crisis poses a risk to us all, to the project, to the european project. we, legitimate political representatives of the eu, can turn the tide. you, the direct democratic representatives of europe, directly elected, you will be at the forefront of the political debate. i want to propose the following. which picture of europe will the voters be presented with? decanted version, or the cartoon version? the myths or the facts? be honest, reasonable version, or the extremist, populist version? it is an important choice to make. i know some people out there will say that europe is to blame for the crisis and hardship. but you can remind people they european union was not the origin at the crisis. it resulted from mismanagement of public finances by the

national government and irresponsible behavior in the financial markets. we can explain how europe has worked to fix the crisis. what we would've lost if we have not succeeded in upholding the single market. because the single market was under threat and upholding the common currency. because at some time ago people were predicting the end of the euro, the common currency. if we had not coordinated recovery efforts and employment initiatives, where would we be now? some people will say that europe is forcing governments to cut spending. but we can remind voters that the government that goes way out of hand way out ahead of the crisis. not because of but despite europe. we cannot do the most workable in our societies and our children, they would end up paying the price if we do not persevere now. the truth is that countries inside the euro or outside the euro, in europe were outside

europe, they are making efforts to curb their very urban public finances. someone campaign, saying that they have given too much money to the vulnerable countries. others will say that we have given too little money to the most vulnerable countries. but everyone i can explain what we did and why. there is a direct link between one countries loans, and another country's banks, between one countries investments in other countries business. the between one countries were present in other countries companies. this kind of interdependence means only european solutions will work. what i tell people is that when you are in the same vote, one cannot say that your end of the vote boat is sinking. we need to unite together when things are difficult. some people might say that europe has grabbed too much power. others will claim europe as too little, too late.

and sometimes we have the same people saying that europe is not doing enough, at the same time that is not giving europe a means to do what europe has to do. but we can explain that member states have entrusted europe with tasks and pretenses. the european union is not a foreign power, but the result of democratic decisions of the institutions and by the member states. at the same time, we must acknowledge that, in some areas, europe still lacks the power to do what is asked of it. a fact that is all too easily forgotten by those, and we know that there are many out there, who are always ready to nationalize success and europeanized failure. ultimately, what we have and what we don't have is the result of democratic decision-making. and i think that we should remind people of that. ladies and gentlemen, mr. president, honourable members, i hope that the european parliament will take up this challenge with all the

idealism that it holds. with as much realism and determination as the times demand of us. the arguments are there. the facts are there. the agenda has been set out. in eight months time, voters will decide. now it is up to us to make the case for europe. we can do so by using the next eight months to conclude as much as we can. we still have a lot to do. namely a.an element the european budget. this is good for our investments in our regions all over the world. it is important for us to have the fight unemployment, notably youth unemployment. advance and implement the banking unit. this is critical to address the problem of financing for businesses and smes. these are our clear priorities, employment and growth. it is in its decisive phase.

because, honourable members, the elections will not only be about the european parliament, nor will they give out european commission or about the council were about this or that personality. they will be about europe. we will be judged together. let us work together for europe and with passion and determination. let us not forget that 100 years ago, europe was sleepwalking into the catastrophe of the war of 1914. next year, in 2014, i hope that europe will be walking out of the crisis towards a europe that is more united, stronger, and open. i thank you for your attention. [applause]

>> let me focus on something called advanced persistent threat, it is something that is discussed domestically and internationally interrelate towards what stewart was talking about there are footprints that go on out there and one of the reasons that changes would need to be made in the cybersecurity posture of this country and what has been made and continue to look out in the executive order and everything else, it is that we need to move to the continuous monitoring and after that we need to move to continually be able to look at the precursor of the context being set for that and we do know what those are. >> we are never going to defeat the cyberenemy. or enter this is inadequate, it

is grossly ineffective and there has to be timing and continual information sharing within the federal government, particularly the dhs and down to the state and local levels, particularly the private sector. after all come in the federal government relies on the private sector in order to function. >> this weekend on c-span, the homeland security committee looks at where the next homeland threats may come from. saturday at 10:00 a.m. eastern on c-span2's booktv. a secret lives hidden from family and friends, the story of america's first female rocket scientist. mary sherman morgan saturday night at 11, and live sunday on american history tv, commemorating the 50th anniversary of the 16th street baptist church bombing, and remarks from eric holder starting at 11:00 a.m. and throughout the day from birmingham, alabama. >> the studentcam video competition is open to all high

school students in this or we are doubling the number of winners and prize money. create a five to seven minute documentary on the most important issues that you think congress should consider in 2014. be sure to include c-span video, she'll point of view, due by january of 2014. if you need more information, visit studentcam.org. >> you are watching c-span2 at politics and public affairs, weekdays featuring live coverage of the u.s. senate. on weeknights, watch key public policy events and every weekend the latest nonfiction authors and books on booktv. you can get our past schedules at her website and you can join in the conversation on social media sites as well. >> last year voters decriminalize small amounts of marijuana ingestion. a memo was released saying that the federal government would not

prosecute individuals in those states. the senate judiciary committee held a committee on the conference between federal and state drug laws. it is one hour and 45 minutes. >> this is a very important meeting with the president on this situation in syria, it is one that the president has met with and has met with and the senate. it is a gravely serious matter, as i'm sure that all of you know and i liken this to the attorney general as well that today's hearing also deals with this serious issue, and i trust that members here will act accordingly. i want to note out the outset that the rules prohibit clapping her demonstrations of any kind,

either for or against any position i must take were anyone else must take includes the view of people around you. including where we can accommodate as many as we possibly can and we have overflow rooms as well. we will remove anyone who does not follow these percepts. last november the people of colorado and washington we have talked about the ways that marijuana is produced in our states. we underscore the persistent uncertainty about how such conquests should be resolved.

should the federal government arrest and prosecute marijuana users that might be in full compliance with state law, or should the federal government take a hands-off approach and let drug laws and policy developed on a state-by-state basis, or is there some middle ground approach that considers both the national interest and the fundamental principles principles of federalism, deciding what is best for their own individual states. so the committee will hold the first congressional hearings and not passed in colorado and washington. it presents an opportunity for some of those people who grapple with these complex questions. and this is going to include what is happening in colorado and washington and this includes the implications for the rest of the country as well. marijuana use in this country is nothing new. but the way in which individual

states deal with the marijuana usage continues to evolve. some states have decided to allow the use of marijuana by patients with debilitating medical conditions. as a result, those who suffered from diseases like cancer and aids are now able to use medical marijuana to at least treat the symptoms and the conditions. in addition, some states, including vermont, have decriminalize marijuana, imposing civil fines on marijuana users rather than criminal penalties. today and we showed on the map, i believe. this map right here, we show on this map that we have a total of 21 states that have been legalized for marijuana medical purposes. sixteen states have been decriminalized. the possession of small amounts of marijuana. but every one of these changes

to the laws have taken place against the same background in the states, possession of any amount of marijuana instead of a criminal penalty under federal law. there is common ground, for example, the federal government in those states that have legalized marijuana in some way all agree with the necessity of distributing marijuana to minors. likewise, there is an agreement about the need to criminalize those from profiting from marijuana sales. the dangers associated with drunk driving, this is another important safety concern and i appreciate everyone's acting to address those from the federal to state levels and local law enforcement level.

i hope that we may be agreement that we can't be satisfied with the status quo. including the dangers of the public safety and the black market continues, to contribute to violence along the southwest border. it continues despite the billions of dollars that are already being sent at the federal and state and local levels. it is also clear that personal marijuana use has contributed to the soaring prison population of our country. it is disproportionately affecting people of color in this context is not surprising that states are considering new calibration solutions that goes beyond the traditional laws. and anyone that has been prosecuted, they need to know that they can't begin to prosecute all of the laws that are on the books when you don't

have the resources. the question is what resources should be used and where. i asked the administration last december, with which responses took some time and we were encouraged by the deputy attorney general that recently provided the federal prosecutors. federal agents and prosecutors have skiers investigator resources. i really don't think that they should be pursuing them to low-level uses of marijuana on complying with the laws of their states. the president said lester the bigger fish to fry his back. i'm glad the justice department plans to commit its limited resources to addressing significant threats and i appreciate that the attorney general is no stranger and is here to answer questions. also the witnesses in colorado,

washington. they see it not in the abstract, but day by day in their state and i want them to explain the implementation of those decisions. so today we've also signed wide on how a series of laws poses significant obstacles including the regulation of marijuana at the state level, and regulating areas such as banking and taxation. that can only be achieved through close cooperation which is very important to our agenda. >> mr. chairman, the map of the country's quilt of different approaches demonstrated how we have taken very different ways of dealing with marijuana use,

particularly for very small amounts of individual users and those who we judge to be medically necessary. including the criminalizing the possession of small amounts of marijuana, our governor, governor chafee, has asked the drug enforcement administration to declassify marijuana as a schedule to substance which would allow it to be prescribed in which the states are luke loosening of the restrictions on the use of marijuana and they are virtually and entirely also areas in which the need for federal prosecution and the rationale for the use of

resources is extremely low. there does not seem to be an underlying need for conflict between federal prosecution policies and state marijuana policies, and yet, i believe that in the past largely due to uncertain and often inconsistent policies from the department of justice, there have been created an artificial conflict. i think the movement will help to clarify that and i look forward to this hearing and hope to clarify it further. i think the deputy attorney general should be thank very much for coming to discuss this with us. i thank the chairman for holding this hearing as well. >> serve?

