>> coming up next, the u.s. commission on civil rights hears from representatives of advocacy groups on the challenges facing military veterans and current service members. after that we're live with remarks from president obama as he welcomes participants to a white house conference on mental health. later, michigan representative fred upton and political analyst dade gergen are the featured speakers at this year's gerald r. ford journalism awards ceremony. and the senate's back at 2 p.m. eastern with general speeches followed by more debate on the farm bill. >> the u.s. commission on civil rights recently heard from representatives of groups for military veterans. among the speakers was an advocate for gay,less wean, bisexual and transgender generals as well as a representative of african-american vets. the commission is expected to release a report with recommendations for helping end

discriminatory practices in the military as well as assisting veterans as they transition from the battlefield to the workplace. this is about an hour and 15 minutes. [inaudible conversations] >> commissioner -- [inaudible] on the phone. thank you. >> yes, i'm here, mr. chairman. >> i am, mr. chairman. >> thank you. so we're going to now begin our second panel. let me begin to introduce our panelists here. our first panelist is heather ansley, vice president of veterans policy for vetsfirst and co-chair of the consortium of citizens with disabilities veterans' task force.

our second panelist is albert gonzalez, national commander with the american g.i. forum. our third panelist is wendy mcclinton, president and ceo of black veterans for social justice. and our fourth panel cysts is danny ingram, national president of american veterans for equal rights. i am going to ask each panelist to, please, swear or affirm that the information you are about to provide us is true and accurate to the best of your knowledge and belief, is that correct? and were you all here earlier when i explaned the system of -- explained the system of warning lights? >> yes, sir. >> okay, great. we will now begin. ms. ansley, please begin. >> thank you for the opportunity to present information about protecting and promoting the civil rights of disabled veterans. we represent the culmination of over 60 years of service to veterans and their families. as a veterans' organization, our primary mission is to insure that veterans with disabilities are able to reintegrate into

their communities after acquiring a disability. to insure thef access to rights, vetsfirst assists them in applying for benefits and administers an online portal through which anyone can submit a question. through this and other outreach, we assist thousands of veterans and can their families. vetsfirst also provides executive branch focus, public policy advocacy on behalf of disabled veterans. our public policy work is guided by three core principles. one, promoting integration and independence, two, insuring timely access to quality health care benefits and, three, protecting the civil rights of disabled veterans. the remainder of my testimony will focus on areas we believe should be addressed to protect the rights of disabled veterans. vetsfirst believes that va programs and policies must allow disabled veterans to receive long-term services and sport in

their homes and communities. providing increased access to services and insuring prommer support -- proper support for services. without these and other types of supports, many disabled veterans would be at risk of institutionalization. the united states supreme court has held that the americans with disabilities act or ada requires that long-term services and supports for people with disabilities administered by public entities be provided in the most integrated setting. we believe that va must be more robust in efforts to rebalance their long-term care system. rebalancing refers to areas to provide additional services, home and community-based services by shifting resources from institutional services to insure a more balanced approach to the provision of long-term services and supports. programs like va's veteran-directed home and community-based services program represent a good way to provide long-term services and supports for people with disabilities.

this program allows veterans flexibility in managing a budget through which they are able to purchase long-term services and supports that they need to be independent. it also represents an important step toward fulfilling the promise of community integration. we hope that this program will continue to be expanded and that disabled veterans will be educated about its benefits. second, vetsfirst believes we must increase access to housing and communities for disabled veterans. true the years -- through the years we have worked with hud to insure access to homes and communities. we believe that hud has an important role to play not only in insuring compliance with accessibility and nondiscrimination requirements found in the fair housing amendments act of 1988 and section 5054 of the rehabilitation action of 1973, but also in promoting visit about. visit about is a design concept that allows people with disabilities to be a part of their neighborhoods and communities by integrating a minimum level of accessibility in housing units that are not

covered under fair houseing or section 504. we are working with hud on helping grantees to include people with disabilities and required planning processes. these efforts are important to broader community requirements to affirmatively further fair housing. we are also, however, working with hud to promote visitability to these -- third, we belief that we must increase access to transportation options. over the years our advocacy has led to numerous victories. however, we know that barriers remain that prevent transportation equity. for example, we are actively work withing to increase the number of wheelchair-accessible taxi cabs in new york city, washington, d.c. and other metropolitan areas. we are also working to insure that individuals with other types of disabilities are knot discriminated against such as

people with disabilities who use service an 3458s. expanding access to transportation options is key to insuring access to health care and opportunities to participate in the community. lastly, we believe that we must increase access to employment and education opportunity. veterans with disabilities like other people with disabilities face barriers to employment that include misinformation about disability and misperceptions about required accommodations. disabled veterans often remain a distinct segment of the disability community, however, which challenges disability rights advocates' traditional outreach and communication. veterans who have disabilities will likely not be as familiar with the disability community or programs generally available to people with disability and are more likely to rely on va for services. for the broader disability community, the ada serves as the primary protection against discrimination due to disability in employment, purchasing goods and services and in receiving

state and local government programs and services. disabled veterans may be less familiar with the protections offered by the ada than they are with is veteran-specific laws and programs. for many veterans, it takes an encounter with the broader disability rights movement to help them understand their connection to the community. outreach to disabled veterans is critical to insuring that they are aware of the employment protections of the ada. the protections available to veterans and people with disabilities generally should work together to remove barriers to employment. the ada is an important tool along with the uniform services employment and reimemployment rights action -- act due to their service. the need to educate veterans about disability-related rights and protections in employment and education begins when they are transitioning out of the military. those who have acquired disabilities as a result of military service need a basic understanding of the protections available to them under the law as they return to the work force or seek education opportunities.

to insure that this information is received by all service members who need it, we believe that it should be integrated into the information presents to transitioning service members about preparing for employment or education opportunities. we would like to acknowledge the efforts of the equal employment opportunity commission or eeoc to reach out to veterans with disabilities about protections available to them under the ada, and we hope that greater interagency collaboration between the va, the department of labor and eeoc will insure that disabled veterans under the protections available to them. again, thank you for the opportunity to present our views regarding protecting the civil rights of disabled veterans. this concludes my testimony. >> thanks, ms. ansley. our staff has asked me just to confirm whether there are any individuals in our audience that have the need for sign language interpretation. if so, please notify the commission staff. thank you. mr. gonzalez. >> chairman castro and commissioner, thank you very much for allowing the american

g.i. forum to come before you and make some comments. we have sat on that side of the table. our founder, dr. hector garcia, was nominated and appointed by president johnson years ago. the american d.i. forum -- g.i. forum did start as an advocacy group for the over 00,000 -- 50 500,000 mexican-american veterans and the discrimination they were facing at the time. but we have evolved. we are a veterans organization. so even though the majority of our membership is of hispanic descent, we are engulfing all veterans whether they be female, black or white. we're a veterans' organization. so in my written statement to you, i was talking -- and let me

preface this. i'm not a combat vet, okay? i've never been in combat. so a lot of my comments are going to be editorial and some of the data is difficult come by. be what i'm going to do is request permission from the commission to deviate and talk about three individuals that the colorado springs gazette did a story on. i was contacted by a grandmother or an aunt from california of a sergeant al valero. he was stationed at fort carson going through the wounded training unit. and the article is called "disposable soldiers." and what it is, is soldiers that are being chaptered out of the military. now, it was kind of difficult, i couldn't find any data as to how

many of those soldiers were hispanic, so i'm just going to use the numbers that we got when i contacted the individuals from the gazette that were doing the research. and as the ptsd -- i mean, there's been, dod admits that there's been over 2.4 million deployments to the wars in iraq and afghanistan with over 400,000 of those being, having deployed three or four times. and with each deployment the possibility of ptsd or tbi or other psychological illnesses rises. for the last two days and today they're concluding right across

the street at the grand hyatt the homeless veterans coalition conference to deal with homeless veterans. so i'm not going to talk to you about the ptsd, which is a contributing factor to a lot of this. but ptsd makes it difficult a lot of times for these soldiers to follow the orders that are necessary to be good soldiers. but at some point some incident caused them to not be good soldiers. one of the soldiers was wounded, came back to the united states, got rehabbed, had half of his face blown off, volunteered to go back. so what made him be a bad soldier so that when he came back the second time -- he wasn't an ordinary soldier east. he enlisted when he was 31 years

old. that made him a bad soldier that the military didn't want to keep him? now, they have a lot of options, they could have given him a medical discharge, medical discharges in 1912 -- or 2012, i apologize, were taking almost 400 days to accomplish that. so in there, there's an article in here again of another soldier who sat in jail in el paso county where fort carson is situated. fort carson doesn't have their own brig or jail, so they put them in the county jail. he sat in jail for three months without any charges, any military charges. so when he did go back to post and they got him into the wounded transition unit, he was kind of offered, hey, look,

we're going to article 15 you to get with you out, or you can sign an article 10 which is a chapter out. you give up your benefits. because article 10 you can't come out of there with less than honorable conditions. and once you give up your honorable conditions, you lose a lot of your benefits, a majority of your va benefits. so it's not the va's fault that we created a lot of homeless in vietnam, and it's not the va's fault that we're creating homelessness today. i guess my there again comment without data is it's the department of defense. we prepared these men and women for war, but we don't prepare them to come home. and so i guess i'll stop there. hopefully, we can have some questions and dialogue on that. >> thank you, mr. gonzalez.

ms. mcclinton? >> thank you to the chairman and to the commissioners. for allowing me the opportunity to speak briefly to you today. in january 1994 i transitioned from the united states army as an active duty soldier to an honorably-discharged homeless female veteran with three children under the age of 5. i completed all the required transition briefings facilitated by the transitional program and planned my future for me and my sons based on the information received. little did i know that as soon as my plane landed in new york city, i would be homeless with no access to resources for my children. while i waited in a homeless shelter assignment, a nicely-dressed gentleman came through the eau which is the

emergency assistance unit handing out flowers -- flyers about a community-based organization known as black veterans for social justice located in brooklyn, new york. the flyer asked, are you a veteran, are you homeless and in need of tender loving care and a listening ear in and i immediately said yes. i took the flyer and paid my way to bvsj. once i arrived, i was shocked by all the veterans that were there for help. i went inside, and i sat down and waited to be helped. there was a desk with a reception area and a phone that just kept ringing and ringing, and no one would answer this phone. so i went over to the desk, i picked up the phone, i said black vets, and i've been there ever since. it was at this organization that i not only received a job as a receptionist, it also gave me a two-bedroom, beautiful apartment for me and my children to reside in. as i began to work, i began the

heal. i took the necessary classes and counseling to help me make the needed adjustments to excel. i sought services at black veterans for social justice for the deprived state of me and my family. within two years i was promote t to become the chief of administration. after several higher level management positions and 17 years later, i am now honored to serve as the first african-american female to be appointed as the president and ceo of a veterans' service community-based organization. black veterans for social justice was established in 1979. it's a not-for-profit, community-based organization servicing many women veteran, their fam families and members f the community. we service an estimated 12,000 clients in the past fiscal year. we provide program services to assist military personnel in making a smooth transition from active duty civilian life. e we are dedicated to servicing

military personnel, veterans and their families in the areas of social readjustment, housing, employment, compensation, disability, family intervention, prison counseling, relocation into the community, legal advocacy, discharge upgrade and redress of grievances within and outside of the military. we will provide coming, benefits, information, tender loving care and a listening ear. the social services under the umbrella of bvsj, we have our veterans service center which services the family of veterans and the veteran themselves; we have a homeless veterans reintegration program and also the homeless reintegration program three for women veterans or veterans with families. we have the consortium for workers' education, supportive housing program, permanent housing, housing for those individuals who have hiv and/or aids, a mixed dwelling unit for

those with mental illness and community-based residents. shelters next step which handle 200 men who are going now trying to get into housing and also employment. we also have the grant per diem program which is for women veterans, but bvsj has put a twist to it; we spry the services for the family members so that they will go into an apartment setting instead of a facility or institutional-typesetting. ..

