insurance exchange where premiums and cost sharing are very much a part of the picture. so there's a substantive balance here. as for the politics, there are many, again, who fall between the extremes represented here, those who were immediately willing to embrace the expansion just as a part of the law and those who opposed it from the outset. and i think what i observe is a lot of political leaders looking for a way that they can still be against obamacare because they went on record as being against it ask they can't change that view -- and they can't change that view, but starting to see some of the dynamics playing out about the economic consequences, the human consequences of not doing the expansion. and the most common political frame is we want a solution that works for state x and fill in the blank. and i think that's a very exciting development. i think it's a very positive development. a colleague, vern smith, a longtime medicaid director in

michigan, early on after the supreme court decision said something to me that i just thought was crazy. he said, you know, this -- the court taking away the expansion from being mandatory and making it a state choice is going to end up being positive, because states that do the expansion are going to go through a process and embrace it as opposed to just doing it because they have to. and i thought that was kind of crazy. but over time i'm starting to see the wisdom of his reflection. which is that every state that moves forward now has a deeper understanding of the program, it's harder to fall back on the rhetoric of it's welfare or it's people who aren't working or it's a big public program when the reality is it's serving working families that the business community is supportive, that it's already largely delivered through private plans. and so don't get me wrong, i have a lot of concern about the

pace of discussion, but the fact is we are having state-specific discussions about what fits substantively and politically in a way that wouldn't have occurred, and we're seeing states saying how do we make this expansion work for us as opposed to just saying, well, we have to do it. and that's where the discussion is in a lot of states right now. >> well, let me ask you a quick follow-up on that, because some states are proposing things that, you know, cms may look at and say, no, you can't do that. and i know you can't get in the heads of governors or legislators in states, but how do you see requests playing out if they end up not being approved, only partially approved, some things like that? what do you see happening this some of those states -- in some of those states? >> well, it's very hard to generalize on this and i, of course, don't know what cms will or won't approve.

what i'm struck by is that there is a somewhat new conversation going on that is a quirk of the statute where the expansion goes up to 133, but the premium tax credits start at 100. and so if you're in a state that didn't do the medicaid expansion, you would have people between 100-133% of poverty who would be eligible for the tax credits and in the exchange. and, of course, in the exchange there are premiums, and in the exchange there is cost sharing, although there are subsidies, of course, very significant subsidies on both of those. and i think what is a hard line to hold in the long run is to say to a state, well, if you didn't do the expansion, folks between 100 and 133 would get it, would have access to coverage with premiums and cost sharing, but if you're going to do a medicaid expansion, you can't charge premiums or cost

sharing to that group. that, i think, is hard line to hold. and so i think what we're seeing is a little bit of wiggle around, again, the blend between going from traditional medicaid up to sort of the core population covered by the exchanges. i think ancillary issues like work requirements are going to be strongly resisted partly because they are, there's no room in the statute really to permit rules like that. and i think the issue of wrap-around coverage, again, is one that people fight about a lot. but, again, remember the medicaid expansion population is eligible for a benefit package that's very, very close to the essential benefits that are offered in the exchange. and although there are difference cans, they are small. and, again, i think those are the kinds of differences where people are going to negotiate. so i think the negotiating room

is over the sort of core or elements that exist in the exchange. when you start putting other things on the table, i think it's less likely the federal government will embrace them. how that will then play out at the state level this terms of what's accepted or rejected, that's a harder question. [laughter] >> i thought maybe you had a crystal ball and could speculate for us. i'm sorry that you don't. >> i have a magic 8 ball and mostly it says, you know, ask again later. [laughter] >> well, clearly we've got people who are coming from different perspectives and can also talk from different points of view, but one thing that in both washington and texas that you do have to deal with is messaging and outreach. ask that's something that -- and that's something that you share in common so, ginny, let me ask you first. in texas it's important to have messages that get the public invested in the medicaid expansion. can you talk a little bit about