>> mr. chairman, i would like to give my opening statement. >> certainly, go ahead. >> of course i thank you very much for holding today's hearing between the conflict of federal and state laws, since the congress passed the controlled substance act, the cultivation trafficking, sale and use of marijuana has been illegal under federal law, marijuana continued presence on the statutes list of illegal substances is it based on whim. it is based on what kinds tells us what is dangerous and addictive drug is about. it is a process with drugs on and off that list, the scientific standard to do that has not yet been met with marijuana. marijuana is not only illegal under laws passed by congress, but it is illegal under international laws as well, and the united states in the 180

nations have signed a single convention on narcotic drugs and it requires the use of certain drugs that were exclusively scientific and medical use that something this country give its word to do. it is a commitment that many others had benefited from public health. colorado and washington decided to be the first jurisdiction in the world to legalize the cultivation and trafficking and sale and recreational use of marijuana. this contradicts the federal law, moreover these laws have nothing to do with the controversy about whether marijuana has an appropriate medical use. some experts fear that they will create a big marijuana industry, including a starbucks for marijuana double damage public

health including those adults and those within the states of colorado and washington. it is trying to strike down laws and prosecute illegal drug trafficking. these policies do not seem to be compatible with a responsibility of our justice department is to faithfully discharge our duty, and they may be a violation of our treaty obligations. prosecutorial discretion is one thing. but giving the greenlight to an entire industry predicated on breaking federal law is quite another whether it is immigration laws or obama deadlines, the list is long and

it hardly needs repeating. what is really striking is that the department of justice is so quick to challenge state laws and the states that change their voting laws to require id and states that try to secure their borders when the federal government won't expect a lawsuit. but if some folks want to start a ministry dedicated to breaking federal law, then the department's position is to wait and see how it works out. but we already have a pretty good idea how it works out. the answer is badly. take colorado, as an example. since it has legalized and attempted to regulate medical marijuana, what have we seen? from 2006 until 2007 -- excuse me, 2006 until 2011, a 114%

increase of fatalities involving drivers testing positively for marijuana. compared to 2007 through 2009, with 2010 through 2012, 837% increase in drug-related suspensions and expulsions from colorado schools, and a sharp increase in marijuana exposure and in the words of the attorney general, the state is becoming a significant export of marijuana throughout the country. the statistics on this point are shocking. but not surprisingly so, given simple economics for 2005 until 2012. there was a 407% increase in colorado marijuana that was destined for other states. in 2012 alone, there were

introductions bound for 37 other states, one of them was my home state of iowa. in 2010, colorado was the source stayed for 10% of all marijuana interdiction in iowa. that number grew to 25% in 2011 and 36% in 2012. and this was all before full legalization of colorado. what do you think this number will be next year? is the federal government prepared to pay for costs because it refuses to import federal law? in 2012, the proportion of iowa's juveniles entering substance treatment, primarily due to marijuana reached its highest point in 20 years. how many more of iowa's daughters and sons will go into treatment next year because the department will not enforce federal laws. there is no amount of money they can make iowa a whole for that. i have a letter from the director of iowa drug control

policy to the attorney general that lays out some of these decisions and ask them to be included in the record. >> no objections to the department would've no many of the things had a consolidated with the folks on the ground before making those decisions. these are people who see the effects of marijuana interdiction and use of transient effects every days. i also have a letter from the many local law enforcement agencies in the united states and asked but that in the record. >> no objections. >> and however they wrote that the department of justice did not consult or organizations whose members will be directly impacted from meaningful input ahead of the decision, this important decision.

or organizations were given notice 30 minutes before the official announcement was made public, and we are not giving the adequate form ahead of time to express our concern with the department's conclusion on this matter. simply checking the box by alerting law enforcement officials right before a decision is announced not enough, and certainly does not show and understanding of the value of the federal and state and local tribal law enforcement partnerships that bring this to the department of justice into public state insurance safety. i will put the rest of my statement in the record. >> thank you very much. >> the deputy attorney general from the department of justice, concludes the marijuana enforcement policies that are in the recent bubble that we discussed earlier.

we first joined the department of justice in 1979 and served for 13 years in the criminal division, where it became part of the divisions public integrity circuit. sure, it is good to have you. please go ahead. >> thank you, chairman. breaking member grassley, individuals in the white house, i am pleased to speak with you regarding marijuana enforcement efforts. the guidance and structure prosecutors to continue to enforce federal priorities. such as preventing sales of marijuana by criminal enterprises. preventing violence and the use of firearms in the cultivation and distribution of marijuana. preventing distribution to minors and the cultivation of marijuana on public lands. priorities that we historically have focused on for many years, and it also notes that we will continue to rely on state and

local authorities to effectively enforce their own drug laws as we work together to protect our communities. as you know, the relevant federal statute, the controlled substances act of 1970, among other prohibitions, make for the federal crimes to possess and grow marijuana and open or have a business for these purposes. for many years, all 50 states have been acting in uniform drug control laws that mirrored the csa for their treatment of marijuana and the possession and cultivation and distribution of marijuana a state criminal offense. with such overlapping statutory authorities, the federal government and the states traditionally working as partners in the field of drug enforcement, federal law enforcement historically has targeted sophisticated drug traffickers and organizations while state and local authorities have focused their enforcement efforts under state laws on lower-level drug

activities. starting with california in 1996, several states authorize the use of marijuana under use of state law for medical purposes. today 20 states and the district of colombia legalized or one for medical purposes, including six states that enacted medical marijuana legislation this year. throughout this time. matt, the department of justice has continued to work with the state and local partners, but focused its own efforts and resources on priorities are particularly important to the pro-government. the priorities that have guided our efforts are as follows. preventing the distribution of marijuana to minors, preventing revenue from the sale of marijuana, going to criminal enterprises, games and cartels, and the diversion of marijuana from states with legal state laws to other states and other

state authorized or one activity from being used as a cover or pretext for the trafficking of other illegal drugs or other illegal activity. preventing violence and the use of firearms in the cultivation of marijuana and drugged driving along with other consequences associated with marijuana use preventing marijuana on public lands being grown and the environmental dangers posed by marijuana production on public lands, and preventing the use on federal property. examples of the efforts have included cases against individuals and organizations who were using the state laws as a pretext to engage in large-scale trafficking of marijuana to other states.

and the context of enforcement priority. on august 29, 2013, the department notified the governors of colorado and washington we were not, at this time, seeking to preempt their state ballot initiative. we expect them to implement strong and regulatory systems to

protect against the health. in washington and in colorado in which the underlying conduct implicated our federal interests. the department reserved the right to change the state law at the later time. and in the event of any of the stated harms materializing, either inspite of strict regulatory scheme or because of the lack of one we reserve the right to preefferent. they issued a guidance memo directing our prosecutors to don't fully investigate and prosecute marijuana cases that implicate any one of our federal ebb forcement priority. the memo applied to all of the prosecutors in all 50 state and guides the exercise of

prosecutorial discretion. no matter where they live or what the law in their state my permit. outside the enforcement priority; however, the department will continue to rely on state and local authorities to address marijuana activity through the enforcement of their own drug law. this updated guidance is consistent with our efforts to maximize our investigative and prosecutorial resources in this time of budget challenges. with the more general message the attorney general delivered last month all federal prosecutors emphasizing the importance of quality priority for all cases we bring, with an eye toward promoting public safety, deterrence, and fairness. our updated guy dan make one point clear. the department of justice expects that state and local governments that have enacted laws authorizing

marijuana-related conduct which will implement effective regulatory and enforcement systems to protect federal priority and health and safety of every citizens as guidance explains jurisdictions regulatory scheme shub tough in practice not just on paper. >> thank you. >> you know, when i worry about the extent we have some who do not take the position or aren't willing to the banking industry is not willing to provide services to state-authorized marijuana dispensary. they fear they may be violating federal money-laundering law. then they operate as a cash only business. no access to bank account or credit cards transition. that's a prescription for

problems. tax evasion. we're hearing the dea agent and what seems to me like a significant step away from reality, instructing the company to seize providing services to marijuana dispensaries almost as if there is a -- have some robberies. i'm sure it's not stated that way. maybe sometime it's it's the -- trump reality. as in this case, but it creates a problem. what is the department going to do to address these concerns? about l banning and tax issues.

>> chairman leahy, as far as the banking issue is concerned. we agree an it's issue we need to deal with. when the attorney general talk to the governor of colorado and washington they raised the same issue. obviously there's a public safety concern when businesses have a lot of cash sitting around. it's a tendency there's guns associated with that. it's important to deal with that kind of issue. we're at the present time talking with bringing in bank regulators to discuss way it is could be dealt with in accordance with the law we have on the book today. >> talk with the -- as far as dea is concerned. i've heard about that. from what i understand dea was merely asking question of the armored car company at the time to the practices. i think the questions occurred before the guy dan memo was put

out. at the present time i don't thinks in -- to instruct them not to do anything. there are implications out there. i hope they get it cleared up. i don't want to see a shootout somewhere and have innocent people or law enforcement in danger. i think it should be specific guidance in the financial service industry. you have noted the department general doesn't prosecute -- small amount of -- which is add the state prosecutors using real problems that deal with it. not that. the department target sophisticated traffickers. they rely upon state a local law enforcement lower level drug activity. they're usually overwhelmed with things that really effect people. in the wake of the recent

guidance for some rather concerns the federal government is abdicated our responsibility for enforcing drug laws in colorado or washington state. and the department's decision free for all drug activity in the states. i would assume you don't agree with the characterization as the department is advocating it responsibility for en0 forcing federal gun law. >> i don't agree at all, mr. chairman. i think what is clear in the memo, we are going aggressively enforce the controlled substance act when it implicates any of the eight priority list there had. that's a pretty fulsome list of priority of important public safety issues present in associated with marijuana. we expect to continue to enforce in every state whenever it's implicated. when they have a state law legal oizing it or not. we not giving community. we are not giving a free pass.

we're not abdicated our responsibility. we are dedicating ourself to enforce the controlled substance act in regard to marijuana. >> you monitor the imimplementation in the state? >> we will be looking how they go about implementing it. we hope they will be doing it in a full and robust way. largely how we operate is on case by case basis. when we see somebody marketing marijuana in a way attractive to minors we're going go after them. when we see somebody growing and cultivating marijuana they can import it or export it out of state. we're going to go after them. if they're involved in drug cartels and illegal enterprises. we're going go after them. >> in you said in your testimony the right file -- challenge the state law in colorado and washington at a a later time.