the trends are faced with a complexity of issues for transitioning from military's civilian life and. these complexities are exasperated when they're faced with policies and procedures that are known but not written, hidden obstacles and values that cause harm to the welfare of veterans. when applying for employment veterans are scrutinized more for civilians applying for the same job. players are not allowed to ask about your medical or mental status. it will pose the question in the form of interest. are you in the military? where did you serve? did you see combat? it must have been hard for you. that was used to handle their plummet. smell seeking housing veterans are known as the angry veterans. they have ptsd, never causes the trauma, they use those traumas to hinder them from housing, especially when they're going

for housing within some sort of board, like maybe a condominium or co-op or even trying to get into gated communities are some other higher level of living. veterans should not be subject to housing that holds case management. they should have of the doors open for them that may have an adequate life for them and their families. thank you. >> thank you. mr. ingram, please proceed. >> good morning. it is a great honor for this georgia farm board to address such an august group of people. i want to thank all of you for your service on this commission, which is, indeed, very important i am the national president of american veterans for equal rights which is a lesbian and gay bisexual and transgendered veterans service organization. we were founded almost ended five years ago by mr. chuck shelton, who served in world war ii, korea, and vietnam and the

ed states navy, worked his way from enlisted up to officer six months short of his full retirement as a you had states navy officer he was dishonorably discharged for being gay due to the work of our organization, and many others like us that will not happen to anyone else and never again will in the american service number by on the battlefield because of the medic it could have saved his life was kicked out of the military for being gay. this is actually my second trip to washington d.c. this week. i had the honor on monday of placing a wreath at arlington with another organization called military partners and families coalition. there the ones who should be speaking to you today, and it is about their members that i will be addressing you, specifically i would like to name a chief

warrant officer time at dunbar, her spouse come alive, their son, and their daughter, michelle, who are stationed at fort bragg. they are a military family struggling with all the problems that military families struggle with, trying to make it through deployments. yet they are denied the same rights of other military families by the defense of marriage act. the defense of marriage act denies equal pay for equal service to the honored united states marines, soldiers, sailors, airmen, and coast guardsmen who are legally married to same gender spouses to stand guard side-by-side with their heterosexual counterparts. here at home and around the

planet to defend the nation's liberty, sharing the same risk and the same level responsibilities, yet are denied the same basic rights. according to the congressional budget office report, cost of military pay and benefits and the defense budget dated november 2012 benefit accounts were approximately two-thirds of overall military compensation. many of these benefits, including health and dental insurance, housing allowances, joint assignment options from a life insurance, survivors' benefits, education assistance cannot burial benefits to moving expenses, family support for deploying spouses to my charge qualification, disability and surviving spouse compensation and caregiver support, among many others are denied to unmarried gay and lesbian service members and veterans,

their spouses, and their children. such a blatant a mile of the civil rights of our service members is offensive to all justice loving americans and this summer's the very freedom that these patriotic men and women risk their lives to defend . service members must be added as a protected class to the military equal opportunity program and included in it the center from minority veterans. minority designated as a protected class have access to unit level of officers who work to immediately security issues of discrimination and harassment inside of the unit. without such protection our lesbian, gay, and bisexual service members did not have crucial access to direct and time the protection from the harm of fellow service numbers. if ever there was a minority group that needed the protection

it will be taken and lesbian, bisexual members of the armed forces who until recently could have been terminated just for being who they are. many veterans from world war ii through the gulf war received less than honorable discharges because of their sexual orientation or gender identity, both under don't ask don't tell and previous policies. these discharges to be upgraded, but the process is slow and cumbersome. the upgrade process for these discharges is to be vastly streamlined so that veterans with less than honorable discharges to to sexual orientation can access the vital health care they have earned from the de a. additionally it should take reason for discharge into consideration in processing these upgrades and allowing the service. the center for minority veterans

should develop an average program for her not only have needs specific to our communities such as double and triple ptsd resulting from maintaining a false identity and fear of being fired from their job and have also suffered obvious and official discrimination in the past. transgendered americans are men and women to this like any other person, and there is no reason that they cannot serve alongside other men and women in the armed forces just as they do in the most of our allied countries. the policies that prevent the service of these men and women should be abolished to allow patriotic volunteers who are transgendered the right to serve in our country military. thank you very much for this a opportunity. >> appreciated. you will not open it up for questions from commissioners.

i will ask those on the phone with you have questions. highlight for me know. >> i do not. >> abcaeight. >> mr. chairman, unfortunately i have to get off the line to actually come in in person. i will pass my question as well. >> will you ask it in person? >> i will see if i can make it in time. no. since i need to leave now anyway i may have to benefit from reading the transcript. >> we will wait for you then. >> mr. chairman, i do not have a question. >> pardon me? >> i did not have a question. >> i'm sorry. i thought you did. i have a question. then are there any specific issues they uc as it relates to the latino and latino service members and veterans, challenges that they may uniquely face or

may face disproportionately compared to other veterans when it relates to issues of civil rights? >> since the 1960's and 70's, so much has improved. it is really difficult to quantify and qualify saying that, yes, there is. there is still some, if you would, covert type of discrimination, but it would be difficult to actually qualify that. i find it hard to say yes, that there is. but at the same time, i find it difficult to say that it's not. >> tuna if anyone collect that kind of data? the commissioner was asking for data.

>> i don't. i don't know of any of that specific type of data. like you say, our veterans outreach program in san antonio, if you come in and are a veteran with dv214 hon. discharge you are allowed into the house. we don't keep that type of the information as far as i and a stand. the employment is, as wendy said, a lot of it is in the human resources people that don't have -- i think he used the term earlier, cultural training. have you deal with these veterans? the veteran population is approximately 1%. so you have 300,000 soldiers and sailors and marines, air men across the country.

that means the majority of the people that sit in a chart positions don't know, don't understand the hardships that our military men and women faced, especially those today that have two, three, for deployments. i've met a retired master sergeant to in the army. kaynine. he had seven deployments in the last 12 years. he was in the first deployment and was there when the last helicopters left. i asked him about specifically his issue with ptsd. he says, i was an older soldier. i had young men and women. i had my family at home when i came home that i could kind of defused a lot of the stuff.

some of these and men and women there 18, 19, 20 years old that saw the horrific incident on tv and decided they would do something for their country. they just didn't have that. >> thank you. commissioner. different subjects. anybody want to chime in, feel free or read. we have talked about veterans, active-duty servicemen, but we have not talked about benefits and serving -- concerning surviving spouses of servicemen killed in action and i was wondering if any of you have any opinion on that. >> certainly it's important, and there are several things that do need to be rectified. one of them is a perennial issue that has come up before congress

related to an offset between a dependency and indemnity compensation for survivors. as it relates to another program that dod has, the survivor benefit plan command right now there is an offset between those two so that the survivor benefit program is something that a service member paid into in the event that something happened to them to help their surviving individual. yet there is an offset between what the person can receive from that and what they would receive you cannot receive the full benefit even though one was dated to with the idea you would be able to get it. >> but a veteran can receive disability benefits that are not taxed and social security benefits with no set off. >> that's correct. you are able to receive social

security. >> in those benefits are not taxed. >> veterans compensation is not taxed. >> anything else that anybody would comment on on that question? >> i would like to comment on that, of course. those benefits can be vital to of the survival of spouses and children in helping them through a very traumatic experiences of losing the partner and, of course, the defense of marriage act denies those benefits to legally married, just like other legally married men and women who happen to be married to same-sex spouses in the military. those benefits are vital command they are denied to some of our service members. >> another question. everyone has been talking -- i am very interested in housing.

you all talked about housing. does anyone have data on veteran exclusion from housing because of ptsd disabilities, things like that? and does anyone have data for a solution just because people are veterans? today someone was talking earlier about being in combat, not being in combat. those people who are deployed to day are all in a combat. you're in a combat zone. no one is in a safe place, so to say. so i think when we keep talking about housing and discrimination , really have not seen any data. is there a need for a collection of data of that sort? there are very few lawsuits in that regard. very few resolutions. we heard today, 1400 labor

claims over the year. i am just wondering, do we have numbers are is this all just anecdotal them permission? and before you answer that i think there was a response. >> i'm sorry. >> he should have just feel that me. >> no. >> when we talk about benefit to dependence, being in the military itself is genetic all by itself. and they always look at groups that are within the military that should receive benefits. you have the survivor's benefit, the retiree benefit. what happens to benefits in general? while we were in the military they said it would take care of all of our needs when we left the military. all includes our dependence. now that we have transition out of the military, what happened

to these dependence? u.s. about the numbers. every year there is an annual legislative caucus that takes place here in washington d.c. under that annual legislative caucus their is a group called the congressional caucus brain trust. the executive director's name is ron farmstead. they hold the data with the various minority groups with regard to housing, defense issues with employment. this congressional caucus will meet the september. and the brain trust roundtable will meet as well. i would invite you to please speak with mr. r instead to see how you could be a part of that discussion, and you will be a will to get the numbers and you're looking for with regard to employment, homelessness, and other disparities with regard to minority veterans in various glasses. >> thank you. in the other responses? >> i would like to add to that

sending our troops to war, taking care of them when they return is part and parcel to that decision to send them to war. the decision was made. we sent them. we are not honoring our part of that responsibility to fully take care of them and all of their needs when they return. that is a matter of national defense because if young people see that we do not care for the veterans return from the wars that we are fighting, they will not to volunteer to serve in the military. so our country is not doing a good job of taking care of our veterans who are returning, and that is a very serious problem. it is a breach of promise. >> thank you. >> commissioner. >> kent.

trying to figure out how to make this work in terms of the context of this commission. one of the quick things the brought of really interested me. it was about the chapter to my discharge with less than honorable. i take it without presuming that when you -- what can the discharge? >> i was honorably discharged. >> they're for you. >> most people on the don't ask don't tell were honorable discharges. >> and prior to that they were not. >> as correct. >> okay. i am curious about that less than honorable discharges, especially those who may not be citizens. that is very curious. aside from that particular group , just to educate me about that, what are the -- what are the benefits or lack of benefits

that anyone receives this kind of discharge receive are not received? and i guess everyone who does this -- help the people for a living. if you receive that discharge, what penalty in terms of going out for a job, the va programs, whenever? >> it depends on the human resource person and have educated they are. if they ask you for your db214. because printed quite boldly is a discharge. general, less than honorable. number one, they have that in front of them right away. they could possibly continue with the interview and then hold that against you for employment. but if you do get a chapter ten, what it is is a lot of times

these individuals, the individuals specifically in the four days coverage of today's favre, it is an option that is given to the soldier. they can give you a court-martial, give you a chapter 14, which is misconduct, or quick and easy as a chapter ten worrier company commander basically size you out and you're gone. i did have one individual that was i not citizen that was chapter out, a chapter out under honorable conditions, and his was, he had in between deployments gotten at the line in the state of colorado. he was starting to go through the required state training or

class's when his unit was deployed again. even though he had notified the state, paperwork got lost in the next thing he knew because he did best to class's consecutive league he never had a warrant out. so he notified his commander when he came back. his said, well, the army, the paperwork that he had a warrant. they did not work with him to find out what the war was for. within ten days, seven days, he was chapter out of the army. we did work with him to get his naturalization paperwork done because he had been one of these dreamers that had been brought here from the age of three years old. senator bennett worked with his office in denver. they got that taking care of real fast. and then we worked on the upgrading his general to an hon.

but it was because his wife reached out. a lot of times he himself was scared to come out of the house because now he had lost his green card, his legal permanent residents had expired because he had not had it updated. so now he was actually an undocumented. so we worked with him. >> just to add with that, even the fact that if you think it takes longer for their claims disability to the process, this will upgrade process is longer than that because even if an individual has a disability that may have a current will be in the military, and you get that upgrade it to a place where they can go, where they can go apply for claim, then you still have to wait. he deals with the disability? could use of the issue until you can get them to the va for that

service. the claims disability takes anywhere from 360 days. they're backlogged. this particular upgrade peace is more tedious and even longer. it is a 2-fold process. also you ask the question about chapters and the type of chapter and discharges. based on what that particular -- there's a code. there is a long rashid, a second sheet. the second sheet as another code. the code can be and are for. are for can be anywhere from obesity. flood of the military for being overweight. if you have this book, some employers will look to you. why am i going to have this person in now has a health risk.