your public messaging strategy and the messages that have worked with different groups, and particularly when you're reaching out to communities of color, what messages have resonated the most. >> yes. so with messaging, i mean, i think we talk about our broad public message even though we have one in four texans that don't have health care, that still leaves the other three in four that do. so we've been thinking a lot about how do we talk to everybody in texas about how we're all in this together, right? and that this is just a bad decision for texans. and so, you know, what we've kind of come to talk about is, you know, we're paying for this three ways. by rejecting this medicaid money, we're leaving all of these people who are uninsured. they go to public hospitals, they go to emergency rooms. so first off, we're paying for that in our public tax. that cost just keeps going up, so by rejecting all money, we're paying for it anyway. and then in our premiums. those of us who are fortunate

enough to have insurance, we have extremely high premiums, so that's the second way why this impacts you. and the third is your federal taxes are going to some other state, and everybody hates to hear that, but i think texans really hated to hear that their -- hates to hear that their tax are going to these other states like massachusetts and things like that. [laughter] that's very offensive. [laughter] the big, broad picture is we're all in this together, so don't think rejecting all of this money is actually, you know, helpful in any way even if you already have insurance. but then talking to the people that are most directly impacted that we want to engage, 60% of the uninsured in texas are latino. a couple of things have worked. one is putting a public face on it and people who are good examples of hard working latino texans who have no insurance and putting them out and talking about, you know, how this is impacting them, how if they lived in arkansas, they would have, you know, with able to

enroll in medicaid right now. we had one of our members who's a construction worker who, you know, doesn't work enough hours to make enough money to be exchange eligible talking about how his brother who has a similar experience but who lives in ohio is already eligible. and we have a really creative and wonderful partnership with univision right now where they've done, like, leading up to the enrollment period in october they did a weeklong event with us where every day of the week was a different angle on health care and how it impacts latinos in texas and really came to us because we had people who were, you know, who could speak spanish and talk intelligently about their own personal story. and this issue. and really a different example every night of the week that led up to a big telephone bank that they nationally -- that they did in all of their major media markets. so we had dozens of our volunteers answering phone calls, and they had said, you know, on their broadcast that night if you have questions about the aca, call in.

so we talked to thousands of people in just one night. and univision got so excited about sort of the stories they were hearing, that one of them they picked up, his name is luis who had to drop out of college because his parenteds had med -- parents had medical debt that they couldn't, you know, that they couldn't pay. they both worked low-wage jobs with no benefits. and so they first wanted to just interview him and hear his story, and they were so impressed by him and how, you know, what happened to his family that they took him around the country and did an entire documentary about the impacts of health insurance on latinos. so they had him interviewing mayor cashman, having a conversation with him. they flew him to florida, had him talk to the governor of florida about his story and talk about health care. and so we've within doing screenings of this univision documentary at churches and neighborhood centers so people can come and just, you know, have a simple conversation about health care. because it's really about taking these things that seem

complicated or seem too political and just making, taking it back to people's lives and families and focusing there. [applause] >> thank you. >> and, mary ann, in states that have expanded the outreach and the conversation doesn't stop. >> no. >> so success depends on getting people enrolled. can you talk a little bit about what you have learned about outreach and enrollment strategies and then particularly on strategies surrounding language access. >> it's, you know, at first part of that whole messaging is one of the things about medicaid is it can for some people come with a little bit of a stigma. they tie it to welfare. but trying to get a message out that medicaid is just part of an insurance continuum. so for the individuals that are at the very lowest income, medicaid is their insurance product. so doing some branding instead of calling it medicaid, we're now calling it washington apple

health. perhaps a new name doesn't make a difference, but just that whole idea that this is really part of the whole insurance continuum and whether you are on medicaid, you have a qualified health plan or in the commercial marketplace, it really shouldn't matter. and so we started with some of that. but i think one of the things was we didn't on the medicaid side have any funding to do outreach, we were -- so we were doing it literally on a shoe string, just taking advantage of every opportunity to get the message out. we started in the summer. we didn't want to get messaging out too early, but trying to strategically plan that we were going to be doing these kickoffs in september for october enrollment, having a health summit with a number of our advocates in the summertime to just start to generate interest, getting the media involved, making sure that there were lots of different stories out there, stories about individuals, stories about communities.

