable dental care to all americans is very important. Far too Many Americans do not have access to care. One of my constituents recently wrote to me and said that american dental care is unfortunately stratified into buckets. The haves and havenots. For those who currently lack access that promotes policy, including federally qualified benefits. Mr. Samper has been instrumental to demonstrating vulnerable populations in areas and we have seen that demonstrated models. And for the haves, that care has grown significantly over recent years putting a lot of stress on middleclass family budgets. We have to do all we can to address these increasing costs. Especially when it comes to economic security. The major opportunities exist at this moment reforms is what we need to focus on, especially reforms delivering health care and Higher Quality at lower cost. This is an integral part of the changes in the reform. Thus ensuring access to dental care must be a major component in Preventative Services so that we can save costs later by helping people avoid developing chronic diseases. Secondly, dental care should become more integrated into health care models. We need to tear down the artificial barriers with dental and medical and they have many artificial barriers. By delivering more integrated costs and quality of care, i look for, mr. Chairman, with todays panel and i would love the opportunity to introduce my constituents when that moment arrives. Thank you very much, senator, for your hard work on this issue. Let me introduce our panelists. Our first witness is doctor frank let me introduce to you Frank Catalanotto, he is a doctor at the university of Florida College of dentistry and vice chair of oral health america. It is my great privilege to introduce mr. Tranfour is my great privilege to introduce doctor greg nycz. He is part of one of the largest dental practices in the nation. In the largest provider of medicaid patients in the state of wisconsin. Many have increased this care through this work in my home state. Mr. Greg nycz, i look forward to your testimony today. Mr. Chairman, i will have to leave midway through the testimony. Thank you so much for being here. The social worker from Falls Church Virginia who has seen firsthand both personal and the professional side of needing to increase access to a portable dental care. She received a master in social work from virginia commonwealth university. We thank her for being with us. Cathi stallings, welcome. Our final witness is debony hughes. She is a doctor that has served as the program chief of dental health since 2007. She oversees the dental product and she also serves on the Coalition Board in vermont. Okay. Why dont we begin. First we need to focus on attention of a crisis that we do not have the resolution to the needs. That is why we are here to talk. Hello, my name is Frank Catalanotto and i spent almost 40 years in dental education. I have been advocating for a better way to deliver oral health care, there are several indicators about this access problems that i would like to mention. First, dental clear utilization has declined about 10 among low income people. Primarily for cost. Second, we have made some Good Progress in improving access to care for children, but we still have approximately 60 of medicaid enrolled children who are not receiving the proven cost affected dental services. And third, hospital Emergency Dental problems have increased over 830,000 visits in 2009 alone. What are the effects of this lack of access care . Two examples, children who miss school because of dental problems do less well in school than other children. Education is the way out of poverty. The children in pain cannot learn. Second, a recent study from 2008. 61,000 patients across the country, including preventable dental inspections. Sixtysix deaths. Sixtysix deaths were reported in the study an estimated 640 million. This is not a personal tragedy only, this is an economic loss. And they actually do provide care outside of school and communitybased settings as well. Dental education is very lengthy and expensive, and they make dentistry is very expensive part of the health care team. Many dentists provide highquality dental care unfortunately many of these dentists do not participate in the programs. There are many reasons for this, including low reimbursement rates. But no matter the reason, this reduces pro bono care and i would remind you that this is wonderful and philanthropy is not Health Care System and does little for longterm health care. Another concern is restrictive date couple practice acts that do little to protect the health of the public. What are some of the potential solutions to this problem . A new dental workforce model. This includes care and they have been employed in over 50 countries for over 90 years and they come from the economically Diverse Communities they go back to serve. They are currently in alaska and minnesota and there are at least 15 other states working to include them as they have been brought by restrictive dental practice and at the National Level as well at the dental association model. In most of the cost of Cost Effective manner is in a large setting providing lower overhead and a traditional single dental practice, thus reducing cost. One example that you hear about and we will discuss it in a minute, and another is providing comprehensive care and in the past eight years they have grown to nearly 500,000 including ebonyevidencebased practices and a community outreach. They have reduced costs of the Medicaid Program from an average annual cost of 328 to 125 in 2012. This is a remarkable difference Business Model that takes care of patients and we need more of these around the country. There are some states that have a restrictive general practice that will not allow some to be owned by a dentist. This is ludicrous because many are run by mbas. In closing, i would like to point out that this is lobbied by many members of the dental industry. For oral Health Services and pain and suffering an increased ability to learn and work and for lower cost. I would suggest that we need you in your leadership roles in congress to fight for those patients. Thank you very much, senator. Thank you very much, sir. It is nice to meet you. Good morning, senator, and thank you for the kind introduction. I want to thank the subcommittee for the opportunity to testify today on a topic that i am passionate about. The need to improve access to dental care in our country. Im here to represent a senator that serves a large return in wisconsin and the state of maryland. About one third of our residents