the federal government can't force the state to criminalize in particular time of conduct or activity. such a loss that would have to challenge the state law focuses on regulatory framework but not on -- what they have to criminalize and not criminalize. is that correct? >> that's correct. it was a difficult issue we had to contend with in deciding whether or not to seek any preseemings action here. because it would be a challenging lawsuit to bring to preempt the state's decriminalization law. we might have an easier time with their regulatory scheme in preemption. what you have is legalized manner and no enforcement to try to regulate it. that's probably not a good situation to have. >> kind of a senate for black market. >> very much so, sir. and money going criminalized

enterprise. instead of going state tax coffer and having the state regulate from a seed to sale basis. what happens to it. >> basically the state voted for -- trying to overturn. >> trying to overturn it. still have decriminalization of marijuana it would exist in the state. i have three question. before i do that i want to take thirty-second out miff own time bring an issue up i think you can help us with. the dea is refusing to comply with the legal obligations to provide tbrks ao access to dea record. senator white house and i have for an report on drug shortages as being delayed because dea refuse sal. i tried to help resolve the issue. but the justice department told dea not to even meet with me. and gao to discuss it.

i think that's unacceptable. i understand that you admitted to the controller general that dea has a legal obligation to comply. however, the justice department and dea are still withholding records from the gao. there's no point in wasting time and the taxpayers on litigation with g ark orbing. that's where it's headed if dae doesn't comply. so the attorney general, i hope you can help us to work with us in congress to solve the dispute. dea needs to provide gao the information it needs to do the work. i don't expect you to respond now. i want you to know how i feel about it doing my job of oversight. and there's a distinguished member of the majority that is interested in it as much as i am. >> thank you, senator.

i have been in contact with the deputy administrator with gao to discuss it once already. we're planning on having another conversation in the next week or so. i'm top of this pep. >> god bless you. >> the coal memo suggests that the department won't seek to enforce the controlled substances act except for certain federal priority as long as the state that legalize marijuana implement effective regulatory schemes. the priorities include diversion of marijuana from colorado to other states, increase use among minor and increase facilities from drug driving. colorado has seen a sharp uptick in each of these priorities over the past few years. more over, a recent audit concluded that colorado department of public health, -- make medical marijuana relations, end of quote. another recent audit found that the city of denver did, quote,

not have a basic control frame work in place. end of quote. to regulate it medical marijuana program. denver did not even know how many marijuana businesses were operating in the border. question, why has the department decided to trust colorado to effectively regulate recreational marijuana when already struggling to regulate medical marijuana and federal priorities will already being negatively impacted. before you answer, would the department establish metrics concerning these priorities that will trigger when it will take action to either challenge these laws or more vigorously enforce federal law. i want to give you an example. 2005 to 2012, there was a 407 percent increase in colorado marijuana procedures that were destined for other states.

how high would the number have to go to trigger a change in policy. i hope it's something you have thought about. >> senator grassley, we have thought a great deal about the issue. i'm aware of the audit in colorado about the enforcement of the regulatory scheme under medical maybe marijuana. it was disappointing. i think along the line of what i talk to chairman leahy about, there are no perfect solutions here. what we're faced with is a situation -- we thought it would be successful in trying to preempt the decriminalization. if we went after the regulatory scheme instead of having -- they would have no regulatory scheme. our hope with the memo and with the engage wment the state telling them, as we say trust but verify. they will have an incentive to but in a robust scheme that will in fact address a lot of these

issues that you have raised and everyone raised and valid issues in this area. and we're hoping that kind of effort by the state enforcing its own state law will have a better effect than having no effort whatsoever. so i understand the skepticism. we're looking in term of trust but verify method. we have reserved quite explicitly the right preempt at the later date if we feel it's in the public interest. i think we at the point now trying to find the best of the imperfect solutions before us. >> question number two, you heard in my opening statement how the department didn't consult with major state and local law enforcement group or former dray administrators when reaching policy decisions. did the department quality anybody at dea, hhs, or state department about the policies.

and if not why not. and if so with what were their views? >> we did consult with hhs. we consulted can dea. we even flared many of the group that wrote the letter. the attorney general and i this morning met with the groups and the attorney general's conference room for an hour and a half. we had received a rost -- a lot of input from them concerning the matter prior to the decision we made. we stated clearly today we should reached tout them one more time before we made the decision. we apologized to them for not making that extra effort. we believe that we understood their position, but we have been such good partners with them. we joed them one more conversation and one more opportunity for them to weigh in. and we ask their forgiveness in going forward and assured them we would be giving that kind of opportunity. we did seek out other views in coming this. we tried to be careful.

we tried to be responsible. we tried to look at automatic -- all of the avenues of it. much of the input we got from them and much of what you've been talking about. helped us to be to be crit lyes and articulate in the different areas what it is uniformly throughout the country we think are the problem that trigger federal enforcement in the area. we thank them for them. this is before legalization of recreational use in colorado was passed. and the words of colorado attorney general, the state is becoming, a significant exporter of marijuana to the rest of the country. diddepartment's decision not to enforce federal slaw obviously

imposes cost of states outside colorado and washington include public health costs and law enforcement cost. i would normally ask the question. i'm going make a statement, if i'm wrong, i doubt the federal government has plans to reimburse the state for the cost. if i'm wrong, tell me. my question, what do you plan to do to protect states like iowa from marijuana diverted from states like colorado. >> i think there's two ways to approach it. one, if the states really do put in the kind of robust system we're asking them to. control from seed to fail. it it will help tamp down that kind of export out of colorado in to other states. and secondly, at least as one of the main priority we have export from marijuana that make it legal to any other state. that will make a federal enforcement priority if i if it's being exported from

colorado to iowa and we find out. we'll prosecute. okay. mr. chairman, in a previous question, second question i had you said you consulted with the state hhs and dea. did they agree with the policy that you announced? >> you know, senate, we had a thorough discussion with them. i don't think it's always appropriate to go in to what the internal deliberations are that take place. but we got everybody's view and we a thorough discussion and aired it out. and this was a well-thought through process. >> thank you. >> thank you, mr. chairman. >> mr. cole, let me just kind of recap what brought us the point. i don't think we were in a good place to begin with. i begin with the memo from 2009

which indicated it wouldn't be a -- individuals whose actions are aren't clear and unambiguous imliens with existing state law. and that gave us an example of individuals with cancer or other serious illnesses. as another example the care givers and clear and unambiguous state law. because the following since talk about operation inconsistent with the purpose of those law. meaning state laws. so we come out of the memo with protection from federal prosecution, patient, care giver and lawful commercial enterprise that are quote, clear, and unambiguous compliance with

state law. among other things it would include dispensaries. the next thing that comes out is the u.s. attorney letter. which i wouldn't assume is department of justice product. all the u.s. attorney letters that came out were identical phrased. i don't think it was a unique 2000 one to rhode island. those protected from federal prosecution are limited to seriously ill -- recommended treatment regimen. m and phut the paragraph that said department of justice maintain -- against individuals organizations participate unlawful manufacturing and distribution activity. and eliminate any shelter of state law.

there was a dramatic difference between th ogden memo and the u.s. attorney letter and created immense confusion. which you thought to verify in the june 29, 2011 memo which said it will protect individual cancer and other serious illnesses, and scare givers are back. they are back in your letter. then you said it wouldn't apply to commercial operations ult elevating saling or distributing marijuana. you drop out the word unlawful rather than deal with the word. paid with money earned by one of the folks. the u.s. attorney letter had also singled out lrdz and

property owners and -- for prosecution. so if you can imagine, it was a mess. so i appreciate very much the august 29th letter straightens out the mess considerably. i don't dispute the defense of the eight different federal priority. i want to -- there is considerable but imperfect overlap between your eight priority and the priority from the original memo.

with state law? >> i think that the proper way to phrase it, senator, as long as they are not violating any of the eight federal priority in the course of what they're doing, that the federal government is not going prosecute. and the state law is up to state law. and state to state enforcement. >> there's -- in all fairness there's a catch-all at the end. it's not meant to swallow the entire memo. you can't anticipate everything coming to the future. there's an ability if it's an important enough matter we hadn't anticipated to prosecute another kind of case even if doesn't fall within the eight priority. >> i understand. and those who receive proceeds from a lawful, proper state law enterprise will also not be prosecuted unless they violate one of the eight federal interests. >> this is one we're trying to work through with the banking real estate laters.

they talk about the control substance act. the prosecution otherwise on the banking end would be the money-laundering substitute. and those, i think, are a separate matter but one, a i said. ones that we need deal with. there's a public safety and public interests aspect of that i think we need to deal with as we gown the road. we're working on that. you are not intending to put people bay proper lawful state law enterprise from being -- it's not your intention. in a same way you knew it was a criminal cartel. no matter your business the proceed of the cartel and you can go after individuals just because they receive money. t nothing else reclaim the funds that the proceeds of criminal activity. you're not intending to use that unless those eight federal

interests are implicated. >> i think that is part what we're trying to work through right now in trying deal with the money laundering aspect. this memo is meant to guide our enforcement effort concerning marijuana in regard to the control substance act and spill over in other ways as we try to work through. >> similarly property owners, landlords, and financiers should not fear federal prosecution -- unless they implicate the interest. certainly a lot is controlled by the substance act. that would be within the memo. that's correct. >> okay. ic that's help to clarify thing. senator grassley raised a number of concerns relating -- i thought from hearing them that all of them fell in to the category by the children or involving effect in other states or involving a relationship with trafficking organizations.

just to be clear, it's my understanding that in all three of those situations those are federal interests that would be implicate the and the federal government would be willing and able to prosecute in those areas. >> that's correct. >> thank you. my time is expired. >> thank you, mr. chairman. thank you for having this hearing on a subject important to my home state of connecticut and -- new law currently allow the production and sale and use of marijuana for medicinal purpose in a regulatory regimen i think is fairly straightforward and complete. and certainly indicates the will l our legislature and state that connecticut wants to move in the direction of providing legal access to this kind of substance

essentially decriminalize the statute so anyone found in possession with less than half an ounce of marijuana will be subject to a citation rather than criminal action. and it -- i think mirrors other state laws that contain very kind of provision. i don't want to speak for the department of justice, but my guess is there are very few cases authorized by the department of justice that involve simple possession of small amount of marijuana currently. that has been the ongoing practice for some time is it not? >> i think that's correct. and from what we have heard from the state and local law enforcement organizations this morning they say there's very few of those in state law as well. >> right. so that current practice will not be altered by anything in the memo as i tread. >> that's correct.