the, an opportunity to benefit be, to piggyback on to what the health benefit exchange folks were doing, they did a bus tour, so we had medicaid folks with them on their tour across the state. some of the typical things in terms of getting posters in every possible lace we could think of -- place we could think of, community centers, churches, colleges, working with the local jails, working with the schools. so every opportunity that we could find ways to touch folks out in the community. working with the spanish-speaking radio stations to help us get some public service announcements out and to target some individual populations. again, sort of like you name it, we did it. if we could think about it. just every group that we could, that we could touch. we also went out and we trained over 2,000 community workers, so

folks out in various community-based organizations. and these were folks in addition to the navigators and the in-person more assisters. so we provided them training on the medicaid program, we dave them tool -- gave them tools to help reach out to folks, help get them enrolled, help sign them up. and that really did help us. and it helped us in particular because when we did have those times early on in the be enrollment process when the benefits exchange was down or it was slow, these were folks that could help people fill out paper applications. they could help explain the program to them. and and so those partners were invaluable to us. as we moved out with the enrollment. therewe're also in the process t now of placing some of our own medicaid staff now out in communities. while we've had outreach workers, they haven't been part of our staff, they've been part of an eligibility team, but these will be folks with expertise in medicaid and medicaid enrollment with hospitals, community clinics and

other sites across the state. so one of the things we're also doing is tracking by county. we early on made some estimates of what we thought enrollment would be by various counties in the state, and we're tracking that on a weekly basis to see if we're getting the enrollment that we expected to get. so we're seeing kind of an interesting phenomenon in a series of counties where there are a lot of migrant workers, where there are a lot of hispanic-speaking. so we do think there is some barriers there in terms of individuals who either don't understand or we haven't been able to reach them effectively. so we're really starting to work on ways in figuring out how to target that population. and we're still working through that. what will be effective means of communicating and getting folks enrolled. and, again, working with our community partners to help us do that. and the one thing is we can't let up on this. we're just going to have to continue to use whatever strategies that we have, again, finding other ways that might be effective to reach populations.

and we are putting in another app to our legislature for some dollars to help us do that. so we'll know if that happens in a couple of months. but, again, we acknowledge that i think there are populations that are harder to reach, and we're having some, i think, evidence that that's perhaps the case. so trying to really rethink our strategies in those areas. >> so it's sort of continuing work. >> can't let it up. >> alan, since you -- in terms of states that have expanded, and you have an opportunity to work with a lot of different states, are there any that you would like to highlight with things that they're doing for outreach and enrollment? >> we've worked with states for years on trying to simplify and streamline eligibility systems. we started focusing on kids before the aca, and we've broadened out. i would focus attention in two places beyond the direct outreach that's been discussed. the first is, as i hope people here know, shortly before open

enrollment cms gave guidance to states on some opportunities to facilitate enrollment under the aca, and there are a number of options in there. but the one that's most sort of exciting and visible is the opportunity to streamline enrollment of those who are already s.n.a.p. eligible through a letter out and response. and a handful of states have taken advantage of that. and it's a very efficient and quick way to bring folks into the program. but i want to say something different which i think is particularly critical given the conversation we just had which is that there's clearly, there's been -- there have been media reports on states that are doing a better and worse job on getting people in and where the enrollment numbers are higher and lower. i think that's all worth tracking. but it is critical to remember that in states whether they do the medicaid expansion or not,

whether they do the exchange or not, there are important steps that they are required to take. the conversion to the so-called magi rules, modified adjusted gross income is a significant simplification in what the eligibility standards are. their requirement to be able to transfer data between the exchange and the medicaid system to determine eligibility as quickly and efficiently as possible is a requirement whether you're an ffe state or you're running your own. and there are a lot of heroic state officials who work deep in the bureaucracy in your states who are trying to figure out how to do those kinds of changes as effectively as possible, often, as you all know, in states where the overall view of the affordable care act is pretty negative. and so i guess what i want to make sure folks do is not just look at these high profile