twenty years ago i serve at the Wisconsin Dental Association access to Care Committee is only dentist. In that role, my phone number was listed as a researcher people seeking dental care. I took many calls. When it picked up the phone and it was a young mother failing to hold back the tears as her child screamed in pain and sobbed uncontrollably. The mother broke down and she had been trying for days, calling over 30 that officers for help. Someone who could stop her childs pain. But what made this a life changer for me is that i came to realize that as i spoke with her, she was not just bearing the burden of her childs pain, but also the selfimposed pain that came with her conclusion that she was a failure as a mother. And im proud of wisconsin in my country, but none of what that mother was wondering because it was also preventable and there was no mystery associated with it. After a decade of trying to improve the system using traditional hall, my boards and find another way, this is your top priority. Ten years later, i brought a picture to show this but we serve nearly 100,000 folks and even we were surprised by the enormous response. The patient origin map shows it in spite of the fact we have seen residents in every county in every zip code in our state. When we establish our clinic, over 1000 people traveled over 112,000 miles to get care, mostly from the rhinelander area. We have a clinic in rhinelander as a result of that. The folks who lacked access for those on medicaid and the uninsured poor we knew about. But what surprised us was that veterans with limited incomes could not get care. Today they now have a place to go. Those who journey the farthest are disproportionately people of all ages who have emergency needs. As well as caregivers who bring their disabled loved ones for care. Another group that is left behind. Recall a quote from alice in wonderland, if you dont know a row, and he will get you there. We knew that we would need societal investment, so we have been relentless in looking for ways to maximize the value of our efforts for the taxpayer and not just the patients that we serve. We learned that we could improve the performance of our job Placement Agency by making job seekers with horrible world became more presentable and employable. One of the counties was that they have about 100 such adults every year. We learned that annual savings on the medical pierside, possibly in the range of two to 3000 for a piece patients with diabetes if we give them to dental care, and he learned to be a real alternative to the emergency room in the hospital by opening our doors to patients to those with emergencies from across the state. I would like to leave you with three dots. First, that we work to change our nations perspective of oral health in its own right, and the value that oral Health Brings to dental health and general health. New graduates need to be better prepared to treat people with complex medical conditions. Third and perhaps most importantly, at the Community Level we are seeking to accomplish this by pursuing an integrated medical and dental model that leaves no one behind. We are solving health care for dental care one community at a time. But over 300 of us are meeting unmet needs, and unfortunately this includes 600 million from private funding and there have been no extensions since then. The Nations Health centers or your Health Centers. This includes the oral Health Disparity problems from a growing number of our nations communities, and i appreciate congresss continuing to give efforts to give us more work where there is more work to be done. Thank you very much, sir. Good morning, chairman sanders and distinguished members of the community. I am here as someone who knows firsthand the dental care is a luxury that millions of us in america cannot afford. I have paid many thousands of dollars for dental work and need much more. I personally would focus on this issue because i am not able to afford to pay the exorbitant cost for the dont work for many. Since finding out the extent of my dental me, i have spent many dark hours wondering how i will for my future. Several years i took at a bank loan to pay for a bridge that i needed. I was told a few months ago that the bridge needs to be replaced. Quoted a price of 7000 for that. The periodontist said that he would give me a discount, but it did not matter because i could not afford that either. I have quite a few other dental issues. Insurance covered with my job covers 1299 per year, which does not cover the company or anything else. Crowns have included me up to 2000 each. In the past two months i have needed scaling for gum disease and an emergency crown, won one of my teeth cracked. As a social worker i work with severely mentally ill clients, many who cannot afford dental care for many years. One issue for them in that numerous medications cause dry mouth and there can be a severe effect with some medications as he usually takes more than one medication to treat the Mental Health symptoms. Including treating cavities like gum disease and the cleansing antibacterial action. One Mike Weinstein up two weeks ago that he has three accesses and his remaining seats. His medicaid benefits only provide extraction of teeth and no dental services. Said he doesnt know how he will be able to eat. Another one of my clients received funds of 220 per month to live on. I gave her information about the dumbest that has been able to give her free xrays. The total price was quoted to her was 1600. I then directed her to a lower cost dental service this summer and she was told that she would win total number since there is a waiting list. I was told by another client that in 1999 he has had 11 cavities and he has never been treated for dental work and in all these years. He said that i guess im on my way to a root canal because i can feel the sensation in my mouth. I had an extremely unusual birthday this year. As i was preparing to go out and celebrate with my mother, i heard on the news about the mission of mercy clinic where mercy General Services were being provided and i ran out of my home and met my mom outside and pulled her that we have to cancel my birthday, i have to go to maryland. We went and were told that they were full for the day, but i try again tomorrow. I knew that dental care was much more crucial than celebrating my birthday and and for that reason i went back and arrived around 8 00 p. M. I was number two in line. I was thinking that i wish i couldve brought all my clients with me. Many others started to show up as time went on. We shared stories of dental nightmares and i spent