>> and in terms of some of the other priorities my assumption is that the enforcement efforts there on individual prosecution cases would depend to some extent on the amount of marijuana involved. would they not? >> that's certainly a factor taking in to account. it's no the the sole factor. >> would the resulting -- and i apologize if the question has been asked. action by the department of justice if there were not enforcement in some of these areas involve a challenge to the statutory scheme and how would that be brought or it would involve individual prosecution cases? how would you make those decisions? >> we did briefly talk before about in response to chairman

leahy's question. what the legal mechanisms would be to challenge the state laws. and -- disclaimer preempting state law in the area. that's explicit. you only have it with a conflict irreconcilable. when you have a law that decriminalizes marijuana, it's we can go ahead and enforce regardless what the state law said. we might be in a position and have a better -- to challenge the regulatory scheme. that puts you in a difficult position. there no perfect solutions here of having the legalization or decriminalization of marijuana and not even a legal structure for the state to try to regulate

it. that's not a very good solution either. none of them are very good in the deal, frankly. that seem to be one that takes you in the wrong direction. >> so the department of justice sundays your answer would be cautious and deliberative about any challenge to a regulatory scheme because the results might do more harm than good. we have certainly put the governor of colorado and washington state on notice we expect them to have robust systems. we hope that all the other states with medical marijuana or legalized system will view the memo as it should be taken telling them they ought to have a robust system to regulate the marijuana usage so they deal with the priority which we think are important. we'll make our decision as we see what kind of public interest issues are raised in the course of this and the need for us take action.

thaindz the memo deals woman the controlled substance act. but there also provisions of a tax code that forbid the expenses by the noncriminal comprise dispensary and other engaged in me dissal marijuana. has the department of justice taken a position on changing the tax code to make the legitimate businesses? eligible to not that i'm aware

of right now. the u.s. attorney there i'm sure has been in touch with them. i'm not positive. thank you. thank you, mr. chairman. [inaudible] i make one point. the attorney general. so you three prosecutors formers prosecutors here and so we clearly appreciate the flexibility that is important for prosecutors to have. we clearly appreciate the discretion that prosecutors

enjoy and should be protected by the department. at the same time, i think the department will be well advised to listen to senator grassley's advice about trying to accomplish as clear metric as you comfortably can because there can be a lot of unintended consequences from the broad uncertainty that you can create and that can frankly be quite harmful itself. so i think in this area particularly with respect to the regulatory regime and what you expect to approve and disapprove. the more you can move toward the kind of metric that senators grassily recommended, i think the better off you would be be. i speak only for myself on that. that's my advice anyway. >> if i may, mr. chairman. i would second what senator white house has just said. particularly as senator grassley pointed out some of the banking implications in connecticut. my understanding is that some

bankers are reluctant currently to be involved with marijuana business, because they are fearful about violating federal law. and the clearer and more definitive you can make your expressions of prosecutorial policy, i think, the more helpful it will be to them insofar as they're aiding legitimate businesses. not criminal enterprises not business selling to minorrers and others who may violate your priority. i would second what senator white house said. thank you. >> thank you. >> thank you very much. thank you very much. >> thank you, mr. chairman. we'll call burke hart, the king county sheriff. jack, the chief legal counsel,

governor hickenlooper. and [inaudible] [silence] the elected king county in washington state. he's the sheriff and state largest metropolitan county. i think he's particularly qualified to help us here. the sheriff has been in law enforcement for more than thirty five years and patrol office a field training office and a police officer. street level -- [inaudible]

administrative agent and several sheriff and the sheriff, would you go ahead and give your statement. all statements apply on behalf of other syria meeting. all statements being placed in the record in full be able to -- you see the record if you want to add things you have said you have a chance to do that. i ask you to summarize within the five minute of your statement. i would hate to say that, sheriff. i know, you and others have traveled some distance to get here. i appreciate you being here. sheriff, go ahead. >> thank you, plch. at the risk of stating the obvious, i'm a police officer. thank you very having me here today.

largest juries dpirks in the country that legalized manner. i've been a last year. during my career i've investigated everything from shoplilft to homicide. we spent almost twelve years as an narcotic detective. my experience shows me the war on drugs has been a failure. we have not significantly reduced demand over time. we have incarcerated generations of individuals highest incarceration rate in the world. the citizen of the state of washington decided it was time to try something new. in the november of 2012 they passed initiative 02 which legalized recreational amount of marijuana at the same time created very strict rules and laws. that was a strong supporter of

502 last year. i remain a strong supporter today. for several reason of the support. i support 502 because that's what the people want. they voted for legalized marijuana, we the government have failed the people and want to try something else. too often the attitude of the police is we're the cop and you're not. don't tell us how to do the job. it's a wrong attitude and i refuse to fall to the trap. the tight -- federal and marijuana law. i don't see a huge cob flict. the reality is we have complimentary goal and value. we agree we don't want our children using marijuana. we agree we don't want it impairing driver. we agree we don't want to continue enriching criminal. washington's honor the value by separating consumers from gang.

i'm willing to be proven wrong. the only way we know is if we're allowed to try. doj recent decision provides clarity on how we in washington can continue to collaborate with a federal government to enforce our drug laws while at the same time respecting the willing of the voters. it's a great step but more needs to be done. and i hate to be beat a dead horse here. we are limited by not knowing the role of banking institutions as we go forward. under federal law it's illegal for banks to open checking, savings, or credit cards for marijuana businesses. the marijuana stores will be operating with cash only. creating two big problems for me as a police officer. cash-only business is a prime target for armed robbery. and they are difficult to

monitor. possible tax evasion, wage theft, and diversion of the resources we need protect public safety. in closing let me make one thing clear. what we have in washington state is not the wild, wild west. and a sheriff i'm committed to continue collaboration with the dea, fbi, and doj for robust enforcement of our respective drug laws. for example, i have detectives right now assigned federal task force including dea task force. it's a great pain for many years. it will continue.

and the guidance provided by the department of justice on august 29th. mr. chairman, i say to you and the member of the committee, i appreciate the difference the federal government has shown to my constituent. i look forward to continuing that cooping. thank you. >> we'll come i'm going have each of the -- witnesses testify then go to questions. certainly testimony based on 35 years experience in law enforcement is extremely helpful. chief legal counsel. he served as co-chair to the task force. recommended legislation and rules to implement colorado's new constitutional provisions.

thank you. please, go ahead. sir. >> thank you. i have been working for the past ten months with a large collection of coloradans stakeholders, government officials, member of the marijuana industry to put together what we will affirm to you strong enforcement regime. the voters of colorado approve what we call amendment 64 in 2012, they oppose the ballot initiative.

we determined that with that sort of clear statement from the people of colorado. we need to effectively and efficiently implement the law. we began through a stakeholder process through a task force followed by a very detailed legislation by the colorado general assembly. and now just yesterday the colorado department of revenue issued 141 pages regulations to regulate the industry. with the they of pa age of amendment 64 the governor and attorney general got on the phone with holder and began the conversation about this conflict between federal and state law. and a lot we just recently as we talk about today received official guidance, we want to recognize that general holder, the justice department, our u.s. attorneys was very forthcoming about expressing federal law enforcement's concern about in

legalization effort. and it really allowed us to one of the things we decide passing bills to regulate the industry, we enhanced tools for law enforcement by passing a new law that gives law enforcement the ability with now have a law that vise if a driver's blood contains 5 -- of t health care chiropractic there's a per admissible infriday the driver of driving under the influence. we really appreciate the collaboration we've had with federal officials. we know we had more to do as has been doesed today. we audit, critical of some of the things in the past to address. ly say that the main reason that we've had failure of regulation of our medical marijuana

industry is because we lacked the resource to hire staff and partner with law enforcement. but we are sending to the voters this law and manner tax measure that will provide the kind of revenue we need hire staff, to also work on public health issues related to marijuana, and education and prevention efforts we are determined to focus on. the bottom shrine we commend the department of justice the guy dan they issued. in the new memo we think it was for us timely clarification. we were in the final week of doing our rule. we got in in time to make sure that our rules imply with the enforcement priority outlined in the memo. we actually affirm and embrace the priority and look forward to working with federal government our department of public safety, our local law enforcement. we'll work with federal law enforcement. we have a great working relationship with our u.s.

attorney. and i think you'll discover not only what colorado's regulators and law enforcement want to partner with federal law enforcement, but the industry will as well. one of the things i discovered in working on marijuana issue over the last ten months is how integrity the folks in our state that developed these new businesses have. i mean, i would compare them to folks you have all met. as you toured winery in nap pa or gone to distillery in your state. mr. chairman, i know they make great rye whiskee in vermont. they established medical marijuana dispensaries for operations in colorado. they will be partners with us in making sure that minorrers don't have access to marijuana that marijuana doesn't flow to iowa or other states.