opportunities for enrollment which are very important, but also remember that behind the scenes if these basic functions of conversion, of eligibility standards and data transfers across different eligibility points, if they work well, that's going to have a huge effect on efforts for enrollment. it's going to change the numbers, it's also going to change the experience of people who interact with these systems so that they'll go tell someone else, you know, it actually worked. i didn't have to fill out the form seven times. i didn't lose it when they said i'm not eligible for this. when i called this number, they told me to go here, and they actually could answer my question as opposed to telling me to go back there. these are very important steps that get a lot less attention, and i want to make sure people are aware that they can in many instances be as important to the long-term success as something more like a traditional outreach effort. >> thank you for reminding us of that. that's very helpful.

keeping up with what's going is also something that everyone's going to have to deal with. and, ginny, by all accounts most people think you're going to have to keep your coalition together active and engaged past this year. >> yeah. >> so can you share your thoughts on what you're doing? you've done some great stuff. it sounds terrific. but to keep people ginned up past this year and keep that going, what are your plans and thoughts on that? >> so we're already meeting now about the 2015 legislative session. i mean, we don't know who will be governor. we know who will not be governor, and that is rick perry will not be our governor. and so, obviously, there's stark differences between wendy davis and greg abbott who's the front runner, you know, the front runners for the governor's race on that issue. but really, so there's a coalition now that meets regularly in austin. many of the groups that i mentioned earlier kind of

talking about what it can look like in 015, can -- 2015, can we revitalize some of these proposals that we had last legislative session, are there other things we can kind of do to push through some texas solutions to medicaid expansion. i think the other thing we're doing is we're launching in the web site called texas left me out which is, you know, a collective effort to keep engaging folks who are medicaid eligible and are falling through the cracks and giving them lots of things they can do to continue to be active on that. and i think the other thing that we're doing to keep, you know, texas is a large state, and so we have kind of smaller coalitions in dallas and houston and san antonio and the valley and different parts of the state who are coming together around local solutions. so are there community benefits agreements that we can win to come up with some local health access solutions in each of those counties. in houston they pushed through what they called a pay or play ordnance whereas if you're a

company that does business the city and doesn't provide health insurance, you have to pay some additional money. so we're looking at different can local solutions because i think as we all know for long-haul fights like this, you have to have some wins along the way. and so we're looking at local collaborative efforts to push through some health care solutions at the local level. >> thank you. and maryanne, in washington sustainability is important as well. and a big part of that's making coverage work for people and also making sure that the expansion's financially sustainable. i know washington's undertaking a lot of innovations in health care delivery. can you talk about how medicaid fits in with those? >> sure. so and, certainly, the whole sustainability question is one that we face every day in terms of how we continue to be able to afford medicaid and looking at it as a program. probably the major initiative right now that we're undertaking, and we have a number of different things going on, but we've just completed a

five-year plan. we got some funding from the federal government to do a state innovation grant looking at how we could look at how health care's delivered across all systems. it isn't just about medicaid, but medicaid is certainly a large portion of that. so that part of your plan literally just got completed. and the focus of that plan is really about value, paying for value, not for volume. how do we look at the kind of reimbursement systems that are currently going on in our state where most providers are paid fee for service. we don't have a lot of innovative payment structures where folks are paid for outcomes for accountability to really change up the thinking and the conversation, to be much more outcome-driven. we also really looking at the community level, one of the things i think so important in these conversations is what

happens at the community. and so much of the policy in health care tends to be formulated at a state or federal level. but what needs to happen at the community level to really make health care work. so part of this innovation model that we are building, it really empowers the community. so working to look at ways that we are calling what we're calling accountable collaborative health. so at the community level, developing infrastructure where the communities are much more involved in decisions about how health care's delivered, and they're much better linked with the health care delivery system. really starting to focus medicaid differently than it has been in the past, but look at the social determine in a minutes of health. what is the effect of things like housing, employment, income on someone's health and their health outcomes, getting away from talking about health care, but actually talking about health. and we know that if someone doesn't have a roof over their head and they're diabetic, it's going to be very difficult for them to be very successful in their health care if they don't have a place to live. also a key to this five-year