it may be 1 pound, not someone who may be a threat. >> i am officially documented homosexual in the united states of america because of my key b facebook.com/booktv. i would like to note that many veterans from the vietnam era who are now reaching an age where they desperately need their va benefits may have received a less than honorable discharge for being gay back in their day. it probably did not care a whole lot at the time. now they need those services from the va. and getting those discharges upgraded is a very serious problem for someone who is facing immediate health problems where they cannot get into the va to get the services that they need. >> thank you, mr. chairman. i have three questions. i will start with mr. ingram. regarding the issue of the

discharge of great, i am very interested in that, in part for the reasons that you identified and also in part because in a prior hearing that this commission undertook with regard to women and some men in the military who are subjected to military-related to sexual trauma and the fact that those people at least allegedly, many of them are discharged under less than honorable circumstances and end up being deprived of the benefits to which they would otherwise be entitled, many of the advocates were urging upon us some examination of streamlined this charge upgrade as a way of

making write something that has been terribly wrong. i am wondering if you could be more specific about how a process like that could be streamlined, what it would take for it to be both practical and fair to of those who were improperly classified and fair to the military such that, you know, their authority to make these kinds of classifications should not be unduly undermined. >> that is a difficult question to answer. the process is inside of the military. and so even if you engage legal help to get that discharge upgraded, there is very little experience outside groups like

service member's legal defense network who have a lot of experience in working with that. very little experience of getting civilian lawyers to work with up process inside the military. my reputation is that you would remove that process from the military and put it outside of the military where average citizens and attorneys would have much more access to the process. >> add to that. >> please. >> if i may. even coming out of the military and then trying to apply for a benefit to my disability benefit, i was denied three times. then once i had other employment i was able to access insurance

of my own where i was able to go to another doctor. and that doctor then was able to produce the evidence that counteracted with the military had said, and then i was able to grant an appeal and then with the attorneys and now i was able to receive the benefit that was due. now, that was back in 19 -- about 2000-2001. it is sad because that still has to happen today. that process that he said, if we don't make this transitional assistance program, and has to be some sort of the intervention so that they can come out and be linked to preventive services. once this starts, if the department of defense and civil authorities -- i'm so sorry. civil authorities did not work together to bridge this gap we're going to continue to have individuals to wait until they come out of the military and have to go back to the military

to get the required documents to be have to go back. you are actually doing civil and human harm to these individuals who are already in a dramatic position. >> would it be your recommendation that the presumption be in favor of the applicant and then there would be -- the burden would be on the military to demonstrate otherwise? do you have -- >> i am saying that everything that identified with the soldier -- i agree with you. once you violated human and civil rights and should no longer be the responsibility of the united states military to handle that case because it is not going to be handled fairly. they should automatically be moved. that is number one. number two, there has to be an intervention program. something has to be put in side of the military component to ensure that everything that

veteran needs to produce whatever claim they need when they come out should be duly given before they leave the military. the additional assistance program cannot be an option, two months long. it has to be a minimum. he had been in the military ten years. it will taking more than one year to transition out. it has to be mandatory, and everything has to come with that veteran when they come out. >> finally, this issue of rebalancing the long term care system is absolutely one of the most crucial issues, it seems to me, facing military if they're going to do justice by those who become severely disabled as a result of their military service

the balloons that people incur are lifelong disabilities in most cases. people will always need the assistance of care providers for as long as they live with some of these -- some of these disabilities that they incur as a result of military service. one additional suggestion that would improve this rebalancing efforts? because i think that is key. in my own family my brother was a quadriplegic. these are not reversible conditions. it is a lifetime of me that has to be addressed here. it is part of -- you sign up for

the military. the military signs up for committing to you for your lifetime based upon your survey. >> i think one of the things, for the programs that viejo does have a place that the veterans directed home and community services, they're educated about what is available so that they understand what the programs are we understand that sometimes you may go into a facility in aspen, would you like to live in a community but to help you figure out how do that. and so you think, already here. i would like to. i am not sure what the processes that is clear to people. also, looking at -- this is really having -- in the civilian sector as well with medicaid and rebalancing because more people want services in their home as opposed to having to go to a

facility. the gentleman who is the chair our board, he says there will drag him out feetfirst to some facility. he has been a very independent for somebody you has been significantly disable for a number of years. i think that having an understanding that we are not talking about says getting rid of the systems we have but that we have to actually transition to systems that really do meet the needs of people not just -- we will have the facilities. good luck to everyone trying to get in is done. we really do have to make the transition of having the program, having them funded, and that the highest level, the viejo, looking at what is happening in the provision of long-term services and support. a long-term care commission that

is supposed to be happening at the federal level. we have been very interested in whether be anything coming out of that that is for veterans? because many of their families are going through the same situations that other families are going through. sometimes we become so silent that we don't really look at what is happening and how we can benefit from what is being learned. what are this is doing? yes, that it -- medicaid program, but what is being learned that could be applied to other types of systems and other types of care? and really just looking at what is it people want these days. i think particularly under people with significant disabilities have grown up it will recall an eda era. you have our rights and an

expectation that you are going to be able to be in your home, your community. you will not be shunted away to live someplace and have a nice life there. that would be some of the things we would recommend. thank you for your attention to that. >> now that you are here,. >> most of the question. i don't have anything right at the moment. >> in the other commissioners? >> the military has been doing a really good job in upgrading and real upgrading their program. but once you are -- >> the program is the transition -- >> transitioning assistant program.

>> when i was in the service it was like give me a sheet of paper. go down. make sure that i turned in my lawn mower, turned in my water hose and housing. but today they're doing a lot more stuff, making sure that you are getting a good medical physical, dental. that type of stuff. when he was saying, we need to somehow @booktv that don't know where you would bloodlines. the department of defense and the va and some of the other military service organizations. if you have an individual like those that heather and then looked at, it comes out of the army. there's should be some sort of not only recovery for that individual, but some training at home so that there is not a gap

when he or she leaves the military base. he and his family are ready for him to move in into everyday society. you know, the same thing with those individuals that have ptsd there is not a lot of real qualified individuals to deal with ptsd is my understanding. you know, we're putting them on the street. the ft -- va goal of eradicating homelessness by 2015, that put more individuals on the street to have that ptsd. they get on these drugs that become addictive drugs or they

learn to self medicate with but, jose, jim, those types of guys. so there has to be some sort of way to defuse the military's last touched to the soldiers. we have to allow the military service serving organizations and in the viejo into that little part of the soldier's life. he is an army men. he is in the active duty and then he becomes a veteran. somehow there needs to be some sort of an actual transition to bring in the veterans of the viejo system and to that department of defense system. >> inside of my testimony at think you have that little place in.

outlining the top programs that he is describing and one that i would suggest as an initiative the veterans of ministration, they give you a model that describes inside help, the full testimony provided. >> commissioner. anybody on the panel. i believe this is poorly directed to you. what i found is difficulty is that the viejo after discharge. determining mostly mental issues . finally deciding on treatment for the servicemen. i have seen many cases nine to

12 months before they actually make a determination that this is your diagnosis, let alone trying to get you into a program for 30 years now since 1980. they just started. a couple of ptsd programs. now they have many more. what does your organization experience regarding the last -- you mentioned the lack of people on the outside. that is just private practitioners. but within the va they have groups. the length of time in making the determination and the length of time of getting people treatment , can you give us an idea of how long that is and if any problems result from it? >> if i could just -- the young man.

>> as soon as the newspaper article came out, within a week he was contacted that the va was setting up a meeting for him 2011, 2010 where he was captured as soon as he went to the media and it came out. the va says, that had nothing to do with it. but i understand anecdotal stories. i am actually trying to get a sense. i know it takes a long time. you all are in touch with these veterans every day. >> what we have done is until we can get who services we have partnered with other community-based organizations. that is why is so important that the va not amid community-based organizations. you have to take access, get them access to those programs. for example, in new york,

veterans to social justice have partnered. they have the mental health program that deals with ptsd. interim those families. they are based on a sliding scale fee. they may not require fees. you have to provide an intervention to them until you can get them to the va. then they're not just passed off. they have to be -- they still have services. they still receive their services through the community-based program. the veterans can now get more extensive treatment. one thing i have to add to my having a problem especially with women veterans because we have a lack of those service providers that can deal with current emphasis me that i may have ptsd, but that stems from my msg so you have to have those individuals.

something that we can tie them into, some sort of mental health until we can get them. >> from what i understand what you just said, it's actually -- i thought about this. the va, once the veteran is expected into treatment, say, for tv guide or ptsd or whenever you have mentally, they also don't bring the families in. in other words, separate treatment outside. in other words, the treatment is not cohesive. >> no, because the veterans, dependents are not entitled to service. it is imperative that you keep the link with the veteran in the community so that with the integration process between the family, the reunification process with the family.

>> and they don't. >> if it was diagnosed when they were in the department of defense. but then the family was not covered. but once you separate you are not. and then it makes an evert -- an even deeper separation in the family. >> retired veterans is a different story. >> totally different. >> the va does allow family members to come in for counseling to get as a family if they are married and end their marriage is recognized. i would like to have very quickly that while i have been sitting in this chair this morning to veterans have committed suicide. one of them was a vietnam veteran. one of the best practices that my organization does is to a pair of recent returning veteran from overseas with an older veteran, such as particularly a

vietnam veteran who has faced some of these same challenges, alcoholism, drug abuse, ptsd. he has overcome them. that is the most powerful thing that can be done for our young, returning veteran dealing with ptsd. let them talk with someone who has been there and has experienced that pain and overcome it. that is the very best thing that we can do, and i would hope that the va would try to develop a program of paring such as that because as we all know, there is nothing like talking with someone who has been in the same place and has overcome those challenges. >> commissioner. >> i will yield. >> if i may. what else has to happen is that the services that they have and

the service that you described, they had that in new york city. they only had a. so the services have to be ecumenical across the board. services that are in georgia that are not in new york. services that are and other places have to be ecumenical and expectable. >> that's a huge issue. >> a huge issue. >> i just have a very quick question. you mentioned the problem of vietnam vets who were separated on account of their sexual orientation, not receiving medical benefits. do you know of any legislation, any effort that would correct that? >> i do not know of any efforts to change that upgrade process. i do know of efforts currently in congress to look at the

window of when someone comes out of the military and identifies some sort of problems such as ptsd. there is a five-year window when they come out of the military to identify that issue. they are put at the front of the line to get that sort of assistance for the way. if it is after that five year timeframe for something like ptsd then they have to wait a long time before they can access services. and that is for just veterans in general. but that is something that is to change. there are world war ii veterans who may be experiencing ptsd for the very first time in their lives. now they want to go to the va to get help. there will be waiting a long time. we need to take care of those people right away. >> commissioner.

>> if i can make a comment on that last statement. we do know for a fact that is true. >> any other questions? if not i will give the question i asked the last panel. some proposed recommendations. in addition to what you've already suggested or perhaps what you suggested would be the one primary recommendation that you would make tass, that you would hope we could then altman the support and make it to the president congress on the issues we discussed today, what would that recommendation b? >> from the perspective, one of the things that we really want to highlight is the need to provide information to a separate service numbers about the americans for disabilities act as it relates to employment. we have talked to the department of labor, va. we actually have gotten language inserted into legislation that

is pending before congress right now saying that this type of affirmation is needed. the transition assistance program has recently come under redesign. the informational material continues to basically comment disability. we know this. yet we have been unable to get more than -- and i'm not exaggerating, more than just a couple of sentences and the information that talks about these needs. and really, that not only is in your first job, but retention and your second and third job. as a comment earlier, we're talking about in many cases lifelong issues. many of our aging veterans who are wheelchair users are not aging people with disabilities

are losing the functions that they regain, not this time because of disability but because of age. so they continually face this every time they are seeking a new job or other new opportunity. you're not just going to have one job or career your lifetime. and so we really need to make sure people have the tools and we just need the assistance of the commission and anyone else that will weigh and that we have got to make this connection for service members regarding the rights and responsibilities that they have available to them. >> -- all my recommendations, very difficult to put into place because i'm sure the department of defense would not want to give up any of their control or authority over their soldiers. so i would just -- i would hold

in my recommendation. >> i would recommend that there be funding produced to community-based organizations so that they can assist with the servicing of special glasses with regard to veterans and also for their family members so that they can continue to help in the transition into civilian life. >> if the american people have to pay taxes until their eyes plead to take care of our veterans who are returning, we must do that. of course, what i want to tell you to do is repeal the defense of marriage act. the supreme court doesn't, congress is too. the president is to. these families need all of the help that they can get to be a good family, to be a good service member. repeal defense of marriage act.