i think that we look to very successful regulatory regime. ly echo the sheriff's comment and other comment today about the banking issue. it's both a law enforcement issue and regulatory issue. and also the tax issue. so we look forward to working with our members of congress to address those issue. >> thank you. >> without objection the written testimony of washington governor. and washington attorney general ferguson. in the record my next within is -- the cofounder. districter of the drug policy. peevely served in the national drug control policy various

capacity written extensively about the topic. please go ahead. because we share the obama administration's drug control goal of reducing drug abuse and consequences, i and dozens of prevention treatment medical and scientific groups around the country found the recent guy dance by the department of justice on leelt and policy grounds. guidance which expressly defer the legalizing marijuana contradict the controlled substance act both on the policy and legal level. especially policy principle designed to protect public

health and safety. far surpassing any reform in europe. i should mention the controlled substance act is an important tool for public health. by keeping marijuana illegal. the use is a sixth and third lower than alcohol and tobacco respectively in the united. i applaud the way the controlled substance act has been used solve by the federal government. not to go after low level users. but instead target -- it was not about putting marijuana smokers in jail. analysis debunked the myth that the prison cell are full of people. indeed as a side note. if we were today to let out every single person in the united states for any drug offense, our incarcerate rate in the u.s. would be four times

historical high. not five times. still as massive incarceration problem. we do not have to wait for legalization to happen. for several years, many states like colorado have been operating with a de facto legalization policy under the medicine. z advertising and provision using item attract toif kids whether they are medical marijuana lollipops. they are characteristic of current policies. the fact of three quarter of kids in treatment report their medical marijuana came from a medical marijuana dispensary. it's consistent a national bureau conducted by researchers

that found two distifnght features -- home cultivation and legal dispin i are. these are found obviously in state that have legalized some state that legalized the medicine. it should matter because despite popular myth. scientists from the american medical association, the american academy of pediatric. american psychological are universal in stating that marijuana is harmful for young people. marijuana use especially among young people is -- mental illnd. poor learning outcome. 00,000 emergency room emissions were applicable for marijuana. in colorado traffic fatalities have fallen over the last six years. marijuana-related fatality on the road have increased. we already had evidence showing

showing in some cases, quote, unquote, medical marijuana is going foreign enterprises. know they mentioned about diversion to other state. how on earth with can we think the task so much more difficult of full legalization is going to be hablgded any better. right now we are in a -- by threatening legal action the administration can prevent the large scale commercialization of marijuana. in fact, you know after spending decades of fighting big tobacco. we are on the brink of creating big marijuana. an executive for microsoft. in the creation of starbucks of marijuana. this is what people in public

health care about. the issue is a small amount used bay adult in the prove of their homeland security is initiative in colorado are about. i would conclude the negative consequences. why would we open the flood gate, hope for the best and try with the limited resources later to patch it up. thank you. and others. and i'm interested in -- 35 years in law enforcement significant part of that is a narcotic detective. you obviously have [inaudible]

than vermont put together. so those who criticize your state's initiative is -- [inaudible] you've heard the concerns. how do you address that public safety point of view? what we need to do is continue what we've been doing all eye long. this is not going change a lot. the rules in place are about to be in place in the state of washington. put a limit on the amount of marijuana that can be produced. for the idea they only match demand. they're not producing enough to export to other states. that's no say illegal marijuana grows are not going to be exported. we can and will go after them. we don't expect what is grown

legally under the new system to be exported. as far as driving under the new law we have away to go after people driving under the influence of marijuana. it's very difficult to get a conviction. we have a standard of.5 man nann gram. we have a standard we can use just like we use.08 for driving under the influence of alcohol. we never had that before. one of the things i'm doing it retraining many of my deputies so they can be drug recognition expert. they got scene of a suspected drug driver whether there's any narcotic or marijuana. they can test the driver.

we did not have a standard alcohol of the use. we had a strict standard. your commitment is to enforce law in your state. are there areas of the federal government can help you? >> absolutely. i think the clarifying letter that came out august 29th helped immensely. it removed the uncertainty we have. it allow the citizen of state of washington what they want. they want legalized marijuana. that's a big deal, i think. it's going take the criminal element as best question out of the sale of marijuana. that really was brought home to me two nights ago when i was here in washington, d.c. my chief of staff and i went out to dinner. we went to the grill two or three blocks from the white house.

we saw two gentlemen walked up to a man standing on the corner and said can i get some weed? they didn't come up to us. >> i take it you weren't in uniform. >> no. they went to the most sketchy guy on the block to try to boy weed. that's going go away in washington. they can go in to a store, not a starbucks store. they can go in to free-standing store and buy their marijuana legally. they know what they get and the price will be. they don't have to go to the criminal element on the street corner at 9:00 at night and solicit somebody to sell marijuana. our 250 is going eliminate. that's a huge step forward.

it's clear if your testimony make sure it works. sinned for a lack of access to financial services. the inability for businesses expenses, for example, federal taxes cited as a it's a criminal

entames regular story. it's right for robbery and a regulatory challenge. it will be easier to make sure the taxes are being paid. make sure that rules we nut place are being followed it's the folks doing business with the bank or credit unit on or other financial institution. >> thank you. my time is up. >> i have a couple of questions. start with you. there's a sharp uptick in expulsions in colorado schools in recent years and the state's second largest city colorado springs. drug related referral for high

school students tested positive for marijuana increased every years between 2007 and 2012. with legalization -- will increase and yet as i understand that earn certain circumstance rules in colorado will allow for marijuana advertising on television or radio. the rules will permit marijuana business to maintain websites that could be assessable by children and the rules will permit marijuana theme magazines to be sold in stores within the region. my question if i'm right the things i cited the rules effectivelily allow marijuana advertising to children. why do you believe that colorado can successfully protect children from marijuana? >> you raise an important issue.

even the institutional amendment of authorizing marijuana specifically said that advertising directed at children can be prohibited the bletion in the new rule also dot same. we try to develop rules narrowly focused on making sure print, television, radio or advertising it will not be targeted at young people. cartoon character and other advertising that would be particularly appealing to young people prohibited. the proposed -- the final rule which was based upon testimony at our rulemaking hearing provides that if there there is advertising for marijuana in november that will

give resources to develop sort of best practices for education and prevention efforts. so what we intend to do is counter any act with very strong and effective programming that will be public service programming that will be geared toward young people to let them know that we agree with you. we believe adolescence smairn a danger. and we intend to educate them. >> also. you had an interview with npr in february. we have strict control over who can have access to medical marijuana. end of quote. there was an audit concluded on

the public health, quote, let me start over. the colorado department of public health quote cousin not sufficiently oversee physicians who make medical marijuana recommendings. end of quote. the audit noted that one physician had recommended marijuana for over 8, 00 parents. would you standby your statement that colorado has control over who can have access to marijuana? and if so why would you standby it? why would the damaging audit findings should the department of justice have confidence that colorado can implement robust regulation recreational marijuana? >> thank you. it you're right. as a matter of fact in the conversation with the general

holder he raised the same question. he asked about the awe kit. -- airtight. he told us we need raise the issue. we are committed to doing that. the particular audit you talk about the is regulation over doctors who issue prescription. what i was quoted in february. we have good medical marijuana rules and regulation. we haven't cone a good job in enforcing those. we lack the resource. with the new tax coming with the advent of legalized marijuana we'll have the resource to hire staff to enhance our oversight of doctors, of those other businesses involved in the marijuana world. our time is up. i'll submit one question to you. answer in writing. thank you.

>> sheriff, let me ask you are you familiar with the eight federal interest areas? >> yes. >> are you satisfied with those? >> yes from an law enforcement perspective adequate and appropriate? >> absolutely. we'll have no problem meeting them at all. the state is enactive. i think it's going work out very well. i have no problem with those whatsoever. i thank the justice department for coming forward they can. and presumably given your years in law enforcement and narcotic investigators worked with the federal government on federal investigations in the past and various capacities; correct? >> that's correct. my detectives are doing it currently. yes. >> are there current activities? >> yes. >> in the same area these

federal interest areas provide for? do you see any area of activity you're undertaking now that would stop? >> not at all. a week ago we assisted assisted with serving several search warrant and con if i we do it all the time. it's not going it change. our cooperation with the federal government is not going change one bit because of 502. and by limiting themselves to the eight area of federal interests, you don't see that reducing the federal law enforcement footprint in the state of washington in any significant respect? >> absolutely not. from a public health safety point of view. how do you feel about the eight area of federal interest in are theyed a grit your perspective? >> we also embrace those.

the task force we put together implement the new law. they were particular lem. we're appreciate the fact throughout the process the justice department particularly through the u.s. attorney office have been forthcoming about the general about the new law. and allowed us focus as we developed our legislative and regulatory response. >> and the governor's legal counsel. >> yes. >> a great job. i used to have that job. you have the responsibility of representing the governor in the legal negotiations about the enforcement program. the regulatory program.

say a word, if you will, about the comments that senator bliewm that and i concludeed deputy attorney general's testimony about the importance of the department providing metric as clear as possible so people know what the rules are they'll be engaging in. >> well, let affirm what both you and senator blumenthal said. we, and think about the industry i.t. in colorado would appreciate that sort of guy cans. our department of public safety and state patrol during the investigation in colorado along with local law enforcement will appreciate guidance, and ting will when the the day comes there's every day of appealing to young people or supporting ma

enforcement action that shut it is down would be welcome by us. >> my time is nearly expired. i would assume that your policy disagreement with the choice to do you sympathy we should continue on the previous path? i think the provision are agreeable based on apple pie. what are the specific metric the federal government use to trigger enforcement? >> perspective metric. they are extremely important. yesterday there were 4,000 joints publicly passed out in colorado by the campaign now

favor of legalization now against the tax. they launched their campaign by handing out 4,000 joint publicly. marijuana festival in seattle a point or two ago. 50,000 people smoked marijuana publicly. we talk about doing the enforcement on the local level. i haven't seen the sowfed far that we're going to try to reign in the big industry that advertise on the internet legally. advertisement will be legal. they -- they worry. we will be monitoring with a watchful eye. >> we look forward to working with you on that. i want to extend my best wishes to congressman kennedy in a colleague in my delegation for many years. >> i would say the sam. as i understand your position,

it is not not so much against legalization, but the evil and the abuses that may be the result, and i wonder if you could say i know you allude to it in your testimony whether in fact those elfs or abuses have in fact occurred in colorado and washington. what would be your advice to connecticut? >> sure. i've definitely seem then occurring in the state. i don't, you know, -- state officials are in difficult positions here to. the effect what we have seen in a state of colorado. less than 2% of people with cards that authorize them to use marijuana medically have cancer, hiv, or any other serious chronic illness. that we have seen them handed out like candy. we have seen the mass

advertisement already. what we see with, you know, that worries me. i don't see the evidence of trying to implement something robust and enforce it. especially in a base of industry that will be pushing back against every single kind of provision like -- advertise marijuana just behind the counter. i know, the governor tried to do that. you can still have marijuana products that redble that are actually sometimes the thing sending people to er even joint in term of an inexpense

that can be a traumatic experience for some people. i don't see it being regulated. that's what i worry about. in term of the position that sam and others put forth. again, i think we are in a country with a first amendment. in a country that has seen the alcohol and tobacco industry relentlessly target kids and addicts. because these industries don't make money off casual users. the marijuana industry doesn't make money after the person who decides every ten years to light up a joint. alcohol and tobacco included make money off addiction and small amount of users that consume the vast amount of the volume. what i worry that americans file legalization is commercialization is promotion.