the night on the sidewalk, but i didnt mind because it is a great birthday gift. It turns out that the gift was over 400 volunteers in action giving their time and hard to provide over 750,000 worth of free dental work that weekend. I wasnt able to get the dental services that i are searching for, as they were able to do specifically what i needed. But i came away with a scene that i will never forget. Men and women of every race and creed and color lined up for what seemed like a mile in dire need with the hope of being helped. It was truly heartbreaking for me to see. I have learned that the al lack of adequate denture care can lead to chronic heart disease, diabetes, and stroke. These risks are scary for me and so many others. You have the solution in your hands. I am a social worker, these are my clients. But on this issue, all of us are standing together in the same lines, looking for help. I beg you to pass this legislation so that health can be provided to all. Thank you for your valuable time and attention to this critical matter. Thank you very much. Good morning. I think your microphone may not be on. Oh, okay. That morning, as the senator sanders said, i begin my prayer in Public Health 21 years ago in vermont. For the past seven years, i have been the program chief of the dental Health Program for georgia county Health Department. In the last fiscal year we provided more than 3200 clinical visits to children and pregnant women and we provide Oral Health Education across the county and work with Community Organizations and patients and clinicians and Community Organizations that have given me insight on the state of all health care locally and nationally. I would like to thank senator sanders and senator burr for this opportunity to share information about the climate and landscape of dental access and cost issues in my jurisdiction. Let me begin by telling you about experiences that inspire my remarks and work. In vermont i lived in a small town of approximately 8000, and there were for dental offices. At that time, vermont was eligible for medicaid but did not have access to any of these services. With the help of a Community Organization we were able to provide care for medicaid eligible residents. The Health Department provided a similar safety net for dental care. Recently i participated in my First Mission ever see. This twoday event provided free dental care to uninsured adults, men and women camped out overnight waiting to be served. Many receive quality care. The patient should not have to endure such conditions to receive treatment. This experience affirmed my belief that dental care is not a luxury, but a necessity. And we must make it accessible to all adults. Achieving this goal will be difficult if we are unable to address operational costs as well. Of course we cannot talk about the high cost of dentistry without acknowledging the cost of dental education. It is not uncommon for a dentist to graduate with a debt of over 200,000. Arguably, education costs are large. But operating a practice is the true cost driver. For example, it could cost up to 500,000 for equipment alone, coupled with the escalating cost of salaries and insurance premiums and dental supplies and Laboratory Fees which are largely unknown to those outside the dentistry field in the practice can expand the cost. My clinic recently had repairs on an extra unit and the labor fee along with 295 per hour. Many consumers that have neglected their dental care, extensive treatment is also required and can be expensive. According to the American Dental Association 2011 survey in the south olympic region, the average cost of a root canal is 1075. The fee increases an additional 1079. Less expensive option is to have your teeth pulled, and this can lead to problems with chewing and speech and the parents and this is the question that i cannot answer a demo can be changed, but it is important to know what drives the cost. I think about education and prevention and outreach prevention and providing accessibility to care. In prince georges county, there is an established medical and dental care is provided to public schools. The county Health Department operates the dental project, which is a mobile unit funded by the maryland for a hlt care of children. We address the needs and provide resources to establish a dental home. We work with the schools of the service to provide a researcher families that will continue to make dental care to easily acceptable. The project provided care to more than 2300 children on a budget of 180,000. They are certainly a model for providing affordable dental care. Prevention and prevention is an important aspect. After the death of the care, the governor assembled a premium program. The Maryland Action Coalition received 172,000 from the Kaiser Foundation to develop a demonstration project to determine the feasibility of this type of program. It showed that it is vital to have a presence in the school. Of the 3000 children screen, 200 were in the number eight category, which indicated that they have an immediate need, even multiple decayed teeth. It is these types of programs that will address a portable accessibility. We need a Strong Financial commitment to support the Health Infrastructure for the council needs of all americans so they can be met. Thank you again for the opportunity to address this crisis. Thank you very much, doctor he was very important informatin that was given. Thank you so much. I would like to ask each of you questions at the end of the response, if you want to comment, that would be great. Let me ask you a little story about the model. About 45 years ago, i moved to a small town in will not vermont. Maybe 10 years of age, all of the teeth in this little boys mouth were brought in. It turned out that he was certainly not unique. We have a major problem in vermont. Over the years in our state, we have made some significant progress, primarily through qualified Health Centers in 43 locations around the state. This includes about 25,000 people that are getting treated regardless of income at the Community Health center. We saw great satisfaction in the low income areas. The towns of richard and burlington and we have state of the art dental services. It is fairly Cost Effective for every member to practice. Now, what we have learned that every time you build, its like if you build it, they will come, like the baseball field. What we have learned is you build the Dental Clinic and people come. Doctor Frank Catalanotto, is that your impression that the need is out there that we build that the people will come . Absolutely. I look at my