>> thank you all, again, for being here today. very helpful and informative and we appreciate your participation there is additional and permission you want to send, we will come at. we are going to adjourn this briefing for the moment. we are going to take a brief break. at 1230 we will start the portion of our business meeting that relates to the stand your ground consideration. the we will then break for lunch every turn of 130 to start panel number three. thank you. you will take a five minute break, commissioners. [inaudible conversations] >> the first speech by sitting first lady, becomes the first president of the dollars of the american revolution, designs are on china and establishes the white house china collection and is the first-ever christmas tree in the white house.

beat caroline harrison, wife of the 23rd president. as we continue our series on first ladies with your questions and comments. facebook and twitter tonight live at 9:00 eastern on it c-span, c-span three, c-span radio, and c-span.org. .. congressional information meantime. since the house and senate are

returning from a week-long memorial break when the senate returns today lawmakers will resume work on the reauthorization of the farm policy and there is proposals making changes to the comprehensive overhaul of the immigration law. senate majority leader harry reid said he's hoping to begin consideration of the bill the week of june 10th. house lawmakers those returning today to start work on funding the federal government for the upcoming fiscal year which begins october 1st. first up is a $73.3 billion spending bill designed to house and equipped the nation's military troops and families. the measure also includes money for a host of federal and services benefits programs. the second spending is up for debate next week this funding for the homeland security department, nearly 39 billion spending bill border security, grants for first responders, cybersecurity and disaster relief. chambers returning for legislative work today, and at

2 p.m. you can watch the house live on c-span and the senate right here on c-span2. for more ahead about the weak and conagra's we spoke to a reporter over on capitol hill. >> with congress returning this weekend the headline from thehill.com some challenges could tear down major pieces of obamacare. they point out the president's health care law is under attack in the court even as the administration brings forward its full implementation. managing editor of the hill newspaper joining us live on the phone. thanks for being with us. it's a busy week. let's begin with this headline from your colleague sam baker. >> guest: this makes the case that legal challenges to obamacare are not finished, and there are really a handful of lawsuits, some in the pipeline that are closer to getting to the higher courts than others. but the focus on the irs setting

up insurance programs, which is a total concern even for supporters of obamacare that if that got to the supreme court that could be struck down. the irs has been in the news recently. there's another lawsuit on the birth control provisions, and then a couple other issues in the pipeline but it doesn't go beyond the two it would probably take more than a year to get to. but the legal challenges are ongoing. >> host: there is a point in the story that gets to what congress is going to be focusing on this week with regards to the irs, one is accusing the irs of illegal implementing the new subsidies to help people buy insurance and of course you and others are pointing out the hearings are in the irs this week. >> guest: that's right. though irs commissioner will be testifying for the appropriations committee tomorrow and that is the beginning of the ways and means committee in the house will be

looking, will be hearing from conservative groups and their experience of being targeted by the irs and then later this week we have darrell issa's committee and we will be highlighting a more of it more trouble for the irs about the spending by the agency that the acting commissioner has already said was inappropriate. so we will begin more details on how much spending, how much wasteful spending was spent on the conference's but clearly one of the focus is will be the irs. >> host: part of the legacy from a previous era putting blame in part on the bush administration. >> guest: yes. it goes back a long time and that is the message there is a lot to be done, a lot of reforms have to be implemented but are just not tied to the obama administration tenure. >> host: another story from your colleague, jennifer martinez. press with president to get

tough on china with regard to hacking. the story available on thehill.com. one key player in this is congressman mike rogers of michigan calling on the president to explicitly warn the chinese president at cyberattack waged by his country's government and military will not be tolerated by the u.s., and these comments from over the weekend of the secretary chuck hagle again accusing china of cyber espionage throwing sums sharp responses that the chinese government. >> guest: yes. this could be an awkward meeting between the president and the chinese leader because clearly the u.s. government believes it has enough proof that over the years the chinese government has been involved in these incidents is. so the fact that they might be setting up some type of new memorandum or some type of process things are not allowed formally is an indication that it could be progress.

they've denied with the u.s. is alleging. >> host: july 1st is the deadline before student loan rates increase. we heard from the president on friday at the white house the congressman has to do something, correct? >> guest: absolutely about a year ago, democrats in congress and president obama challenged republicans to keep the rates at 3.4%, and republicans didn't like the democratic remedy but under the political pressure they caved. they are saying we are not going to cave this year. they want to tie them not on to an artificial number, they had passed legislation in the house mostly along party lines that would tie it more to the market rates. that has drawn a white house veto and senate democrats are working on their own bills that they hope to get to this week

that would freeze the rate at 3.4% for two years they say the house version would simply raise rates. they don't want to do that. between now and july 1st. >> host: we are talking with the manager of the hill newspaper. a couple other agenda items. the farm belt, where does that stand in the senate and also in the house? >> guest: the farm bill, the bipartisan bill is going to be the first thing the senate addresses this week. they start to be for the last recess and they will be working through various amendments. that is a bipartisan bill that is expected to pass the senate. now, it passed the senate last year, but it didn't get -- it got a committee on the house but not on the floor. now if you talk to house members who are pushing the farm bill, they are very optimistic they are going to get the floor vote and house leadership has indicated there will be a floor

vote. and a lot of the controversy between the senate version and the house version goes to what is called snap and those are food stamp programs allowing for funding in those bills. very different and the conservatives really want to ratchet that number down. so, there is more hope that it could be signed into law this year or perhaps into early next year. but there is a long way to go. >> host: and a major center piece of the president's agenda remains immigration. you saw what happened before the senate judiciary committee. we talked to the congressman bob goodlatte of the house judiciary committee. two different approaches of the legislation in each chamber. >> guest: yes, very much so. the senate judiciary committee has reported a bipartisan bill. 13-5. that bill was going to go on the senate bill next week. conservative critics of that are planning to tell us to ramp up their opposition to that. but will it pass the senate?

in all likelihood, it will. then the focus is on the house, and it is a bipartisan group in the house that has struggled to get a bill. they say they are getting very close to releasing a bill that would move through bob goodlatte's judiciary committee. but, you know, in talking to various house conservatives, they don't like that senate bill at all. and they are saying no matter what the senate does, the house is not going to pass that bill. that's something the speaker john boehner has said. and i think that's right. unless there's enormous political pressure over two or three months, the house isn't going to take up the bill. so they are going to move this a bipartisan house bill from the gang if they ever come up with a bill, or bob goodlatte is going to move a series of individual bills through his committee. and then on the floor. one area the house has moved is that they are not going to vote on one big bill like the senate.

they are going to vote on a very narrow bill and then get a conference. and that's when the battle will begin and if you ever get that conference that will be of course another vote in the house and senate to see if we can get to president obama as desk. >> host: to political notes from your colleague about mitt romney trying to resurface in 2014 and remain relevant among the republican party circles. could we see them on the campaign for the mid term election for wealthy the behind-the-scenes player raising money? >> guest: he is very good and raising money. he did say i'm not going to go away. and the candidates that what his house especially on the money side, i don't think that you can see them everywhere and in every kind of campaign across the country. certainly president obama and more michelle obama but if the

candidates want from me, he's clearly indicating he will show up. >> host: a special election at the end of the month, june 25th in massachusetts. the special election to replace the secretary of state john kerry. from the newspaper gomez is the key for taking the senate in the tough race against of a congressman. what are you looking at? >> guest: the race is going to get nastier as we get closer. markey, a veteran of the house, he is basically the favorite. but he's not a huge favorite so that's where republicans think they can pull another type of scott brown. they haven't said that he is another scott brown. he says i am my own person. it's interesting that in the various interviews he's compared himself to get the independent

vote so this is the key. remember they need six seats to take back the majority. as mitch mcconnell is indicating this is a key phrase and we have a momentum. there is no doubt about it. that republicans winning in massachusetts would be in upset. >> host: the managing editor of the hill newspaper. thank you for being with us as congress returns this week. appreciate your time. >> guest: thank you triet appreciate it. [applause] >> good morning and welcome. i am deeply honored to be here with you today to openly discuss the very important topic of mental health in america today.

mental health affects tens of millions of people for the country each year. and deutsch to unnecessary stigma, only a small handful will receive treatment and instead they suffer in silence. those who do receive treatment will be left to face feelings of shame, guilt and secrecy. understand these challenges all too well. i connect with this deeply because i've been there. i was 15 on august 5th of 1999 when suicide took my brother's life at the young age of 20. in the acre of grass next to our childhood home, or at least the last place we played together. eight years later at the age of 23, i was diagnosed with major depression disorder. after suffering for years in silence.

as i begin to heal, however, i had this overwhelming urge to share my story with others, and i've been able to do that the past three years through active mind scummy national nonprofit organization that in powers students to openly discuss mental health issues on campuses nationwide. the tens of millions of people who are suffering, they're our friends, family members, neighbors and colleagues and it's time we put together to put an end to the suffering and to the silence. and now it is my pleasure and my honor to introduce to you the president of the united states, president barack obama. [applause]

>> everybody please have a seat to this genex thank you. welcome to the white house. thank you, janelle come for that introduction and for sharing your story and for making such a difference for your organization. we are proud to have you here. i want to thank secretary sebelius come secretary arne duncan, secretary shinseki for their leadership in helping organize this event and welcome some outstanding members of congress who are here and who care deeply about this issue. finally, i want to thank all of you for participating in this national conference on mental health. we want to bring together folks who've suffered from mental illness and families who supported them. we wanted to bring together advocates and educators, veterans, local officials, all

of you have shown an extraordinary commitment to what is a critical goal and that is to make sure people are not suffering in silence and that we have the capacity to pull together all the resources and support and love that's out there, to go after an extraordinary challenge in our society. the goal of the conferences and to start a conversation. so many of you have spent decades waging a long and lonely battles to be heard. instead it's about elevating a conversation to the national level and bring mental illness out of the shadows. we want to let people living with mental health challenges know that they are not alone. and we've got to be making sure that we are committed to support those fellow americans. because struggling with a mental illness or caring for someone who does can be isolating, and i

think everybody here who's experienced the issue in one way or another understands that. if it begins to feel as if not only are you alone, but you shouldn't byrd and others. the darkness day in and day out what they call a cloud you just can't seem to a state begins to close in. the truth is in any given year, one in five adults experience mental illness. one in five. 45 million americans suffer from things like depression anxiety come schizophrenia or ptsd. people are affected at a similar rate, so we all know somebody. a family member, friend,

d or will struggle with mental health issues at some point in their life. michele and i have both known people who battled severe depression over the years. people we love and oftentimes those that seek treatment go on to lead happy healthy productive lives. so we know the recovery is possible. we no help is available, and yet as a society we often think of mental health differently than other forms of health. you see commercials on tv about a whole array of physical health issues, some of them very personal. [laughter] and yet we whisper about mental health issues and avoid asking too many questions. the brain is a body part, too, we just know less about it. there should be no shame in discussing were seeking help for

treatable illnesses for too many people that we love. we've got to get rid of that embarrassment. we've got to get rid of the stigma. to many americans that struggle with mental health and illness are struggling in the silence rather than seeking help. we need to help the men and women who would never hesitate to go to the doctor if the had a broken arm or came down with the flu, but they have that same attitude when it comes to the mental health. we've seen veterans who come home with the invisible wound of the war but who feel somehow seeking treatment is a sign of weakness when in fact it is a sign of strength. we see it in parents who would do anything for their kids but often fight their mental health battle alone. afraid of reaching out what effect. we've seen it in the tragedy we have the power to implement.

i want to be absolutely clear that overwhelming majority of people that suffer from mental illness are not violent, they will never pose a threat themselves or others. >> involve someone with a mental health or substance abuse disorder knew when the condition goes untreated it can lead to tragedy on a larger scale. treatment is available and effective. we can help people who suffer from mental illness and continue to be great colleagues, great friends, the people but we love. we can take out some pain and give them a new sense of hope to the above requires all of us to act and there are few ways we can do our part.

first, we've got to do a better job recognizing mental health issues and our children. and me get easier for americans of all ages to seek help. today less than 40% of people with mental illness receive treatment. less than 40%. even though three-quarters of mental illness emerged by the age of 24. only about half of children with mental health problems receive treatment. think about it. we wouldn't accept it if only 40% of americans with cancer about treatment. we wouldn't accept if only half of young people with diabetes got help. why should we accept that when it comes to mental health? it doesn't make sense. but the good news is there are plenty of groups stepping up to change that. so a former colleague of mine, gordon smith, former republican senator lost his sonto suicide

ten years ago. and i remember him speaking so eloquently about it. gordon is now the head of the national association of broadcasters. and today the national association of broadcasters is announcing a new campaign to designed to change attitudes about mental illness through tv ads and social media because gordon doesn't want other parents to go through the agonizing loss that he has endured so we thank you for that great work. [applause] the of secondary school principals holding conferences on mental health and organizations like the ymca volunteering to train staff to recognize depression and other than mental illnesses and our young people. we have leaders from different faith communities who are

getting their congregations involved in the dozens of other organizations have made similar commitments so we are thankful to you. there are people who were leading by example. my good friend, patrick kennedy, when he was running for reelection he could have avoided talking about his struggles with bipolar disorder. let's face it, she is a kennedy. [laughter] his seat was pretty safe. everybody loved him. yet patrick used his experience as a way to connect and lift up these issues, not hide from them. one day a woman cannot patrick at the senior center and told him she was afraid to tell her

friends she was taking medication for a mental illness because she was worried they might treat her differently. she told patrick your the only one that knows aside from my son. so patrick started realizing how much power there could be for people to speak out on these issues. he carried the stories back to washington where he worked with a bipartisan group of lawmakers including his dad to make sure the mental health services to get through your plan and worker covered the same way that physical health services are. [applause] >> because of patricks' efforts and the colleagues that worked with him, it is easy for millions of people to join him on the road to recovery. which brings me to the second

point. it's not enough to help more americans seek treatment. we have to make sure the treatment is there when we are ready to seek it. for years now the mental health system struggled to serve people who. that's why under the affordable care act we are expanding the substance abuse benefits for more than 60 million americans. new health insurance -- [applause] the new health insurance plans are required to cover things like screenings for adults and behavior ... and for children. beginning next year, insurance companies will no longer be able to deny anybody coverage because of a preexisting mental health condition. [applause] we are also investing in science and basic research to make it easier to diagnose and treat

disease early. i announced an ambitious initiative to develop tools for mapping the human brain that could help scientists, researchers unlock the answers to conditions that affect mental health. we are also doing more to support our troops and our veterans who are suffering from things like traumatic brain disorder, traumatic brain injury or ptsd, post-traumatic stress disorder. today we've lose 22 veterans today to suicide. 22. we have to do a better job of that than preventing these all too often silent tragedy's. that's why we have poured an enormous amount of resources into the high quality care and better treatment for the troops. and today, under rick shinseki's leadership, the va is going even

further into the the partnering with nine states to help reduce the weight time for veterans seeking mental health care. and they met their goal of hiring 1600 new mental health providers which means this summer they will hold more than 150 like this one in communities across the country so that every one of our service members and fattens understand. just like to take care of yourself and each other on the battlefield you have to do the same off the battlefield. that's part of being strong. but for many people who suffer from mental illness, recovery can be challenging. what helps more than anything, what gives our friends and loved ones strength is the knowledge you are not alone. you are surrounded by people that care about you and will support you on the journey to get well. we are here for you and that is

what this conference is about and why these issues are so important. if there's anybody out there listening and you were struggling, speak out. >> thank you mr. president. >> you're welcome. [applause] you know, somebody who is struggling, help them reach out. remember the family members who shoulder their own burdens and need support as well. what people were suffering in silence know there is hope, there is possibility, and that's what all of you represent with the extraordinary advocacy and work that you have done. thank you for being here. let's do everything we can to help our fellow americans feel in tonight.