who get caught with a small amount. it's about the commercialization. >> i wonder if the two other witnesses reacting to the point that have been made about the problems that have risen under the colorado and washington law would respond. >> you know, i think that we do agree with the concern that he raised with respect to the dangers of products that are designed for young people. and so we have put in to place some significant restrictions on packaging and labeling the gummy bear story, you're right. it's a problem. and our department of public health our regulators who are looking over the license premises will be make suring those type of packaging and that

type of promotion for young people doesn't happen in colorado. it's happened admitly in the past. we're going redouble the efforts to make sure that young people don't have encouragement and don't take the fact that it's now legal for an adult as a sign it's good for kids. seattle is going to turn to the starbucks of marijuana. with 50,000 people smoking it. there's going to be gummy bears used as marijuana. that's going to happen in the state of washington. big business is not going take over the marijuana business. the legal marijuana business in the state of washington. there's no vertical integrated involved. the processers and not sold or

marketed to people under the age of 21 under the age of 21 in any way, shape, or form. >> thank you, mr. chairman. my time is expired. thank you to you for being here today. >> that brings the hearing to a conclusion. let me thank deputy attorney general cole and the three witnesses on the second panel for their contributions to our understanding and work on the issue.

with that, we are adjourned. [inaudible conversations] [inaudible conversations]

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t only national television networking devetted to non-fiction books every weekend. four in ten adults skip visit to the dentist because they couldn't afford it. this is an hour and twenty minutes. [inaudible conversations]

[inaudible] [inaudible conversations] hearing of the u.s. senate subcommittee on primary health and aging is going to begin. and i want to take this opportunity to thank all of the panelists who are with us today. to thank c-span for putting this issue across the country. and to thank my colleagues for coming in and out for the hearing. in the last couple of years we have had a lot of discussion in

our country some 50 million people have -- we have a crisis in primary care. despite poor outcome we spend twice as much on health care as do the people of many other countries. unfortunately, in mist of the discussion about health care in general. we have forgotten and paid little attention to an element of health care that is enormously important to all americans. that is dental care. and fact we have a major crisis in den call care. it's an issue that needs a lot of discussion. it's been pushed under the rug. it's time we brought to the sunlight. last year i held a hearing we

learned in the united states has a crisis in term of oral health. people who need dental care the most are the least likely to get it. that's low and middle income american, racial or ethnic minority, pregnant women, seniors, individualses with special needs, and those who live in ural communities. low-income kids are twice as higher income peers to develop cavity. millions of millions of people in live in town and cities where it is difficult to access dental

care. even if they might have some insurance. they can't find the dentist who will treat them. we learned about 17 million low-income children received no dental care in 2009. we learned that -- this is a mind blowing statistic. one-fourth of adults in united states ages 65 or older have lost all the of their teeth. what about that? we learned that low-income adults are almost twice as likely without ten tal checkup in the previous year. we learned that bad dental health intake overall health and increase the risk for diabetes, heart disease, and poor birth outcome. we learned there are over 830,000 visits to emergency rooms across the country. preventable dental conditions in 2009 a 16% increase of a 2006. in other words people are inning a any ag any their only way to

go to the emergency room. we're spend money on dental care. kids five to 17 have cavity. making them five times more common. there are more den dentists retiring each year than there are den call school graduates to replace. the dental crisis not the only has high economic and financial costs to individual in our country. it comes with high social costs as well. over second degree 00 billion is spent every year.

over a third is out of pocket. it's second to description drugs. in addition to the billion spent. billions are lower house in missed school days. tragically, sometimes people become extremely ill because of oral infections. and on occasions people die because they don't get the dental care they need. let me be clear. we are paying for this den call crisis now in an inefferent, uneffective, unjust dental system. we spend money on those coming to the hospital mj rooms suffering in pain. we refuse to provide to people to get the care they need. i believe in making sure people to get to the dentist when they need will prevent not only a lot of suffering, but at the end of the day, save our country money as well.

interestingly enough, last year i asked the people of vermont and people all over the country to send me their stories about dental problems. we were just blown away by the kind of response we got. we got 1200 responses. ic people are ever asked to talk about it. what we heard are people who are in pain who can't find the dentist to worry about their gift. it was really quite something. i think we have a real problem that needs to be discussed. when we talk, by the way, about the concept of insurance, we usually mean that insurance covers the need. i think most people understand that dental insurance often pays for a relatively small percentage of one's needs. the average benefit cap is just about 1500 a year arizona everybody knows dental care is extremely expensive.

hope hopefully today we'll learn. if you have serious dental problems $1500 will not do it. despite the limit people with dental insurance are far more likely to see an dentist rather than those who don't. one out of every american doesn't have any insurance. traditional medicare. i see it every day. i don't know if you run in to this. seniors off come up and say why is medicare not covering dental services? and certainly does not. i can tell you right now it's an issue we're working on. the va doesn't cover dental service except for the problems for the veterans. and states can choose whether the medicaid programs provide coverage for low-income adults. nearly half the startses have no dental benefits or ask receive

service in the case of dental emergency. in my mind it's unacceptable. in our country, millions of people cannot get the care they need to lead healthy lives. dental 3r0bs sprier the stigma of mitdzing teeth. if i don't have a job and looking and don't have front teeth what do you think they're going say? it's like a p on the head a poor person we don't want in the workplace. it's an issue we have to address as well. the lack of access to dental care and the national problems that is often the case they are acute for lower americans. many beam medicaid it's almost impossible to find dentist to see them.

med said inadequate. even if you have medicaid. it's in many cases imphonal find a dentist to serve you. only 20% of dentists accept. only a small percentage dedicate a significant portion. if a report released today. the government accountability office, the gao found wide variation and fee charged by dentists. for 8 of 24 common proceed your the g ark o exam those charging at the high end charged more

than double with those with average fees charge their patients. that's a whole another issue. why the cost of dental care is expensive. and the discrepancies and prices we see all over the country. now there is some good news out there. we're going to hear some good news today. and the good news is that we are making progress and expanding the number of locations. it we're lower income can people can get access to dental care. they provide dental services to more than 4 million americans across the country regardless of their ability to pay on the affordable care act i and others work very hard to expand to the tune of some $12 billion. we get dentists cridz

beautiful. the dental clinic right in the school cridz coming in. adults are coming in. that's a concept i like very much. maybe we can talk about that. we try to reintroduce the --

we have a crisis in the country waging huge amount of money. it's time to make sure that every american gets to den call he or she needs. and make sure we ease specialt -- especially take care of our kids. i understand you have to be leaving soon. you want to make an introduction to one of our panelists. >> if i can make an opening statement. i can stay for a little while. we do it in the regular order you planned, mr. chairman. i want to thank, mr. chairman, for holding this very, very important hearing.

those americans currently have access to den tell care.

it has grown more expensive over recent years. putting a lot of stress on middle class family budgets. we have do all we can to address these increasing cost. because they ultimately threaten public health and economic security. major opportunity exist at the moment. as we move forward with reforms to our underlying health care system. reform that focus on delivering health care higher quality at the lower cost. dental care must be a part of the changes in the reforms. first, insuring access to dental care must be a major component in investigating in preventive service. we can save costs later by helping people avoid developing chronic diseases. secondly, dental care shower more integrated to health care model. we need to tear down the

artificial barrier that exist between dental and medical. they are are official barriers. by delivering more integrated care we'll increase cost and improve the quality of care. i look forward, mr. chairman, to the testimony of today's panel. i can remain a little longer and would love the opportunity introduce my constituent when that moment arrives. >> thank you for your hard work on this issue. let me take the opportunity of introducing our panelists. our first witness is dr. frank. doctor is a dentist and professor with the department of community dennist i are. he's also vice chair, senator do

you want to introduce him? >> thank you, purchase. it is my great pleasure to introduce mr. greg. he's the director of the family health center of march field, wisconsin which is a federally qualified health center. he's been involved with the planning and operation of family health center for over forty years. the family health center of mash field is one of the largest dental practice in the nation. and the larnlgtest provider of dental services to medicaid patients. i admire the work the family health center has done to increase access to care in my home state. i will look forward to your testimony today. and as you noted, mr. chairman, unfortunately i have to leave mid way through the testimony. thank you for being here.

thank you for coming with us. the final witness is dr. hughs. worked the georgia county health department for 17 years and served as program chief of dental health there since 2007. she oversees the dental project. she also serves on the again tal action coalition board. she began her public career in vermont. but she left us. [laughter] why adopt we begin. i want to thank all of you for being here.

with a we're trying to do what this hearing is about focus attention on a crisis which doesn't get the discussion it needs. it's going to be a long hard fight. that's what we're trying to do. dr., thank you being here. please make your presentation. >> thank you for the opportunity taunt. we spent forty years of dental education and advocating for -- there are several caters about the access problem i would like to mention. it declined about 10% in the last decade. primarily for cost. we made some good progress the last decade improving access to care for children. we have a approximately 60% of medicaid enrolled children who are not receiving proven

cost-effective. and third, the senator said hospital emergency room visit for dental problems have increased 16% to over 830,000 visits in 2009. a very significant wasted cost. what are the effect of the lack of access care? two example the. first, children who miss school because of dental problems do less well in school than other children. education is the way out of poverty. with children in pain cannot learn. second, a recent study from 2002 to 2008, 61,000 patients across the country were hospitalized for preventable dental infecial. it was not an isolated example. 66 deaths. 66 deaths were reported in this

study. an estimated cost of $804 million. it's not a personal tragedy. it's an economic loss. let me mention dental school. dental school is an important part of the dental safety net. faculty and students that provide care outside the dental psychological and community based setting are -- dental provide high quality dental care to those patient bhos can afford the services. unfortunately, many of the dentists do not participate in the medicaid program. there are many -- no matter the reason, this significantly reduces access for patients.

dentists provide significant proe bono care. i would remind you while philanthropy care is wonderful. itst not a health care system. another concern i others have is there are restrictive state din tal practice acts a this do little to protect health and the public and can specifically impede access to oral health care. ..