own example from working in florida and a dental school is very large and we had patients travel two hours away and they cant find a formal care in their communities. Next to the state capital of tallahassee, on the way we did the exam, one in five children report obtained that day at the exam. One in five children . One in five children about five years ago reported pain. One in five children. A young graduate of ours went to the Health Department and took a job. Shes a pediatric dentist who gave up what she could have made in private practice to work in the Health Department and overnight she made it a major success and large numbers of patients. So yes, the need is out there and people will come if provided access to the services at an affordable cost. Access to services are a great partner in doing this. All of my dental students at the university of florida spent approximately six weeks of their clinical year in and fqac. It is because many of the students figure out that this is the private practice the date plan on practicing that they decide to go to public practice. Is between you and me, yes i have the impression today that it is no secret that there are dentists who are making a pretty penny at treating the uppermiddleclass. If you look at the yellow pages, a beautiful smile and all the cosmetic dentistry. We have a lot and the kids are still in pain. Bs. What we do and what ideas do we have . What do we do to create the kind of dental workforce that we need so that we dont have to be embarrassed that their places in america in which there are not enough that are trading lower income moderate people. We do need to include medicaid reimbursement in the United States and the result is only 10 say that again because i want everyone to hear. One in 10 dentists will take medicaid patients. Yes. Because we have some of the lowest medicare reimbursement in the state. Number two, i think that there is very clear data like scholarships and loans and forgiveness programs which are wonderful. Theres some states do have and we do not have them in florida and im happy to say that it is lobbied by your state legislators and many of them are to keep to do it. And this is the longerterm solution. Third, title vii Funding Provides grants to dental schools to help change the culture of dental school and dental students. They focus on disparities. Im the principal investigators of one of those grants at the university of Florida College and we have an upwards curriculum to produce a more cultural competence, sensitive to the needs of the underserved patients and have more Public Health experiences to add to the faculty so that secondyear dental students can go out to schoolbased setting where they understand going to school for poverty, they see the picture early in the dental education with a goal and they hope to become more sensitive to this issue after they graduate. Are you funding, and we have the same issue as primary health care. That we have doctors and young medical students. Given the opportunity, we would be able to attract young people to serve lower income folks . Yes, there is no doubt from what i hear. The students are working for us and they are seeing the problem, they have a better appreciation of the needs of these kinds of patients and their going into the settings. Yes, sir. Well, thank you, very much. Senator franken, i want to be able to say this right now. If you want to jump in. Okay, i want to follow up, and thank you. Thank you, mr. Chairman for inviting me. It is so important is a hearing. I want to pick up where you are on dental care in minnesota. We became the first in the nation to create a license for advanced dental provider focused. This was first started in the United States and alaska. To address the population there. Including on dental providers and youd really only get a dentist once a year would fly and for a couple of days and now they have dental therapists and other individuals have dental therapists, i guess the last ones were trained in new zealand or something. There is a doctor do you pronounce it as Frank Catalanotto . Gets. Doctor Frank Catalanotto, in regards to the National Dental care crisis, we were just talking about this limited access to dental care. That we have some wasteful spending. The gao reported that only 62 of americans have dental coverage and only about 40 of people have a dental visit in any given year. And you also noted that one important way to dental care is for states to consider this like minnesota. Could you elaborate on that. And what can we, in congress, what can we do to support the expansion of that program and of the number of Dental Clinics. That is a great question. I have been to alaska three times, looking at that, i have talked extensively with the folks from minnesota that have both trained dental therapists and employed a dental the dental therapists. Last week i testified to the new Mexico Legislature and with me was one of the folks that employs dental therapists in minnesota. I have read most of the literature on us and i am absolutely convinced that this is a costeffective and wonderful model to deliver care to people in need. The beauty of dental therapists is they can do the kind of simple procedures that a dentist might do, that allow for them to work at the top of this scope instead of the bottom of the scope. They are inexpensive to educate and they usually come from the community and go back to serve the underserved areas. They are a wonderful solution and the difficulty comes at the opposition which i think is your question. At the state level, it is a restricted dental practice that prevents these individuals. Approximately 15 or 20 states are now disclose to get dental therapists in their state. But i would also add that its not just dental therapists, these practice acts also prevent dental hygienist who are experts at providing services needed. They are restricted from working at the top of their skills across many states. At the federal level, the impediment that currently exists is that language was inserted into the Health Service reauthorization just a couple of years ago that prevented the first folks across this country who want to prevent them from doing this and this includes language that says they cannot use federal funds. This is an affront to the sovereignty of the nation. That is something that you could do at the federal level. Its not what you can do at the state level. It is the individuality of dental practices. I just think that this is an incredible, and mr. Greg nycz, would you hire a dental therapists many do what they are allowed to do as well as dennis. Am