now i would like to turn over to secretary sebelius who will be leading the opening panel. thank you very much. [applause] >> [inaudible conversations] >> i would like to join the president in thanking all of you for being here today. it's incredibly important to see so many people representing so many different parts of society

from advocates and health professionals faith leaders, families and people with mental illness and i think there is no question that having this conference kicked off by the president of the united states closed later today via the vice president of the united states gives you vindication of the importance of this administration. overcoming the negative attitudes and misperceptions about mental illness has been a challenge for way too long in this country. so it's really encouraging in this in part a moment to see all of you come together to help us address them. the president mentioned some of the challenges we face. 60% of people with mental health conditions and nearly 90% with substance abuse disorders still don't receive the care that they need. one reason is because they lack access to care and we are

starting as the president said to change that with the walls like the affordable care act and mental health parity which will expand benefits for mental health and substance abuse to 60 plus we think it's about 62 million additional americans. people also need to be willing that the need help. all of us know someone near and dear to us that suffers mental illness and those conversations are often the same. as soon as they talked to someone and as soon as the open up, there is an admission from lots of other people that they too know someone, but the conversations are few and far between. so, mental health needs to be an issue that we can talk about openly and freely without the fear of being judged or penalized. today too many americans with mental illness continue to be outcasts in our communities.

years of the recent public attitude survey shows. a 38% of americans say they are unwilling to be friends with a person having mental health difficulties. 64% are unwilling to have a person with schizophrenia as a close co-worker. 68% say they are unwilling to have a person with depression mary into their family. and i can guarantee some of that is because they have no idea that the person is sitting next to them or their friend or neighbor or across the hall. people think they know what this looks like. but we also need a change in heart and mind. we need to break down social barriers and help people

understand that care is available, and recovery is very real. the best way to do that is by increasing understanding about mental health illness and that's why we are so glad to have you all here today. one important resource that i am proud to announce is the launch of a new website, mentalhealth.gov. it's a one-stop shop people can find help. it showcases stories of people that have overcome the mental health challenges to little feat productive lives. a former u.s. senator gordon smith and actress glenn close and many others have already been kind enough to share to stories on the site and we intend to populate the site with many more. but i also want to hear about new approaches and ideas from all of you. what we ultimately want to do is take the conversations we are having today in the white house

and take them to the school auditoriums, community centers, houses of worship, living rooms, kitchen tables across this country. and there is no way we can do that without you. so to get us started i would like to bring up the first great panel of advocates and leaders to take a seat on the stage. senator smith, glenn close, janelle michelle, robert and norman anderson. they are going to share their experiences and best lessons they've learned about the best ways to reduce negative attitudes and perceptions about mental health. and i'm going to introduce them one at a time. [laughter] come on. former u.s. senator from oregon gordon smith who's the president and ceo of the national association broadcasters and a longtime champion of mental health policies. [applause]

acclaimed actress glenn close, founder of -- [applause] or you may not know is she is the founder of bring change to wind, an organization aimed to eliminate misconceptions about mental illness. janelle michelle, use all briefly with the president earlier. janelle who is sharing her -- [applause] janelle stairs to the crushers are story to empower students to speak openly about mental health. barbara terrie [applause] barbara is the founder and president of give an hour, a group that helps provide veterans and their families with mental health needs. finally, norman anderson.

[applause] and norman is the chief executive officer and executive vice president of the american psychological association. if you will take your seats they are going to pull the podium and we will start the conversation. thank you. >> well i'm going to start the conversation with gordon smith.

gordon, i understand in response to the president's call for action, nab, the national says edition of broadcasters who is going to announce a new public campaign. can you talk about that? >> absolutely, madam secretary. this grew out of not just my heart, but the goodwill of america's broadcasters, radio and television. we met with vice president joe biden, a beloved colleague of mine who was there for me in some of my darkest hours. and we talked about the difficulty of the first amendment, the second amendment, the political boundaries of those, but pointed out the common thread running for the violence in the country is mental health. and broadcasters stepped up and said we would like to professionally produce a campaign that you rolled out in july, late july that has the

white house hhs messaging for item spitting it number one, it's okay to talk about mental health to begin talking about. they are helping and available and effective. number three, if you need help, get it. and number four, if you know someone who needs help, help them get. i am very, very honored to be part of this effort. it's about the brain's but it's also about our hearts. >> very clearly you are a public person. people recognize you. but you and your sister and your nephew have briefly been very public about struggles with mental illness. some people say that negative attitudes about mental health, the stigma doesn't really exist

anywhere. can you talk about that since you've been on the forefront of the conversation? >> i think people got that idea because i think we are pretty well educated should the fact mental illness is an illness unlike many others. but for that reason, people say there must not be any more stigma. but the truth is stigma has hardly budged, and there's research and surveys everybody in this room knows that. my nephew when he came back from two years in the psychiatric hospital lost all his friends. my sister was afraid she was diagnosed with bipolar disorder to have her little girl have people over to their house that they wouldn't be allowed to come because she had told them she was suffering from mental illness.

my friend who's in the audience today and some of her colleagues did a survey of adult americans across the country. there is something called the backbone of stigma. number 1i don't want anybody with mental illness living next to me. number 2i don't want them teaching my children. number three, i don't want them supervising in the workforce. number four, they are going to be violent and unpredictable, and number five, i don't want them taking care of my children. that is the reality of what people are still thinking in this country and around the world. and i think -- i like challenges but i think we are not just talking about somebody understanding. we are talking about changes in behavior. one of the things that has to happen in our society is inclusion.

the amount of talent that we are losing because we are not taking care of people suffering from mental illness is catastrophic. the cost it is costing the country and the cost is to us is viable and enlightened society. assisted by its huge and everybody in the room has to work together to start the conversation and to end it. [applause] >> so glenn has come at this at a personal pathway. janelle gun you have a personal issue that brought you into this world. first your brother and then yourself. but you are dealing with students across the country in that so-called transitional age come a very critical age. tell me when you found to be the best way to reach out to kids and how do they deal with this issue?

what have you found in the lessons learned that we should learn about? >> through active - -- at combat sensitive age group i guess what i've been able to find is that when i first started getting my presentations, i was focusing more on educating about mental health disorders and the signs and the symptoms and what i found in my questions and answers is that the students were interested in how i was able to recover in the coping mechanisms that are used. so i was able to tailor my messaging to focus on how i was able to recover. we speak from personal experience and so we talk about how i was able to kind of dumb

about my backpacked and get rid of mick mechanisms that didn't work for me, abusing substances, hiding from my feelings and emotions, not being open to my friends and family members with what i was dealing with, and, you know i let the students know that we need to fill up the backpack with something that works. i had a huge relief from doing yoga and i got involved in that community medication as well. so these are some of the things i talk about with the students being able to connect with yourself again, connecting the mind and the body and connecting with each other to be able to find that support, that support network, and to think open to seeking help. these are some of the things i found going across the country that the students were engaged with how to recover and what are

those steps to take. >> so barletta has been working with veterans and their families. and i'm curious both about what you find with people coming forward to first admit that they are dealing with some issues they need help with how difficult that is, how to get to the family and friends. and you talk a little bit -- i understand you are launching a new initiative in response to the meetings today and the call today to set up. can you talk about what is going on with that and what is going to be in new? >> thank you for the opportunity. in a military veteran and states have been dealing with men and women coming back from the war for over ten years now, and for many of you coming you have seen the reports, you know the stories it's been a struggle to get the men and women who come home with the invisible injuries as war.

>> in addition to those that serve, one of the things that we found is very helpful. one is what they are experiencing makes sense. any of us that are in those situations in combat seeing what they have seen coming home trying to bring in to read into our lives doesn't mean they are broken that they cannot be great parents and great co-workers and great partners helping them understand and finding other veterans to step up and share their own stories. another important issue which is one size doesn't fit all. not everyone who is on the road to recovery will find that in a mental health professional like

me. i'd be service in the community and working with mental health professionals, and finally making sure that our mental health professionals are well prepared so they understand the culture because as we all know it takes a lot to step up and ask for help so if you ask for help and then you feel like that person doesn't understand me you are not going back again. what we are doing -- i'm very proud that several of the organizations i work with, the case foundation, the global initiative, america's promise and the aspen institute have agreed to assist me in a group of individuals taking what we've learned from working in this case in the past ten years and looking at how we can apply those lessons. more to the veterans' population but also to the communities around the country. what we know is there are a lot of great initiatives, great

programs many of you are here today that represent those programs, but often what is missing is the coordination, the collaboration. so, our job in this new work that i am very proud to be leading is all about how we identify great programs, how we bring the programs together and give those two communities so that the mayors and the communities have a plea last that they can look to and put those into effect. >> that sounds great and really important to coordinate those services because oftentimes people don't have any idea where to go so mapping and collaborating at coordinating. you are leading an organization of mental health providers. i know that part of the issue is are there enough mental health providers, are they in the right places, but also i think what can the mental health providers do to inform other health

providers about ways that they can more effectively identify and reach out to folks. the psychological association and others can intervene what other health care providers identifying and reaching out to folks. >> thank you que dalia appreciate the leadership of the administration of initiating this and expanding this dialogue. it's important both from the professional perspective as the american psychological association and also personal because i have a close family member that suffered for decades with chronic schizophrenia. and of the things that has done to his life and how it affects our family.

this is an exciting opportunity for all of us here. we are really approaching this from a developmental perspective to make sure we are using the expertise of other professionals to spread the word about mental illness and a sort of reduce some of the myths and reduce stigma. one of the partnerships that we started is with the y. the of 18,000 employees and in the summer they actually add another 49,000 employees to work in the summer camp. so we are galvanizing the mental health professionals to develop educational materials and tools for those employees to help them better recognize mental health problems and especially depression among some of the children they serve and take

appropriate action given whatever the circumstances are. those materials are going to be ready for the summer camps this summer, but also they will be available for all of the programs throughout the year. the second partnership that we have is with the american council for education and the national association for student affairs administrators at the university to try to target mental health services for the college student population. recent statistics show that mental health problems are a major concern on college campuses. so, we want to bring together the best practices, the best evidence based practices for how you improve mental health on campuses, but those resources together and distribute those across the country of the university president, student affairs administrators and campus counselors. a third partnership that we are very excited about is with the

association of american medical colleges. call the aamc. a top provider of medical education and it's the association for schools of medicine around the country. it's called med ed portasl for physicians and other to get information about that evidence based practice and health care. we are partnering with them to make sure that they have a fight within the portal just on mental health because as many have cricket priced, primary care physicians, medical doctors are on the front lines in many cases. we want to make sure they have information. the final thing we are doing is we just started to have discussions with microsoft.