>> with a not-for-profit center from alabama's that

gives excellent dental care in the past eight years they had nearly 500,000 it using a combination of a culture of care come evidence based practices common marketing and community of reach. let me leave you with this last item they have done. they have reduced costs the medicaid program from the average it will cost of $320 down at $125 in 2012. this is a remarkable business model that takes care of patients. we need more of these are of the country.

congress has been lobbied but who lobbies for the patient for increased access to care? for oral surf of -- or services and for lower cost of it's just that we need you you and your leadership roles in congress to fight for those patients. thank you very much. >> good morning it chairman sanders and the key for the kind introduction in. i want to say access subcommittee on the topics that i a.m. passion about to improve access to dental care eyes serve a large region in wisconsin about the size of maryland. about one-third of the

residents are pour. 20 years ago i served on the access to care committee as the only non dentists. i was listed as a resource for those seeking dental care if it took many calls. one day i picked up the phone it was yet another failing to hold back tears as her job was screaming in pain. the mother broke down is she had been trying for for-- calling over 30 dental offices for help someone that would stop the pain. such conversations were not uncommon for me back then but what made this a life change your his that i came to realize as i spoke with her that she was not just bearing the burden of for child speedball so this self-imposed pain that came with her conclusion that she was a failure as a mother. i am proud of wisconsin in my country but not of what

that mother was in during because there was no fix after a decade of frustration trying to improve the system using traditional routes the board said find another way this is a top priority. tenures later -- 10 years later we have served nearly 100,000 people even we were surprised by the enormous response. the origin map shows in spite of the fact we're located in northern wisconsin we have seen every county in 73% the patients tell us where we are needed. reestablished. >> now today we have a clinic in that area.

with the uninsured for what surprised us was that veterans with limited income could not get care. today they have a place to go. those who journey the for this are disproportionately people who need emergency dental needs a and care givers who bring the disabled once and for care at our website -- to our site. we recall "alice in wonderland" if you don't know where you are going any road will get you there we knew we would need societal investment so we have been relentless to look at ways to maximize the value of the efforts of the taxpayer not just patients we serve. we learned we could improve the performance of the job placement agencies by making job-seekers horrible decay more employable.

one county told us they have 100 adults every year. we learn it annual savings are possibly between two or $3,000 are possible with patients' diabetes as proper dental care and we could be a real alternative to the emergency room in hospital but opening our doors to patients with dental emergencies across the state i like to leave you with three thoughts. first, success requires that we fundamentally look to change the nation's perspective on oral health and the added value it brings to the general health. second, the work force matters of the next 20 years wisconsin could face 2.two dentist graduated -- retiring for everyone graduating in the need to be prepared for these medical conditions. third, at the community

level we're seeking to accomplish this by pursuing the integrative medical / dental model that leaves no one behind. this is the mission of all health centers where solving access problems one community at a time and we're in 9,000 communities but there is outpacing our growth over 300 applied for funding of with the unmet dental needs in 2000 and 11 unfortunately the deal cut six headed thousand dollars from health center funding and there has not been any opportunities since then. the health centers and your health centers the model has what it takes to solve this very problem for the nation's communities in their appreciate congresses past supporters and ask you continue to invest in our health centers. give us more work. there's more work to be done. >> figure very much.

>> could morning. distinguished members of the subcommittee might -- i was social worker from virginia. i am here as someone who knows firsthand that dental care is a luxury that many of us cannot afford. i have paid thousands of dollars of debt to working and need much more i am focused on this issue kasai cannot afford to pay the exorbitant cost of the dental work that i need since friday of the extensive work i have a'' wonder how can i afford my future seven years ago i took out a bank loan to pay for a bridge i was told a few months ago that the bridge needs to be replaced. i was quoted the price of $7,000. the periodontists said he would give me a discount but it did not matter i could not afford it either.

i have quite a few other dental issues. the insurance coverage with my job covers $1,290 per year that does not even cover one of the crown's let alone anything else. that has been quoted to me at $2,000 each. in the past two months i have needed stealing a cleaning for gum disease with an emergency ground went to a cracked. as a social worker i work with severely mentally ill clients most who cannot afford to get to a dentist in many years one issue for them is numerous medications causes dry mouth but with psychotropic there could be a more severe effect as it takes more than one vacation to treat the mental-health center -- symptoms. and saliva helps to cleanse the into bacterial action. one of my clients has very

few teeth left and found out two weeks ago he has three abscess in the remaining cheese. the medicaid benefits only provide extraction of t's but no dental services. if more teeth are pulled he said he does not how he will be able to eat. another client received general release funds of $220 per month to li o i gave them permission about the dentist that provides a free emergency exam and x-ray and she found out she needs scaling andrew cleaning the price quoted to her was $1,600. i then directed her to a lower cost of dental service this summer issue was told they may have an opening in november because there is such a long waiting list. this week and was told by another client he was told in 1989 he had 11 cavities but has never been treated

for any dental work and he said i guess i am on my way to a root canal because i feel a sensation in my mouth. i had an unusual birthday as a was preparing to go out to celebrate i heard the news about the mercy clinic where free dental services were being provided. immediately ran out of my home and my mom in told her we had to cancel my birthdays like to go to maryland we went in told there were full for the day but i could try can tomorrow. i knew that dental care was much more crucial than celebrating my birthday so that evening i went back and arrived at 8:00. i was number two. i was thinking of wish i could have brought all my clients with me. many others started to show up. we shared our stories of dental nightmares and i spent the night on the sidewalk but i did not mind because i was getting a

great birthday gift. it turns out the gift was seeing over $400 -- 400 people in action to provide over $750,000 worth of free dental work that weekend. i was not able to get the services i was hoping for as they could not do what i needed but i did come away with the scene that i will never forget of men and women of every race and creed and color windup fox for what seemed like a mile with the hopes to be helped and it was heartbreaking. i have learned the lack of adequate dental care can lead to diabetes, chronic heart disease and stroke. these risks are scary for me and others. but you have the solution in your hands. ina a social worker, these are my clients, but on this issue all of us stand together in the same line

looking for hope. i biggie to pass this legislation to be provided to all. thank you for your time and attention with this critical matter. >> good morning. i am a -- i began my career in public tells 21 months ago for the past seven years i have been with the prince george's county health department. we provided more than 3,200 clinical visits to children and pregnant women and in addition provide oral health education across the country -- county working with patients in clinicians and health administration. organizations has given me the insight.

i would like to thank senator cinders for this opportunity to share the landscapes of dental access with cost issues in my jurisdiction. let me begin about what is happening. in vermont i have a population of approximately 8,000 at that time for lunch was eligible former medicaid did not have access. with the help of a community organization we could provide care and expand access to all eligible residents in prince george's county they provided a similar safety net. recently i participated in my first mission of mercy. the today large scale of them provided free health care to ensure diddles men and women waited to be

served in many received quality care. the patient should not have to endure such conditions to receive treatment. this confirms my belief that the care is not a luxury but a necessity in must make it accessible to all adults but this is difficult if we cannot address the cost within the industry and of course, we cannot talk about the high cost of dentistry without a knowledge in the cost of dental education it is not uncommon to graduate with debt over to dawson and education costs play a role. it is the true cost driver it could cost up to $500,000 for equipment alone. coupled with the escalating cost of salaries in insurance premiums and dental supplies and equipment upkeep which are

largely unknown to those a practice can experience staggering costs. recently have repairs on the x-ray units to repair bomb was $295 per hour so for many consumers to have neglected their care extensive treatment is often required and can be expensive. for example, according to the 882011 survey in the south the atlantic region the average cost of the root canal this $1,075. add the cost of a crown the fee increases and additional $1,079. of course, for less-expensive option is to have it pulled but this could lead to problems with the parents and chewing and speech can of the cost be contained this is us question i cannot answer but important to know what drives the cost. i think about education and prevention and outreach to

obtain more resources for accessibility to care in a prince george's county we provide medical and dental care to public schools and the county health department has a mobile unit funded by a the oral health to children be addressed american needs to provide resources to establish a dental home and work with those in the neighborhood reservists for the families that continue the efforts to make it accessible. the project providing care to more than 2300 people on a budget of $180,000 per couple per units are not a panacea but they are a model for affordable dental care. prevention is the important aspect that after the death of the deal mont a driver

when of the recommendations was to have school based oral health screening. the committee received $172,000 from the foundation to develop a demonstration project to determine the feasibility of this type of program. the results show it is vital to have a presence in the schools. 200 in the number eight categories showing they showed the immediate need of multiple decayed teeth. these programs of a sensibility we need a commitment to support the public health infrastructure so dental needs can be met. think you again for the opportunity to address this crisis. >> thank you very much dr. hughes.