plan is to do better integration with physical health and behavioral health. our system in washington is not well integrated. we have two separate delivery systems for folks that have significant behavioral health needs and for individuals with physical health needs. so, again, how do we bring that system in a way that it's more integrated and, again, engaging communities to help us think that through. in addition to that effort which is really one of our major initiatives right now, we're also in the middle of implementing a dual demonstration. again, we got some funding from cms to develop different ways to provide services to dual-eligibles, so those are folks who have both medicare and medicaid, often some of our highest cost folks. and looking at ways to better serve them so they have better integrated care, better access to care and have delivery systems that, again, can be responsive to their needs. another aspect of that project and other projects, another project we're doing is implementing health homes.

so for some of the highest needs individuals within our delivery systems, so folks that have really significant health issues, that working with them to have a care manager, care coordinator, someone that can work with them that makes sure they get into the services they need, they understand what's available, helping engage them in their own health care, creating health action plans, getting them more involved. but i think, again, the real focus for us is to really move this to the population, think of medicaid as just part -- you know, in a way differently than we have in the past but that really has the health of the community so critical in medicaid right now. >> and let me ask you a follow-on question. provider access is an issue that gets brought up a lot. and what is washington doing to insure that there are an adequate number of primary care providers and specialists? >> so always a challenge, and i think particularly with medicaid.

so a couple things. before the implementation of the affordable care act as we were moving forward, we did some pretty significant survey work of the primary care work force in the state, and for the most part, you know, it looked relatively good. i mean, providers were saying, yes, they were taking new patients. they take medicaid in many areas of the state, but we found certainly this rural areas where that's a problem. it's not just a problem for medicaid, it's a problem for anybody who lives in that community. so having some knowledge about where some of the access points and problems are and, of course, still working to find ways toen gauge more providers -- engage more providers. we have a work force piece that's part of that to see how we can grow the work force. also just, again, in preparation for implementation on the medicaid side we went out and did a reprotourment of -- reprocurement of our managed care programs, brought some new plans into the state, and with a

couple of the plans they actually were able to negotiate and engage providers that haven't been in medicaid before. so growing the number of providers that would actually serve. and that has been, that has certainly been helpful. and also with the accountability with our managed care plans, having the accountability of having an adequate networking. we look to them to be able to have enough providers. providers aren't there in the community, there's not much we can do about that and that's, again, part of ongoing work that we need to do. you know, also there was -- cms granted an increase to primary care providers for 2013 and '14, and for washington that was significant. we had for certain codes we had on the adult side providers that got a 70-90 percent increase in their fees when we went to a medicare fee schedule. so you can see the rates in our state have been relatively low for medicaid. that only lasts two years, and

we'll have the evaluate what the effect of that has been. we're starting to do that now. and then what will happen in 2015 at this point is still unknown. i think the other thing we did is look at what providers could serve our populations, and we had nature paths who are licensed to be primary care providers, we added them to the medicaid enrollment so they can now take medicaid clients which they couldn't before. again, trying to look at both providers making the more accessible and then also looking at from a delivery system perspective who can be a provider and making sure we're engaging anyone who has the license to be primary care or are able to provide services to medicaid clients. again, there's no easy answer. we're still working this one. i think it's one of the major questions we're going to continue to grapple with over the next couple of years, if not longer. >> thanks. that sounds like you are doing

some really innovative things, thank you. and, alan, with the benefit of working with a range of states, are there any particular state programs that you'd like to highlight? >> well, was washington state is doing a little bit of everything, there's not a lot to add to the list. but i think it's important to remember, again, that there are many states that aren't doing everything, but that are doing something. and the tie between those initiatives and medicaid is important. so maryanne already mentioned half the states have state innovation model grants, and they are looking at system transformation. there are two federal demonstration projects around primary care infrastructure, there's the health homes development that she also mentioned. i think the only thing i can think of that budget on maryanne's list is there's a lot of attention now to birth outcomes and, clearly -- i know you're doing it, you just didn't say it. [laughter] but the link there, obviously, to medicaid. you know, arkansas gets a lot of