i right . Yes, that is what the evidence shows. But again, because of the state laws, we do not have access. And, there are not many of them either. I would like to circle back to the chairmans point about if they build it, will they come . Welcome to map that shows we are taking care of close to 100,000 people that have come from all over the state, and i would add maybe 141150 from the good state of minnesota that have come to us for dental care. When we see people and we open up a clinic, and this is why it is a little nuanced. We get people with such horrible dental disease that young men and women just coming out of their dental training, many of them are kind of dogged by the task in front of them. We had one been asleep after six months saying that theyre not prepared for this kind of work. We had another dentist come and say that, you know, im not prepared for this. She went back and got a year residency now shes going to work for us at october 1. So there is a training aspect. Doctor Michael Mcginnis once wrote about the dirty dozen reasons why we dont do prevention. One of his points was this and how it relates to dental therapists. It is a really, we have dentist they can do the job thats put in front of them when they come out of training because they are not used to that. As a Health Center director, that is what we are faced with now. So i need welltrained dentists to tackle that problem. But i want to get over the top of the hill and have our population so they can help the population and is our population gets healthier, that we have responsibilities as taxpayers as well and we build Group Practice dentistrys with hygienist. When i see it as our population gets healthier, we need to substitute in other providers who can handle the more routine things to allow our dentists to help on those emergencies and the more complicated cases. So i see this more in our future if the problems were discussed can be resolved. Let me just jump in. Mr. Chairman, if i might. Because i have to go back from there. Then we had testimony on this, we had a dental therapists who worked in a village from her own village. And she said that she was able to, because she had been from the village, apple store or so miles, she would say brush your teeth everyday. So when youre talking about this prevention piece, i think that it is actually key that we have people that are more likely to go back to where they were and i think that this is something that i would really like to continue to pursue. Thank you, mr. Chairman. Thank you. Let me just pick up where senator franken picked up. What we are talking about is the workforce in general. Whether dental therapists or an dentist or hygienist. We will talk to doctor hughes and get around. What ideas do you have and doctor Frank Catalanotto made some suggestions. But is it your experience that we are not attracting the kind of practitioners that we need to take care of the population that has a lot of needs in this area . Actually in maryland we have seen an increase in providing and we currently have over 1600 providers. Our access deals more with adults not having coverage, and those adults that do have medicaid, the benefits are so limited that they cannot find a provider. What happens . They do not get seen. When they are in pain . What happens . To go to the emergency room. Then they are referred to the Health Department. That is my other issue is that there is not enough funding for Public Health at the structure. Right now i could easily have an Adult Program in the Health Department. But when there were budget cuts, one of the first things that was cut was the money for a dentist that saw the uninsured adult population. As we have the capacity, but we do not have funding. Because we dont have the funding, we cannot offer the services. I think that we have all seen pictures whether its health care at dental care of doctors who volunteered their time to be treating folks that dont have access and actually one of my Staff Members in southern virginia, and he mentioned something similar. Where it looked like a third world country where people had Terrible Health and dental problems that could not find a doctor or dentist. And this was the United States of america where people were spending the night waiting online in order to get a tooth extracted or some basic checkups with whatever they may see. And we are familiar with this. Is that right . You are familiar with that reality . Yes, i am. Most definitely. Tell us a little bit. You are a lower income americans. Youre on medicaid and you dont have access because medicaid does not pay for this deductible. What do those people go through . We have an office and when they had a client that was in severe pain and i took her to the main office and we got her an appointment, i believe it was in a couple of days and we were told that they would pay up to 200. And they have very limited funds and many times the only option is clients waiting months on the waiting list to be able to be seen in the clinic where people are donating their time and their off hours. But the wait list is incredibly long and they have to wait for a long time oftentimes. So many of your cards points are going to their days in pain . Well, it is more that we have when we are severe in pain, we take action to get the treatment to them that we can possibly get. A lot of our clients do go through extractions, quite a few. And if someone is really in pain, we try to do everything that we can with the limited opportunities that we have. Okay, let me go back to anybody here. Doctor, you raise this issue. We have a crisis and we dont have the workforce to address the crisis. What role does the American Dental Association play in august . By the way, we invited them and they were going to be with us, but then at the last minute they chose not to be here. There has been a shift in the National Picture and they are calling more and more attention to the access issue. One of them would be you need to lobby equally as hard as you do for the Business Issues announced still not necessarily seeing that at this particular point. The state organizations are very independent of the national organization. So one example would be they have policies on better licensing procedures and at the state level that is not particularly happening. Easier reciprocity between states is a National Policy with the American Dental Association, but it is Getting Better and i want to be positive about that. You guys are doing very well. I think we are doing well in vermont as well. Have you done any computations is what it would take in a state like