microsoft wants to initiate something called skype in the classroom. they want to use the technology to expose adolescence to local and national mental health professionals to provide them with information about mental illness and the fact that it's treatable and the recovery is possible. those messages will be recorded and then disseminated across the country to others that didn't see them have been live so those are a few of the things that we have been involved in recently curious, i want to turn to the audience for questions but before i do, i want to recognize -- i know that all of you in the room are doing important work and have initiatives. but i want to particularly give a shout out to pamela who leaves or substance abuse mls to --

analysis. [applause] >> she will be helping to organize a lot of dialogue across this country and has been a great inspiration to the work so far. but i would also like -- there are such a number of champions of change here. members of the house and senate who have worked on these issues. many of them throughout their career and some former members. would you all stand and let the audience recognize and thank you for your efforts. members of congress, please come and former members of congress, you can stand up. thank you. >> thank you. this is a passion for a number of folks in this room and we want to recognize their efforts in the fact we are kind of a historic juncture where

hopefully we are having this important conversation that also benefits are coming on line for about 65 million additional americans. this is a great time for the dialogue to be launched. let me turn it over to the audience and see if -- yes, sir. >> [inaudible] >> we talk about mental health as much as we should would you address the mental health from -- >> barbara and some others may want to jump in now as well. >> a great question and issue brings to mind something i talk often about which is that we all have mental health. every one of us every day of our life. where we are on the continuum

depends on so many things. external factors, a car accident, the loss of a loved one. an explosion in iraq. internal factors, whether you have a predisposition common genetic marker that would lead to depression or bipolar disorder, schizophrenia. so, we need to think about trauma as being mental health not separate from but connected to. and so how we treat trauma should be well integrated into the picture of the human being once wellness and ones being and mental health. so thank you for asking that. it's a very critical issue. >> withheld when you identify yourself and then if there is a particular panel member that you would like to have answered the question or if it is sort of open to all of the panel members. yes, sir. >> president of the american

psychiatric association from columbia university. one of the issues that complicates mental health care and care for people with mental illnesses is the comb of substance abuse. there is a commodity that people with a disability have shorter life spans. so, in terms of the issue of substance abuse i would be interested in the panel members' reactions as to how we might address these in the context of the respective initiatives that you are pursuing. >> janelle, i know you talked about that a little bit. and i don't know if you have some substance abuse of also plaques >> yes, my sister is now 12 years over. [applause] part of our message is that you cannot start thinking about

recovering from mental illness until you deal with your substance abuse. it is a battle but hopefully you have the support of family and a place to go in your community wherever it is the you can get help. >> i wish to make the observation that substance abuse is a manifestation of a deeper problem and in fact if you can attack that problem, the substance abuse piece gets fixed as well. the current members of congress, this is not a topic that registers republican or democrat. this register's human.

i found my greatest champions were among both parties. patrick kennedy the chief among them. and it's really something that uniquely can bring our country together with the issue is health care, gun control, media violence, however they want to characterize it this is a common thread and it doesn't need to be partisan and it is a basis for healing not just individuals but as a platform for healing our politics. >> i come from connecticut and my mother recently turned 89 and we were all with her. how many of our relatives had serious depression and he drank himself to death. she drank herself to death. in our society it was a cocktail party and because we had no

vocabulary for mental illness, people were self medicating. and i think it is a very common -- >> speaking from personal experience this is something i dealt with myself. i had never really coped that well when my brother passed and it wasn't until leader in my ear early 20s that all these feelings and emotions in questions and anger that i had kind of bottled up came spewing out and i had no way to deal with that i didn't recognize it as depression. i didn't know that. and i wasn't very happy to the i wasn't taking care of myself. i wasn't able to take care of my animals but i kept pushing through. i thought this is something i should have control over. little did i know that is when i needed to seek help. that is a sign of strength, not

a sign of weakness. that's when i should have reached out for help but i didn't know. that's why educate now moving to the substance abuse i started looking for ways to be happy. of those things stopped working and i gave up and i felt i couldn't be happy so that's when i started abusing substances. i numbed myself and that's exactly what i was looking for. little did i know that my substance abuse was driving me further into my depression as we all know throwing the chemicals off even more. we reached the point it was so bad. i had insomnia slipping 23, 24 hours a day. the point the light bulb finally went off i was in the shower and i could barely lift my arm to wash my hair. my arms felt like they were 20 pounds each and i stepped out of the shower and i looked in the mirror and the face looking

back at me, i didn't know who that was and finally the light bulb went off. as far as the substance abuse, it was -- the depression came first for me and bennati had used the substance is to feel from these emotions. we are looking for a positive way to bring about an open dialogue so others don't have to suffer in silence or a beach that plank of substance abuse. >> norm, you have a question. >> in this country for too long we've separated the problems for mental health and substance-abuse problems and we treat health problems over here and separate substance abuse and mental health the need to be integrated. i'm happy with the provisions of

the affordable care act, but we need to do more. when people go to their physicians they are comfortable doing that there should be an assessment of substance abuse, the screening of some sort of mental health problems. it should be talked about. the would help people become more comfortable talking about it and things they can handle on the short term there needs to be mental health professionals that's part of the primary care teams such that when you see your primary care physicians, it is understood that you will talk about the behavioral health substance-abuse issues and its understood if you need help you will get it there. the things that are more serious it should be understood that it's from or specialty, more intensive care possible. we just have to make it an interpol part of the health care system.

>> ceo of mental health america. my question or issue really has to go with the issue of capacity. in 2009 income of the mental health system in this country wasn't in very good shape in terms of meeting the demand at that time. since the recession and the state's respected challenges in meeting their own budget crisis and attempting to balance their budget we lost in excess of $4.5 billion to the publicly funded mental health system. this is happening at that time we are at the advent of the implementation of the affordable care act when we will have millions more americans with coverage potentially increasing the demand at the time that we are still under capacity. i want to make an appeal to those members of congress in the

audience that unless we have additional resources we will have the kind of access that we are all advocating for today. we really need the parody rules and i know that you are actively working on those. but as it stands, we don't know whether or not any of the class's with benefits in the essential health benefits have parity across-the-board. we don't know if the benefit on the side will compare to the behavioral hall side and it would step down kinds of services and levels of care like residential services to the hospitalization etc. we don't know from the primary care side the behavioral health commissions would be covered. as the primary care physicians and i could go on. thank you. >> it's a great segue with our friends and colleagues. i can assure

this room are champions funding things in a positive vein as the states have cut back on mental health services there is no question there has been a dramatic reduction in the state funding. we have been trying at the federal level to not only keep federal funding but increase access to services. so throughout the country the footprint of the community health centers as expanded and added mental health providers in the communities across the country coming and that footprint will continue to expand the president's 2014 budget has an additional request for training for 5,000 more mental health providers, and particularly mental health providers who will work with the transitional age group, some in schools, some in community health centers as folks transition into the world at

large. so we recognize part of this access issue is providers and part of it is resources and are trying to make sure at the federal level we are working on that and also encourage a hour colleagues of the state and local level ending one of the important things about this dialogue is it can raise only awareness but awareness of gaps and make the budget priorities around mental health more of a focus issue at the state level so when the legislators reconvene in january in the states across this country, hopefully there will be more constituent pressure around the mental health budget at the state level. we are working hard to finalize. we are committing to finishing the parody act this year. i know there are lots of the unanswered questions that we are working hard to deal with, but that is within months of the final decision. and i think frankly have in the

parody come on line at the same time as the central health benefits and health plans are expanding is actually a positive step forward so that that is being written with an eye towards the essentials health benefits, new health packages and states around the country. >> on that issue of the implementation of parity the insurance companies often have the final say on whether the services are covered or not. we want to be a to call the insurance companies and will require them to have a full disclosure when they are complying with the second law or they are in violation of the law so we don't expect you to find all of these but it would be essential in the rule in the

disclosure requirements so that we know in the health insurance company is making these decisions they treat the brain like they would treat the heart like we would treat cancer if someone had a cancer. it's equal treatment and public disclosure. insurance companies will make us do more work unless they know someone is looking at them and we appreciate the attention that you are giving this important issue and we want to help you in this process. [applause]

>> i have stolen his line he talks about we need to have everyone get a checkup from the neck up. >> without thinking of your work, the implementation there's a lot more to do. i agree with patrick we have to make sure that there is transparency and accountability. but i can't resist putting in a plug for legislation that we have in the house and the senate and all of my colleagues are working here but if we don't have services we are not going to get this done. so as many of you know we have been working very hard to make sure that we have the right kind of funding mechanism for behavioral health as we do for

the federally qualified health centers. we allow the community health center services. the final piece in the structural stigma is making sure on the community level we have the health centers having access to the same kind of payment opportunities as physical health. we were talking about structural stigma. if the insurance system builds differently, if you can't get any care that sends a message, the wrong kind of message whether or not this is important and whether or not it is comprehensive health care. same thing in the community right now. we are sending a message by not funding community health or

substance abuse services. we say it's important but until we find this, we will not structurally be giving them the indication that the stigma is gone. the excellence in the mental health act, the house and senate, please help us get it passed. [applause] >> i'm going to return to a few questions to the panel members. can you tell us since you have been working on this for a number of years has the conversation changed all? and what needs to change next? >> i think it hasn't changed enough that there are so many wonderful organizations here even outside of the media where i work now that are doing great

things. you fort with the action alliance on prevention and it's pulling together all of the study was organizations that represent. the trends were trying to pull together all these wonderful strands to make sure that we transfer what we know in to the affordable care act as it is implemented so that never again are issues of the brain relegated to the back room but they enjoy in equal place in american health care never again to be returned to the attic. >> glenn, can you talk about why changed mind was created and

what have you learned as a part of that organization? >> change to mind was created because one day my sister came to me and said i need your help i can't stop thinking about killing myself. and this was even after her son had been diagnosed with schizophrenic disorder. it started certainly my education. i am ashamed of what i didn't know about my sister to but i could say i was going to college and i was starting my career. she lived in montana. i was in new york. but the fact is we are lucky that she is still here. she definitely felt through the cracks of our family. and so i decided -- we helped her and started on the journey

of recovery. but -- i just lost my train of thought. but no, the thing about bringing change to mind is the power of the story. i think everybody that is in the mental health world realizes and there have been surveys and research efforts that the most powerful thing is the way to change somebody's attitude. that can lead to a change in behavior to actually meet people and hear their story. and as leaders and advocates, we have to figure out how to get those stories on the grassroots basis across the country. and what you are doing with your wonderful senator was getting it into grassroots, local tv, local television.

that is going to make the difference. .. with dark glasses in the cavernous grand central station, i didn't know whether he could make it through the day. we just had another psa called

schizo, learning about schizophrenia and he was able to an entire day to stand in front of the camera, looking to the high day i've been living with schizophrenia for 11 years. he actually has that, i think my brain is healing. but he is somebody who says, it took me 10 years of learning about it, of fighting, learning this little moment of clarity is real. everything else is it real. maybe i have 10 minutes of clarity and you cling to that. incredibly courageous way. the story, my sister's story, people we all know when mr. are what will it as together a country and one community to the next. >> adam secretary, i think it is important to recognize that people at the gravitas of it going close -- glenn close,

bradley cooper, people changing how they speak about mental health issues can have an enormous impact in what they produce and shaping attitudes toward tomorrow. we appreciate people like glenn who's willing to step out, like radley, to change attitudes by what they see on television, by what they see at the movies and that's a very powerful tool and you organized here today. >> well, i think there's no question that having personal stories is critical and having the media to help drive that, we have some wonderful partners who are going to be part of the affair. not only the national association of broadcasters, but a number of venues, mtv and

others. social media leaders willing to use their platforms, but they need to be inspired by personal stories, so it's a combination of the platforms and the media messages. >> well, i want to go back. i think are really critical thing for us to focus on a piece of this conference today is that it's incredibly important to make sure we have capacity of trained mental health professionals like me and norman and other great folks throughout the profession. but i want to make something very, very clear and that is about the notion that one size doesn't fit all and there are many ways to use people like me. this is what we've learned in our veterans community. we are at a service project yesterday in new york city at ps 197. we brought students and veterans

together to learn about each other, but that's not what i wanted to talk about. what they were doing at the school is painting murals for inner-city kids who don't get murals, but talk to them about via good friend. those messages embedded in the art, that mental health care. that's prevention. working with the mental health community lovers chests, make use of those who can consult to employers and schools. we have to work on capacity, absolutely. if we harness and connect those of us who have the skills were so many others touching people who are struggling with mental-health issues. >> well, i would like you all to join me in thanking the members that have joined us. [applause]

i know that many of you have questions around the room are statements to make him the good news is this is the start of the conversation. this is not the end of the conversation, so there will be lots of opportunities. i thank you all for being here today. hopefully you'll be part of the group that i see the eisenhower executive office building for the next session. but also in your home communities, i hope you look for opportunities to participate in the dialogue that will be launched. i hope he figures out ways that you, your information can help leverage space as we move forward. i can tell you the administration looks very much forward to having this year-long dialogue. thank you so much for being here today.