there is a lot to go over. we can do this in formally i would like to ask each of your questions but at the end of the response of the others want to jump in that is great. let me tell you a little story about 45 years ago from the northeast kingdom i saw a neighbor of mine i never saw anything like it may be 10 years with the teeth writing in his mouth. it turned out he was not unique we had a major problem and over the years we have made some significant progress through the federally qualified health centers now 43 locations with 25,000 people getting treated regardless

of income at the community health center is a source of great satisfaction. we have state of the are dental clinics but what is fairly cost-effective we have technicians we have a long way to go. if you build that they will come like the baseball field. as you build the dental clinic people come. dr. catalanotto is a your impression the need is out there if we build that people will come? >> absolutely. i looked up my own examples in florida at our dental school is very large the

asian travels two hours away because they cannot have affordable care going to the next day capital of tallahassee the day we did a school exam one of five children reported pain that day. one out of five about five years ago reported pain. a young graduate of which the health department she was a pediatric to start -- to his dentist giving a bush ticket of made an overnight was a major success with large members. so yes been in need is out there. people will come if provided access to the services that the affordable cost. we have a wonderful partner to do this and as an example all of my dental students at

the university of florida spend approximately six weeks of their clinical year not because of the short-term labor but these students finally figured out this is the place i might practice. it is no longer the private practice they see the opportunities. >> let me ask you a tough question just between you and me. i had the impression today that there is some great dentist out there to see their job to treat people in the you but also no secret there is a lot of dentist that graduate deeply in debt and we will talk about that in a moment that make a pretty penny to treats the upper-class with all the cosmetic dentistry the we have a lot of kids in pain.

what do we do? with it is do have? we try to expand the health service corps, what do we do to create the dental work force that we need so we don't have to be embarrassed there are places in america that there are not deaf dentist toward treating low or moderate income? what is your idea? >> we do need to improve medicaid reimbursement. in florida where the worst we to only 10 percent of dentists saying medicates. >> see that again. >> we do have medicaid but only one out of tin dentist take the medicaid patients be but that because we have the lowest reimbursements in the state's. number to it is clear that scholarships and loan forgiveness programs are wonderful there are some states that have them we do not have them in florida and

our legislature has been lobbied but it is just too cheap to do it. third, title seven funding shows the koreans to help change the culture of the dental school. they focused on health care disparities i am the principal investigator to one of these in we are revamping the curriculum to produce students that are more culturally competent and more to have a public health dentist than the second your dental students go out to the school based setting because they know they go to school so poverty a and their hope is that they will become more sensitive to this issue after they graduate.

>> are you finding we have the same issue with primary health care? are you finding that given the opportunity we would be able to attract more young people to serve lower income? >> yes. no doubt you are sending the students to work for us they get a better appreciation for these patients in their going into those settings. >> thank you very much. in to give the opening remarks. >>. >> i just want to follow up mr. chairman for inviting me to attend this it is very

important. i want to pick up where you were on and dental care in minnesota we became first in the nation to create a license for the advanced practice dental therapist this was for started in the united states in alaska to address native population in there because in alaska to get a dental provider or a dentist you only get it once a year. but now they have dental therapist or at others have them. i guess the one telesco were treated new zealand.

dr. catalanotto, in your written testimony with the financial impact of the national dental care crisis did we were just talking about the limited access haoles to race will spending, then a gao report announced only 62 percent of americans have done the coverage of the 40% have a dental visit in any given year. also with your testimony one way to expand excesses' for states to consider those like minnesota could you elaborate? what can we do to support the expansion of that

program? >> it is a great question i have been to alaska three times looking at that model and i have talked extensively with the folks from minnesota that have trade these debt the therapist and employed them. last week high testified and with me was one of those that employ that dental therapist in minnesota. i have read most of the literature and i am absolutely convinced this is a cost-effective spacer wonderful model to deliver care to those in need. the duty is they can do this simple procedures that a dentist might do that allows the dentist to work out the top of the scope of the practice. they are inexpensive to educate.

and they are a wonderful solution but the difficulty comes at the opposition that the state level and national level that i think is your question. those that forbid these individuals approximately 15 or 20 states that are this close to do legislation to get a dental therapist in their state. but these restrictive tax privet dental hygienists that are excellent at providing primary services they are restricted from working at the top of their scale across many states. at the federal level the impediment that currently exist is language was inserted a couple of years ago that prevents the first nation folks across the country that want to implement dental therapist per plenty of them because

the language says they cannot use federal funds. this is a travesty and the indifferent to the sovereignty of the nation that is something the you could do that the federal level. not much you can do at the state level because of the individuality of the practice acts. >> i just think, mr. nycz if you would hire a dental therapist they do the tasks they are allowed to do as well as a dentist, and my right? >> yes. that is what the evidence shows because of the state law we do not have access and of course, not many have spent that i would like to circle back to the chairman's point if you build it will they come? the map will show that we

take care of close at one headed thousand people who come from all over the state may be adding the hundred or 40 from minnesota. when we open a clinic we get people with such horrible dental disease that young men into women just coming out of their dental training , and many of them are daunted by the task in front of them. one left after six months say they are not prepared for this kind of work. another said i am not prepared for this is she went back to get a one-year residency now she will work for a starting october 1st so there is a trainee aspect. once writing about the dirty dozen why we don't do prevention and one of his

points was the privacy. as relates to the dental therapist, we have a dentist who cannot even do is a job when they come right out of training because they are not used to that but as a health center director that is what we're faced with so i need well-trained dentists even more than in the for your schools to tackle the problem. but i want to have our population find they can experience the same oral health and at that time there we have a responsibility to taxpayers as well. so what i see over time is as the population gets healthier we need to substitute other providers

to handle the more routine and say this to help out with the emergency is so i see this more in our future. and if these could be resolved. >> i just want to end if i might to because i have to go back. when we had testimony we had a debt to a therapist from a native village and she said because she was from the village when she would see kids in the village at the store she would save pressure cheese every day. with the prevention piece it is key that we have people who are more likely to go back and this is something i

would like to continue to pursue. >> let me pick up that what we're talking about is the work force in general. and let me throw it to dr. hughes, what ideas do you have? dr. catalanotto made some suggestions but is it your experience, you're not attracting the practitioners that we'd need for a population that has a a bunch of beads out there? >> actually in maryland we have seen did increase we currently have over 1600 providers our issues deal

more with adults and not having coverage those that do have medicaid the benefits are so limited that they cannot provide so then they don't concede. then they go to the emergency room then stare referred to the health department there is not enough funding for public health infrastructure. right now i could easily have an adult program in the health department that with the budget cuts one of the first thing that was cut was money for it did test for the uninsured adult population so we don't have funding we have the capacity agree to have problems finding providers. >>.

>> we have all seen pictures of other health care or dental care of doctors who volunteer their time to treat those who don't have access. one of the staff members in southern virginia you mentioned something similar in look like a third world country or maybe the fourth world country people with terrible health and dental problems it was hard to leave this was the united states of america where people would spend the entire night to get the 26 attracted to find data they had cancer or whatever it may be and it did not look like america. you are familiar with that reality? yes? >> yes. definitely.

>> so you are a lower income american, you are on medicaid but you don't have access medicaid does not pay? what do those people go through? >> we have an office one day i had a client in severe pain i took her to the main office we got her an appointment. i believe that a couple days a and we were told they would pay up at $200. they had very limited funds. many times them the option is waiting months of the waiting list to be able to be seen in the clinic where people are donating their time with their free off showers but though waitlisted is incredibly long and they have to wait for a long time.

>> so many clients goes to their days and paid? >> in paid? >> when they are in severe pain we take action to take any treatment we can get a lot of treatments to have extraction's, quite a few and if someone is really in pain we try to do everything we can with the limited opportunities we have. >> let me go to anybody here. a and dr. catalanotto, you raised this issue. we have a private one dash crisis in don't have the work force to address the crisis what role does that ada play a part in this? we invite to them but at the last minute they chose not to be here.

, are they stepping up to the plate to address the issues we talk about today? >> in my opinion the last couple years there has been a shift with the national picture of the leadership and they call more and more attention to the access issue but one of my arguments back to them is you need to lobby equally as are the access issues and i am still not necessarily seeing that at that particular point. but the state level are very independent of the national organization. one example would be the american dental association has policies on better licensing procedures. but at the state level that is not happening.

easier reciprocity between the states as a national policy is still impeded in some states but it is getting better. so i want to be positive about that. >> you guys are doing very well i think we are in vermont as well. have you had any computations would it take for a state like wisconsin how many more facilities would you leader how much were many what would require for universal dental care? >> it is a big number. our states asked could the state health centers help to solve the problem? and we said yes if we step up with the resources we could do that. when governor trial -- doyle came to the ribbon cutting

he said the approach we're taking is building sees group dental practices many colleagues tell me will never solve the problem by trying to get a dentist to establish a practice in this town of 1,000 or 300 but somehow to centralize that at the county seat where people can come so then we can gain efficiencies it is easier to recruit and retain the governor said in a love the model how many do we need? could we have fled every 50 miles apart? hint of the number when we simulated this it does cost a lot of money to do this. we were in the $100 million range. has a form attorney-general

he said particularly in the folks on medicaid have a legal right to these services and may need to find no way to do that. so in my written testimony i show collectively we have done in their hair -- they have been a wonderful partner to this day but the fundamental question is it is costly because we have neglected this and because we have had a population that does undervalue oral health that does not fully understand the general health and we have that point that around 42 or 43% visit to a dentist every year. it should be more in the model that we try to do high you capture savings talking about people coming out of school was certain income targets but the real savings

is to raise the oral health profile of the american people and that potential is gigantic. all of this can be prevented. rearing gauge in a generational effort to make the difference in places that could be helpful we hear great -- grateful to have adults of medicaid. why don't all states have adult dental or have them in the exchange's? people say because we cannot afford it but then i asked how do we afford adult dermatology? the thinking is we have to totally change your thinking to integrate these things. >> you are absolutely right and that is why we are holding hearings like this did you made the point that is true if you experience access it is the expensive proposition war if not it is

perhaps more costly new ones to say a word about people walking into an emergency room and how much have cost? >> we did our own report in florida in 2010 when hundred 15,000 dental visits at a cost of $88 million. if prompted me to write an editorial entitled paid me now or pay later. we pay for this. we pay for this today every day. . .