wisconsin and how many more facilities you would need . The. The governor to real said to me when he shook my hand as of this model. I wonder how many of these we need . Is it 50 biles the pars and a pretty close more than introduce 5 miles or 40 miles . The number is led mesa they did this it does cost a lot of money to do this. You written the 100 million range and he was the former attorney general and he said the to convey a those on medicaid have a legal right to the services did we have to find the right and find a way to do that. In the written testimony and show we have done collectively but the fundamental question is, it is costly because we have neglected this and have a population that does undervalue oral health of foley does not understand the general healthy and we have a point of less than 42 . It should be more with the model. How loved you captures savings . You talk about people coming on a school having to price items but the real savings is to raise the oral Health Profile of the American People and the profession in the the United States of dead to trip dentistry is but to try to make those places that are free we have adults dental with medicaid is in our state. White dog allstates . Why do we have the adult dental in the exchanges . People say we cannot afford it but how do we afford adults dermatology . The thinking is if we have to totally change our seguin e and integrate. You are absolutely right in this is why we are holding this to put in peoples conscience that if you spee and access to dental care it is expensive proposition but if you dont expand it is it is perhaps more costly proposition. Who wants to say a word about people walking into any emergency room and how much that costs . Senator, we did our of emergency room workers florida in 2,010,115,000 dental visits at a cost of 88 million. It prompted me to right to an editorial entitled to pay me now or pay later. We pay for this. We pay for this today every day. Adjusted medicaid costs alone was approximately 35 million. I did a rough calculation based on florida medicaid fees i could have purchased 495,000 preventative that visits. Rather than a wasted visit in the hospitals emergency room with all they get is antibiotics and pain medication and told to go see a dentist and moral. Which is why they are there in the first place. Were opening a clinic in a few weeks. The reason were there is the folks were leaving to go to the Dental Clinic pro with recast for a letter of support they sent me a letter is hess says we have the 28 yearold and that is why the model is so good. It is believed no one behind model. Lot of this revolves into a talk about medicaid but as other panelists have pointed out the barrel have to medicaid or have it without the coverage or Health Insurance if out of the coverage. So this 28 yearold, and no insurance, paycheck to paycheck with nothing in the bake starts to get sicker and sicker and his sister starts to worry as he goes downhill. She thinks he must have lyme disease so they call the local clinic to say i would like to make an appointment. Does he have insurance . No. I just want someone disease test parker does the of money for a down payment . He gets worse parker she takes him to the Public Health department and they say oh my gosh we have to gauge the hospital and they said he probably would not have survived another 12 hours. Of advanced jaw cancer and three abscess. How much money had to be spent in the system and what haunts me in the end they said we agreed if you have this sent to a clinic period this would not have happened what we do about dental care and health care if the medicaid patient needs primarycare it cannot find primary Health Care Walking into an emergency room it costs 10 times as much as walking into the Health Center. Because as the doctor pointed out the emergency room in a hospital does not really a treat the dental problem as well because it deals with the infection. I would figure out how all i could make as much money as i could. If you worked at the Community Health center you are eligible for a loan repayment. That is what i think it is a board to establish more of these types of programs we have a population of over 800,000 people but we only have one federally qualified Health Care Center and one safety net clinic. That is all we have and there is only one dental shortage designation area in the county so is a daunting dash on dash task as the health sure digit area because it requires you have surveys of of the dentists of the area how they practice and it is hard information to get so we have to improve the process but i dont know how to answer that question. It is costly. In dental school were doing procedures with the cost for the equipment back actually doing procedures of that is why the cost is elevated. What to go back to the situation were familiar with a and you see that as a potential model to provide costeffective quality dental care . Yes. Going from one to 15 clinics in about nine years with no grants only on medicaid but they do it because first with the culture of carrying the business issue is day run it to with the groups the co did this as a volunteer activity in his community but now it is a major notforprofit business. The quality . I have free range to walk into a clinic. Every time i walked in. Just before each visit they take highs in wait in icy toothbrushs ioc procedures but prevention that is the only way to readers the on dash reducing care alan hundred 25 a newly. But they use their facilities, 60 hours per week with mass purchasing power. In to but the deficits are paid a straight salary whether they do 15 or five. They treat their patients with dignity. With a common claim they dont keep their appointments. So there is the utilization rates and of renewed . Because they treat patients with dignity and respect. As you are telling me they are making money . They are making money. There notforprofit but they put it back into a new clinic or just recently got themselves equipped to do dentistry with community service. Each clinic has taken the person that goes out into the Community Summit a assistance are collegeeducated men and women. We will pay your way if you decide to come back. They have their own national Health Service corps i can tell you not paid they want to expand to the state because the us eat the bow, we know. We have psychiatric problems in people with disabilities so we have to be more wellrounded. For example, we could make our site more efficient is said to not expect the and i think is with the distinct population is and and and because there are no adult benefits in the state