[applause] [inaudible conversations] [inaudible conversations] [inaudible coninaudible convers] [inaudible conversations] [inaudible conversations]

[inaudible conversations] [inaudible conversations] [inaudible conversations]

[inaudible conversations] >> nsa wrap up this portion of the white house conference on mental health issues, let you know will return to the conference at 2:00 eastern time for closing remarks by vice president biden. watch that live in a companion network three. senator frank lautenberg has died at the age of 89 from the monad. this is his arrival at a senate vote earlier this year. he served in the senate to separate times. 1982, 2000 retired and returned in 2002 to replace senator robert torricelli who is facing corruption charges. senator lautenberg was planning

to retire again after his current term. new jersey governor chris christie will appoint a temporary replacement until the next election. and here on c-span 2 will be led to 1:00 p.m. eastern for a national press club for the gerald r. ford journalism award.

>> host: tell us more about what is going on at the hearings on capitol hill regarding the

irs's josh hicks and the "washington post," columnist for the federal eye. >> guest: thank you for having me. >> host: we will see the act dana commissioner, danny werfel today. why is his appearance significant? >> guest: well, he'll be talking to a subcommittee of the house appropriations committee of the financial services and government -- general government subcommittee. so this is the fourth hearing on this matter, so i'm sure some people are saying some. fatigue at this moment, especially the inspector general, russell george is also testifying today. the focus may be different than the others because werfel is there any say to the irs and he wasn't there. he had no involvements obviously would do targeting campaign. so there may be less focus

within testifying on who's done it and why and more about next steps. >> host: who is danny werfel? percy come from? this is his first time before congress in this capacity. just go he's been mainly a career guy. by most accounts he didn't have ambition to become a political appointee leahy is now come even though this is a temporary position, it is still a political ploy meant. he worked for the white house budget office says the controller. he handled financial management, contracting, said i.t. matters and is also involved in an initiative called the camp came to cut waste, where he held basically stopped payments to fraudulent government contractors and that sort of thing. >> host: we heard on the sunday talk shows yesterday about new developments in the irs story.

irs halted on conference spending. true sense of the scope of what it danny werfel will be asked about? >> guest: i don't know that he'll be asked about the irs conference spending again because he's new to the agency, it may be more about what are your plans to fix some of these problems rather than what if these problems occur? and maybe he's probably just learning about the causes of these problems. they may ask what a nice base of a short time he's been there. i don't think it will be as intense as the questioning that happened at the previous irs commissioners they are during the time of the targeting campaign. >> host: and the subcommittee tackiness today, why are they looking specifically? >> guest: well, they have oversight over treasury. the larger committee does, the

appropriations committee. and then, you know, what they said committee, part of it is general government that they oversee. so this would fall into their territory. and maybe the case, like i said, this is the fourth. so maybe it had a lot of different committees already oversight and the senate financial services committee and someone, maybe the case of the high-profile issue like this, everybody wants to take a whack at it. you don't want to have one degree of oversight over the irs treasury again hold a hearing on this. >> host: josh hicks, "washington post," "federal eye" columnists, thank you for talking with us. >> it is an important thing we're seeing from the community relocation and the sensitive issues. people are debating whether or not to recover specter. we are debating what the first bribe and arab land should look

like. that's the hard question. the u.s. is the first in the world to figure it out. there is some tricky but important issues to address. >> host: it's not like the new chairman walking on a friday and have an auction on monday. there's orders that need to go out and as i said many times before is no exaggeration, this auction will be the most complex and world history with the ex-chairman and now we are moving faster than the rest of the world and how the loan. so the eyes of the world, at least in the wireless space are looking at the u.s. to see how we handle this.

>> last week the government released new regulations on wellness programs offered by employers. they include increases in the maximum disk and disk and the players cannot for workers who participated in programs. the alliance for health and vitality discussion fighters health policy professionals debating the impact of programs on health insurance costs. it runs about an hour and 45 minutes. >> my name is that howard had gary go, thank you. i am with the alliance for

health reform and i want to welcome you to this program that is going to examine one of the fastest spreading health promotion strategies in america and that is worker -- working place wellness programs. easy for me to say. according to the labor department, nine out of 10 larger employers have wellness programs in place already and have been around for a while, as have some of the rules employers have to follow to be sure programs don't discriminate among workers. the health reform law, the affordable care at more room to tailor programs to their own needs, especially in the rewards and penalties that they include. as many of you know, just this wednesday the labor department issued final regulations, spelling out just how much the way employers are going to have

when the new rules go into effect next year. today we are going to take a look at wellness programs, the ones already in place, how well they work to improve worker helping to save health care dollars per worker and firm alike amalek a cautionary flags some of the consumer groups have raised about the programs on the context of existing programs and the new rules will be dealing with. we are pleased to have his or her partner and sponsor in this briefing come on the robert johnson foundation, which has been helping americans enjoy healthier lives and get the care they need for more than 40 years and were happy to have with us today to co-moderate, the vice president of research and evaluation at rw jay. david understands health policy, how it shaped, washington having spent a big chunk of this great

art obj career i've met back, so we are doubly pleased to have them at this today. david. >> at afternoon and welcome to this meeting on workplace wellness. during the last year the robert wood foundation has accomplished much to improve the health of americans preferred sample of the 1990s, we took on tobacco and spent about $700 million on anti-smoking programs. the sufferers helped cut the number of adults and teenage smokers, probably saving 2.5 million lines. between 1996 and 2005, were invested almost $170 million in improving end-of-life care, creating standards of care for dying patients. the foundation of her brought a

sea change in the way the health of the oceans approach death. taken from her tobacco successes in 2007 we pledged $500 billion to reverse the scourge of childhood obesity in the united states by 2015. these and other offers several successes, but it's time for the foundation to update game, to increase our impact. we are envisioning a future in which we as a nation strive to create a culture of health that enables everyone and are diverse society to lead healthy lives. individuals, families, businesses, governments need to work together to foster this culture of health. for those of you, and i will remind myself, too, are those of you on health care issues or

medical care issues, good health is not solely dependent on health care. in fact, good clinical care is a small part of good health. health is where you live, learn, work and play. in this session, we'll focus on work and as i've mentioned, most employers, most large employers have wellness programs, even a majority of small employers have at least one wellness benefit. in 2011, the cdc created the national worksite program, and $9 million two-year programs to help businesses set up in one wellness programs. i recommend their site for more information on wellness programs that work on a checklist about what would work. you can go to your google machine and type the national healthy worksite programs and

find that site. while most programs include programs on tobacco cessation, obesity management, hypertension control, diabetes control and nutrition. some employers provide incentives for employees to make healthy choices and even a smaller number of employers are providing incentives to have healthy outcomes, not just healthy choices. in 2010, health affairs published an article analyzing the previous work on wellness with research on wellness and the article concluded employers for $6 for every dollar spent on wellness. the drop in health care costs and product tbd increases were increase is worth about $2.37. this era the article in health management review previous studies of workplace wellness.

it demonstrated success of wellness programs with the corporate culture, more successful companies tended to include wellness as part of the corporate culture, focusing on improving lives, not on health care costs and supported employee participation in wellness programs. the big question for today is which type of wellness programs work, which programs produce a benefits, which programs produce savings and which programs under which conditions produce results. which programs are supported by wellness clinics as ed mentioned on wednesday hhs released the final rule on the wellness plans. now it's time for employers to decide where to put their valuable resources. i want to thank the alliance for holding this timely meeting, especially timely given the hhs

rags and the distinguished groups, i look forward to learning more about workplace wellness programs. >> to sa. thank you, david. excellent framing of the issues before us. unfortunately the panel that can respond to that challenge. a couple of housekeeping notes. you see on the screen there is a hash tag at wellness programs if you want to tellier collects this briefing is being broadcast on c-span re, you can. if you want to tell them they better look at the webcast when it's available next week, you can do that as well. in your packets to find a lot of information on this topic, including speaker bios mark senn says, powerpoint presentations and hardcopy where we received them in time to print them.

and a list of materials, which if you go online at all health.org you can convert links they get you to an even more extensive background pieces. there'll be a transcript in a few days at our website at all health.org. green and blue are the colors of the day. green is the color of the question card you will find when we get to the q&a. write a question on that card or go to one of the microphones you see in the audience. the blue evaluation form, we would appreciate you filling out so we can get feedback on how to make these briefings even better. as david said, we have an all-star cast here and we want to get them to you as quickly as we can and we are going to start with on my far left, paul

bennett. paul will give us an overview of wellness plans and the material and the new rags. he is vice president for health care reform at the american benefits council, whose fortune 500 members provide benefits, including health insurance to more than 100 billion americans. paul has also spent time in as a health policy adviser to senator baucus and this is way about health policy and health politics. paul, thank you for being with us today. >> thanks very much, ed and thank you, david. those miniatures introduction for the topic today. my role today is to provide you legislative and landscape that wellness programs are embedded in. you'll also be be hearing from others with employer is in a moment to talk more specifically about practices and some of the wellness programs out there and

what do they look like. so i'm going to start with some basic background and i have a slight slight limit, so that as a way of focusing your mind on what is important. so wellness programs we know now in terms of regulatory framework really started to be defined under regulations issues and 2006, to flesh out what was permissible under an exception to discrimination and that hipaa act. the basic row and seven and his group health plans with her cell phone shared are prohibited from discriminating against individuals based on health care status. but there are two exceptions in hipaa. one is nothing prevents a group health plan or insurer from

discriminating in favor of an individual with an adverse health care condition. that is called benign discrimination, so you can do something that benefits somebody with a health care condition or you can have a health wellness program that needs regulatory requirements then laid out in the 2006 regulations. so along comes the affordable care act three years later and congress wrestles with this whole issue. they basically codified the 2006 wellness rules and then increase the allowable incentives that are available for a program under these regulations from 20% to 30% and then gave the secretary of hhs discretion to have incentives all the way up to 50%. >> paul, could i ask you 20% to 30% of what?

>> said the 20%, 30% of the premium contribution by the employee, the maximum amount would be based for employees only coverage unless the wellness program is also available to the employee's dependence on them that would be 20% or now 30% of the cost for family coverage paid by the employees, said the employee's contribution that also applies to any car sharing under the plans you could not very coinsurance by more than those amounts as well. so since 2006 an elderly after the rules issued on wednesday, wellness programs are divided into two basic categories. participatory programs and health contingent programs.

a participatory programs is one that is not based on any health that turn has to be available to all similarly situated individuals, which most employers do by making it available to all employees. this would be tantamount to go participate in a fitness center if he wanted to do that or complete a health risk assessment or take a diagnostic screening tests, where it's not a stunning result, just participating doing not are learning about smoking cessation not requiring results. health contingent programs are those that do relate to a health care factor them in the final role that came out yesterday, they are then subdivided into two other categories do not get to that in a moment. those types of programs are only permitted under the exception to help discrimination and started

with the hipaa statute if they comply with federal regulations issued now by three agencies, hhs, dll and irs treasury. so those are the ones will focus the most on because those are the ones with the regulations concern themselves with. the regulations on wednesday defied those programs into two categories as well, the health contingent programs now divided into activity only programs. that would be where to obtain the reward, the individual has to perform or complete an activity related to health that are, but not required to achieve any particular outcome. so when activity programs specified, for example, a walking program where you wear a pedometer or walk so many miles a week and an exercise program

or diet program, but no outcome is required, just hit dvd itself. an outcome space program to obtain the reward you have to chain or maintain a specific health care outcome. for example, they are the examples are also included in the regulation, a program to stop smoking, not just to learn about stopping smoking, but to stop smoking or lower your body mass index or blood pressure, cholesterol, glucose, both health risk that others. within these health contingent programs, the now umbrella term for activity only programs are outcome based programs, these programs within their category have to meet five regulatory standards and only if you meet those standards could you offer them in the work place.

some of them have not changed. some have changed very significantly this week. you have to provide an annual opportunity to qualify for the reward. you should understand that opting into the program during the time you often to your health plan choice during open season. there is a limit on the reward and as i mentioned, that used to be 20% of the employee's contributions to the cause of coverage or car sharing. the affordable care act increase that to 30% in the regulations increase up to 50% for tobacco use programs. so that one is using the secretary discretion provided in the affordable care act, but only for tobacco use.