of alabama. They only do children. He is absolutely right. Now paid to developments there have recently hired an oral surgeon with daily treat the children surveyed 20. Okay. We are going to continue to focus on why this hearing is so important than fight for those communities centers delicate debt the therapist which seems to be high quality. Your point to but with the overseas said driver or that project tell us because of people may have forgotten about the project. Mr. Nycz tape drive her is that 12 ruled that died from the access. His parents was again able to access dental care in the medicaid have lapsed and she could not find a dentist to treat the child. He was taken to an emergency room and given treatment isnt was then rushed back and then they found it had pledged up to his brain and he died february 27, 2010. As a result, the governor of maryland to set this cannot happen taken. Said dental Action Committee was formed and seven recommendations were made. Also from their actions the project was initiated by dash initiated a mobile dental unit that goes to the title when schools throughout the county and we treat all children in insured and uninsured we really felt with those that are of insurable we have a Large Population in the county and in the state. By definition the mobile unit it is not our purpose may work through Case Management to ensure all children are in aa gentle hall. Fe will treaty merchant need so they dont have another deal want to a driver. In the process, we are trying to establish statewide school cleanings. Children are required to have the immunizations. Quiet are not required to be seen in attendance books . It was vital lever there. There were a number of children who could possibly be to him because we eliminate that to be in the schools also provide treatment at the school that he attended. The program has been very successful in this will come to buy all the schools that we attend to. Dr. , thank you for the work that you do of that. To remember him. Our job is to dedicate ourselves to make very, very significant improvements with the bill dental care i want to say to all got to be here today it for being here today not only but also to address this issue. With that lets adjourned the meeting. [inaudible conversations] [inaudible conversations] i can remember the day that it happened so we went up to the church. My mother was the choirmaster. We were getting ready for service then all of the sudden there was a loud thud. We knew a bomb had gone off but we thought maybe in our community and within a little while my fathers cousin came id to say the church was bombed. Of little while later agreed newton names of the little girls who were killed and to cease and was one of those little girls who was said family friend and kindergarten friend there is a pitcher of my father giving her heard graduation diplomacy from kindergarten so it was a very sad and terrifying day for our community. Secretary of state john kerry repeatedly said that president s aside use it chemicals and gases as some people. You can watch this anytime at cspan. Org. This challenge obviously teston greater urgency august 21st when this Serious Research team used chemical weapons in the indiscriminate way against its own citizens. Obama and dozens of our partners believe that that action is unacceptable that made it clear we cannot allow that to happen again. In light of what has happened the world wonders and watches closely whether or not the aside regime if us of worlds most powerful nations can together take a critical step forward in order to hold it to its stated promises. I have seen reports that the Syrian Regime have suggested as part of the standard process to have 30 days to submit data on the chemical weapons stockpile. We believe there is nothing standard about this process at this moment. Because of the way the regime has been paved but we dont say kurds were e. F. Why we happen to come here there is the dedication but in order to racers in this hint be achieved, the United States and russia continue to have our share of disagreements about the situation in syria including the difference as to the judgment reid just offered with respect to who may have done that. But what is important is there is much that we agree on. We agree august 21st syrian men and women and children die grotesque death due to chemical weapons. We did agree that no one anywhere at any time should employ chemical weapons and said we agree that joining together with the International Community to eliminate the stockpiles of these weapons would be a historic moment for the multilateralism non proliferation efforts. Wheat in three you would help and to save lives and reduce the threat to the region that it would uphold the norm that was established here in geneva almost one century ago and could do chief it the best of all aspirations for curbing weapons of mass destruction. Mr. President for so many years and we had the imagines his science in the world. Along with environmentally Friendly Energy sources and that is one area we have been so good. Every year for the last many years coming end of a steve the Energy Summit in las vegas, we had governor sam president s and all kinds of cabinet officers there as a bipartisan event. One of the things we do there is to recognize the most smartest and creative and vests investors to show the latest discoveries. This last time i learned about the American Company developing a hightech battery and a great point down show a twostory solar power after the sun goes down. I met the inventor of a flying went turbine across between the kite and a small plane and on the california and nevada border there is an amazing thing going on. They have hundreds and hundreds of thousands solar panel meters in they have three very tall towers that looks like skyscrapers. They do that to harness the sun. Dick reason is because invention is so terrific one thing we found when the sun goes down it no longer produces energy but that is not the case because these during the day keeps up in bet at night is still gives what is needed to achieve. 