the third is the program has to be reasonably designed to withstand it goes back to 2006 are basically the standard has to have a reasonable chance of improving health care can be overly burdensome, can't be a subterfuge for discrimination in the method chosen to improve health care can't be highly suspect. in a new aspect of the regulations provide is a fear and outcome space program like lower bmi, stop smoking, the typical ones, then these programs must provide a reasonable alternative to that goal oriented program, measurable goal oriented program for individuals to qualify who don't meet the initial standards. if your initial standard is reduce your weight by five pounds this year or your bmi below 30, you have to provide out individuals in an alcove is program the

opportunity to have a reasonable alternative to that program and regulations describe what this have to mean. i'm not going to describe the regulatory standard. so that is the standard, which would be suffering a regional alternative. the first is the reasonable alternative as i satisfy that, for example, if i have a program to lower bmi a measurable amount, the reasonable alternative might be that i'll pay you to go to jenny craig or weight watchers program. if you do that, the full reward must be available to the individual that satisfies the reasonable alternative standard with the employer can with the standard altogether provides a reward. which many employers do. the other requirements you have to pay for the cost of the alternative, and make it available to the employee.

you can't omit them find and guess what the program that would be reasonable lives. you have to provide it to them or assist them in finding that. any requirement in the final role as the time commitment involved and satisfying the reasonable alternative standard has to be reasonable at 12 and then there's the revised standard in the final role that the reasonable alternative standard must accommodate recommendations of an individual's personal physician at the plan standard is not medically appropriate to that individual. in an activity only program at the standard basically is the individual can obtain the reasonable alternative standard due to a medical condition that would allow them to participate in our achieve the plans primary standard, but showing for that

is they have to demonstrate it would be medically inadvisable or unreasonably difficult for them to achieve that standard due to that medical condition. i was in 260 would continue to apply to it tvd programs. the plan or t or the employer wa participated to obtain a position verification of the aca as this new requirement is reasonable under circumstances. for outcome space programs, the final role has a different standard for obtaining the reasonable alternative to the plan's goal oriented standard and that is that it simply has to be furnished to all individuals on request that's been a concern for employers under the proposed rule remains a concern and the final rule. or some other special rules that

would apply there, too. i'm a fan of requirement for both activity and outcomes programs is they have to notify participants about all of these requirements and how to obtain alternatives and the availability to get a program designed by your physician in their sample language now on the final role for doing that. how does all of this relate to premium tax credit and the health insurance exchange is also a major concern that comes about three different roles issued earlier this month. the general rule is if you have access to affordable minimum value coverage for your employer, you don't qualify for premium tax credit in the exchange. so the rules that cannot and may may said for purposes of participants and wellness programs that you disregard any premium or car sharing related to the wellness program.

for example, you would pay more if you didn't complete a health risk assessment, you would assume therefore that individual faces a higher premium contribution that makes it easier for that individual to obtain a premium tax credit, but it works in reverse for tobacco related program under that situation. you assume the individual did was smoking a participated in the tobacco cessation programs and therefore purposes of qualifying for premium tax credit for premium contribution is lower, whether in fact it was or not. finally there's a transition rule for all of this, for programs in place as the time of the rule that came out earlier this month in the transition rule will remain in place for 2014, so effectively for many requirements they would kick in for 2015. >> very good, thank you.

>> if we could ask you to pass around the sliding fanfare, we look at it to our next speaker, who is mary greeley. barry has the health care leadership council, whose members are health care companies and groups, most of whom have experience with wellness programs and they have them -- that experience with their own workers. she's done work with economist ken thorpe, look at how programs can help workers with chronic conditions and that one pager raising your materials. mary, share with us some real-world experience. >> thank you for wilderness program today. it's such an important topic, especially as we see rising rates of chronic disease. so not to start my brief remarks on a down note, but i saw a piece on the cbs news website

yesterday that i think really underscores the need for these workplace wellness programs. the story was headlined, is your job making you fat? and a focus on a survey of 3700 workers by career builder. according to the survey, 55% of employees consider themselves overweight. 41% had gained weight at their current job and 30% said they had gained more than 20 pounds. i think we have our work cut out for us. they say show the need to emphasize wellness at the site where people spend on average about eight hours a day and also points out there is a lot of work to do to how we can let the workplace itself your behaviors. the good news is workplace wellness has been catching on. according to a survey by public opinion strategies, over half the organizations they serve a humbleness programs in place.

with the heaviest concentration among publicly owned for-profit companies. most companies plan to expand or improve their existing programs and two out of every thregrams and two out of every three organizations that don't currently have programs are interested in starting one. in terms of what these work place bonus programs are achieving, it's fair to say we are still very much in the running stages. in fact, rand reported there is a scarcity of peer-reviewed studies on the efficacy of workplace wellness programs and in fact we have some employers who are putting these programs in place and putting money into them while they haven't been gathering the metrics to see what is the return on the investment they're making. now we have some good news. according to the same public opinion strategies survey, roughly half of all

organizations that have workplace wellness programs say that they have seen their health care costs decline. according to an adp survey, majority said they've they seen reduce absenteeism as to result of better health. guess we all want to know if wellness individuals have an impact on the employer to assess whether better health and wellness with productivity and keeps workers on the job. the hull ships with her counsel that they embrace very, very strongly is the use of mentoring. if they invest resources in the new initiative, they're going to make sure there's tangible, measurable accomplishments as a result. for those of you not familiar, where an alliance of chief executives of many nations

leading health care companies and organizations representing virtually every health sector as you can see from logos on the side. so is there a shared pharmaceutical companies medical device manufacturers, they believe and wellness within their own workforces and they are putting their money where their convictions are. we've taken a close look at what our members are doing on a couple different ways. first he conducted a survey of our membership about the wellness programs in the tools they're using using their own employees, but an more detailed initiative, we created a publication called the hoc wellness compendium is combined on our website at www.hoc.org. in this wellness compendium, we take a much more detailed dive for supporting metrics into what some of our individual members are doing on the wellness front.

so let me briefly mention the highlights of our survey in a couple real world experiences that i've mentioned. we found serious and her mission about wellness programs within our member companies. the first of all, more than nine out of 10 not only have initiated wellness programs in their organizations, but they've also desert needed an official whose job it is to monitor and promote healthier behaviors. most are assessing the return on investment, the financial impact their wellness programs are having, so they're really looking at metrics and a majority are also investing significant resources. whether it's in the form of constructing facilities for wellness activities are providing financial assistance and incentives to get insight gym memberships. we found also that these companies are predominantly using information technologies

to create a online portals for employees to access and make better use of the wellness programs and they're also creating personalized health risk assessment and prevention plans for their employees. let me touch on a couple of specific examples that illustrate the impact that can be made when a wellness program this well conceived and well implemented. one of the world's leading medical device manufacturers was roughly 26,000 employees in the united states, took a look at its workforce and found preventable illnesses were making up about 70% of its health care claims and i think that's probably the average vc and health care costs generally. to submit comments on shtetl house, which included a wide range of tools and resources for their employees and also for the families of their employees. these tools included health assessments, screenings, disease

management, health coaching, division support tools and education on the prevention of chronic conditions and also 100% coverage of preventive exams. they really cover the waterfront of their initiative. the results have been striking. over 90% of the medtronic employees completed that health assessments and thousands actively utilize the health coach made available. two of every three participating employees eliminated at least one health risk. the company calculated significant savings with the cost of health, even the cost of health screens was measured against the doctrine emergency room visits. the total return on investment has been valued at about two and a half dollars saved for every dollar they spend on their program.

here's another example we caught a cold. the st. john's and detroit as part of ascension health, the nation's largest nonprofit catholic hospital system. looking at the road workforce, st. john's providence found 50% of the employee health care costs in the hospital system in the detroit area were being generated by 5% of the workforce. so they thought if you could create an individualized wellness approach, it would be easily accessible to those high-risk employees, those that are likely to be occurring a chronic disease that they could make a significant band in their employee health care spending. so the health care system created case management program that identified boeing employees to help them better manage illnesses. this included a web portal, round-the-clock nurse hotline, free physical, fitness center

access, by so coaching on preventive care reminder system. for st. john's providence, the results have been quite significant. the health care costs are now below those of other major employers. their inpatient admissions are down. emergency room visits also done to millions of dollars in cost savings have been achieved with this program. i know they've been asked by their community to expand a much broader basis. so returning quickly to, just to give you the statistics, to the survey we did have hoc numbers, one of the things we found was a key factor in making wellness programs successful was really the hands-on engagement of senior leadership that they really had to be encouraged and supported the program. i think there's a corollary point to that and that is their greater success comes from a wellness approach that

recognizes the challenges and needs on the makeup of the particular workforce. but they're also unifying traits. i think victor rice many programs that were probably going to be hearing about that do seem to be working and that is accessibility of healthier foods, having better choices in employee cafeterias, the ability to engage in physical or committee plus incentives to do so and also in your fingerprints information on how to develop a healthier lifestyle. so again, there's much more need to learn about these programs and his hope that more employers will begin tracking specific help and economic gains that we can really have the peer-reviewed proof the world looking for. there is a great deal at stake here with chronic disease and associated costs on the rise and millions of americans spending a much higher percentage of their lives that work, we need to

determine how can we best use those workhours to elevate better health and better well-being. thank you. >> thank you, mary. >> karen, do you need to click or to advance one's wide? >> now we have to fight my fight, right? >> thank you. >> i might say by the way that the ceo of st. john's, patricia maryland is on the board of the alliance for health reforms. we are pleased to use that example. were going to shuffle the order of the from the published agenda that you have them turn out to karen feldman, who's the benefit of social insurance policy specialist at the afl-cio. for the last three years, she's been in the lead on the afl-cio's work on implementing the affordable care act that

includes dealing with the mountains of newbridge relations. she was telling me how many are in the stage of having comments do in the next two or three business days, so she's going to have a busy weekend and of course that includes regulations issued by the federal agencies with respect to wellness programs this week and were very pleased to have karen with us this afternoon. >> thank you, ed and days. i've often enjoyed the publications the robert wood foundation has included and the one on health education is fabulous, so i urge all of you to read that. a former colleague of mine is the co-author, so give her a plug for magellan olds in the georgetown center for health insurance reform. so wellness programs, the title of it, and a briefing in today's

workplace wellness programs, do they work? i think we will hear a little bit more from mary hahn not and i know we were here somewhere from professor horowitz. and from the worker's death, since the workers involved in people -- employers hoping to have participate in these programs, as a general matter, the labor movement here in the u.s. will support well-designed programs, programs address that the group involved really shouldn't look at one-size-fits-all programs and i think responsible employers will approach it that way. but it seems as we l@

but it seems as we look at things that by focusing solely on the health status of the individual workers, mary, paul, others come you cannot work in the health policy world without hearing more and more about chronic disease. and members of our family is that we may suffer from one or more conditions or addiction, but to the extent that these programs are focusing on these individual conditions, we are sort of taking away a focus on the collective, on the group and undermining in our view the key feature of health care coverage in the work place and that is for decades that coverage has been available at the same cost

to workers regardless of their age, gender, race or health status. and so when you start introducing some wellness program and focus on health status factors and were introducing underwriting and the work place, which has never been a feature of group health coverage particularly in the large market, large group market or employers that have the affordable care act outline based on health, age -- not age because you can't take age into account, but limiting underrating in the individual and small group market that were opening a backdoor through some of the permitted set is under

wellness program, outcomes-based programs are even in the tv when the health computer programs call was talking about. paul mentioned the cost, that it's a current role, the ceiling is 20% pay variation allows for an award or penalty. 30% is allowed under the affordable care act with the option for 50%. i think it's important we take a look what that means for workers. so if you look at the gold standard of surveys on employer health benefits, last fall's kaiser survey showed that the average total annual premiums for individual coverage was just

over $5600. and a worker contributes that coverage $951. these are annualized numbers of cores. so before we talk about any possible contingent reward or penalty, on average the annual worker contribution is 17% of the total cost of coverage. so when we say 20%, it is not 20% of the 951 that the workers already contributing, but under today's rules, 20% is 20% of the total cost of coverage. so the 1123 is 20% of the 5615. so now we look at 30% permitted now, not required, but permitted

and if we had the additional 1685 to the $951 to workers already contributing, at that point the workers paying 47 -- contributing 47% of the cost of coverage, a huge jump from the 17% that they otherwise contribute and depending obviously could be representing a significant portion of their income, depending of course on their underlying wage. so i'm the one hand you can thank g, moving from 20% to 30% is a small amount. 10%, what is that? i thought it would be helpful to illustrate it can be a big amount because of what the bases. the total cost of coverage, not just the worker's contribution and that is a primary concern when we see some of these

programs that are based on a satisfying fact year. this pretty tremendous. the other thing mentioned is programs complied with the antidiscrimination rule that are now carried forward into the affordable care act, but we shouldn't forget that there are other work laws regulating discrimination and then choosing the fact tears, employers and inventors the way involved in programs need to be careful because certain characteristics, certain health factors are tied

to age, gender and as we know, you can discriminate on the basis of the age and the work place, title vii covers race, john dare and national origin. ..