98 complete. Select at the ingenuity that shows of bright spot during those dark and secular times. But. We need to be a part of the solution. That, mr. President , is what it is all about. To be more efficient at home to start with small traces replace in the light pole with the Energy Efficient one when installing a the furnace thermostat it could be regulated rinaldi and the stresses are real but also the building is that we were kids and lived in an but what has happened for generations is you put a building out it is built with respect but otherwise people dont care at the time they is they have been constructed to get done as cheap and quick as possible so the appliances are not as good as they could be. So we need to make as well as the technology more efficient much of the technology has a boy growing up less than 1 mile from our home with a massive power coming from the hoover dam we used to always hear the electricity popping and snapping. Of. Just heating and cooling in our homes and offices is one reason may waste so much electricity. This legislation before the senate will spur the use of technology. The Energy Savings fell all spur the use of Energy Technologies but commercial buildings as does the industrial sector. Um i think the chairman wirehaired and didnt and murkowski . That is one of the most fax this to end effective ways it will make us more Energy Independent poll also save me money by lowering its energy bills. This fit into mccready one had to 50,000 lew jones looked at the private sector even as say yet man ive presented how quickly 2030 will you have just taken 70 million cars off the road. Those dash no government also has a role and we have not done this very well as a taxpayer. It is the single largest user reducing the energy lose tonight seats . I am aware censures to an i am orange tariff is 18 and purves union lifted the left side accord to work with them in the with the build managers to help to reduce the Nations Energy consumption. While some answers to American Energy will come from the ventures and researches the others must come from where we live and work. Whatd great piece of legislation this is. In and how from the house and from the senate. The speaker could not pass a simple see part today. When asked that if merrick in a position here that people who dont believe in a different tell us when need to be head. That is a shame. Also a defunding obamacare. Or we will not fund a the government. Mr. President , president of United States will love negotiate. If the republicans in the us even though i gave in the fiscal year what have we accomplished . Not much. I did a lot of listening over the last several weeks of meetings in defense all across kentucky and last week i participated in my 51st hospital town hall since 2011. I will tell you, one thing kept emerging over and over and over. The people from kentucky are really, really worried about obamacare. They have read the same stories we have had or businesses being forced to eliminate health care with people being laid off, they read about double what is becoming a massive mass and how their personal information could be compromised by scam artists. Now know that there is some of you that theyre thinking they will learn to like it. But it is precisely. That is what got us into this mess avarice are room. The doctors, and nurses, for the. I did then and optics of the number theyre talking about and a new more about health care than those who voted for the law and for will. The fact is the more the constituents know about obamacare the more worried they tend to be. Fed is to for the business owners. One wrote to me in wishing at cardiff dash emphasis to an glad of it is another concern to wrote to say f a matter at but the realistically they may no longer have a choice. How long . One of the biggest employers announced to stop providing health care to spouses spouses, 15,000 of its employees also due in part to obamacare as feat isnt. I have to guide a referral from leo and another one the year later. Yesterdays the Largest Union federation aflcio found serious cause that could hurt members and they came very close and they came but i dont think they could even all that. Here on the floor. One union leader replied obamacare could the to the federation of losing threequarters of its membership in just the next few years. This is the biggest supporter the president has. Coming this close to calling for outright repeal. We dont think big labor is leaning on the president. We know they want help but to have them rewrite the same law they help to ram through and what about. You can cover rap in a few errors per she says was about the recent polish and as soon with with those set of such to but the same kind of to date but my family built this and before the august recess went to do that. Last month they tried to pass the same bill in the senate but the democratically the ship plovdiv and i am not sure why. So today i will try it again in tomorrow. This time i hope my colleagues will help to join me as the democrats did in the house. I know they all got an earful when they were hall last month so maybe they have reconsider the wisdom and fairness of the early position and think individuals and family members should be no treated not differently when it comes to obamacare. This a legislation from both republicans and democrats in the house and there is no reason to block it here in the senate. We need to pass the oneyear delay of obamacare for everyone. That is what the amendment i filed would do. Then asks what people really need a full repeal of the job killing mess of a lot and just what i intend to keep fighting for. So those Union Members now turning against it in droves so are our constituents i dont care what part. So take the first death together to delay obamacare mandates for families right now. Just like the white house in four businesses while there is still time to do it and Work Together to reveals a lot for good to replace it with common sense stepbystep reform to actually lower cost. That is what kentucky once once, americans want and anybody who listens to their constituents last month knows of what i just said. Mr. President i yield the floor. [inaudible conversations] were year to announce a record was just broken with the first time in senators entire career he has been late for a press conference. [laughter] overly . [laughter] i met with senator mcconnell, nancy pelosi in it lasted 45 minutes. As me know the speaker has a problem how to hit government funded. I will vides had helpful as i can be and told him all the same as we are trying to do. We have not done the energy bill in a long time. Lets see that. Smooth route so as i have explained receipt other leaders have. This is not the time for political stunts or rhetoric on a transportation bill or obamacare or energy bill. If they want to work with us, lets do it. But not in the guerrilla attacks. Those who are really in to work with him miss those among anything else. They have worked very hard legislatively to come out to fix things that need to be fixed. In a couple of weeks it will start up for the vast majority of americans