attention for the private option, but they're also in the middle of of a big payment reform initiative around -- they don't call it bundling, but i think that's the closest single word to describe it. and then tennessee is sort of looking at arkansas, so there's a little spread there. i guess the point i would make rather than list a bunch for more programs is that setting -- it's hard to remember given the political polarization over the affordable care act that the interest in cost containment and moving the health care system more toward value and less toward just spending money on individual services is a broadly understood imperative that is not really partisan. of. ..

i think part of the evolution over time of states is used about the medicaid expansion further after some of its shifting politics, some of it is economics of providers and business interests, said the three reasons we're losing it. ginny described. but part of it is if you have an agenda for improving health system delivery and finance, is medicaid, if you don't use medicaid and i think over time we'll see the same thing about exchanges, as letter points for that transformation, you're not going to be as effective. so to me this is where the pieces all come together.

if you have a broader health system set of goals, the tools of the exchange and medicaid are one that you can't afford to leave behind. and i think that's -- the more states the to the combination of things that maryanne described in washington, the clear i think it's going to be, that you need all of these forces. if you're going to get health care system where you want it to be. >> i think that's a nice segue to the next question i have, started out looking as -- at where states are not and want to talk about where things might be going in the future. alan, i'd like to start with you. you talked about the so-called private option for expanding medicaid. exchange plans or medicaid coverage. what do you think are the long-term implications of that approach? >> well, you know, to me and i realize this may not be a broadly held view, but to me the private option terminology is more a political, ineffective

political communication than it is a substantive matter. because as i said at the outset, the vast majority of you and the vast majority of your states, medicaid enrollees are already in private plans. and so if you do a medicaid expansion it is a private option. whether you are doing it to the medicaid or the exchange infrastructure, it has its pros and cons. but i think it comes together, and again, this ties to the marketing and the system change issue, fundamentally the question is, is the medicaid expansion, as maryanne described, in the continuum of options available to people depending on the resources? is the insurance exchange a place where the transmission that needs to occur in health care takes shape because it's around individual choice and better knowledge and competition and the kinds of forces that

people think can help move the health care system into a more effective place. so what i see is more, over time, more alignment that instead of medicaid being a program, and exchange coverage being a system and private health insurance through your job of being here and medicaid being there, over time we are seeing a lot more blending of these. and to me, that creates opportunities partly on a message side that we get away from this stigma or these black and white decisions, but also for the health care system is going i think it creates opportunities for purchasers and payers to have more leverage. so i think the long-term path here is a positive one. i think the private option, which is where you asked the

question, helps clear the way to breaking down some of these barriers. don't get me wrong. i do have concerns about the erosion of patient protections, if we move too far from the core medicaid model of the base medicare program, particularly -- i used to run medicaid agency in colorado so i'm very attuned to the importance of those protections, but i think the fight over public-private is one that will fade, and what will be more important is whether the people have coverage. >> i want to thank you for bringing up the medicaid reduction because i am at the end going to come back, my next question, is a closing question and want to touch on that. many people assume that in texas we call straight medicaid expansion is not something that's going to work. >> it could work, it just might not happen.

>> are there any types of solutions, anything you see being discussed out of you think has a lot of legs in texas? >> yeah. so again our legislature meets every of your council last year there was lots of proposals on the table. the governor was asking for a block grant to just come that was his solution, you give me the money, no strings attached. i do my plan. that was not acceptable to any of us because we don't trust them with a block grant of money. so the other two major kind of proposals that were being kicked around, one was about co-pays, could get the medicaid expansion population to at least put some skin in the game and pay something. which is loaded of a slippery slope, ma right? how do you know what those co-pays are going to be and if they're going to be affordable. but in our membership, people are willing to pay something. we had one of our members who

sadly found a lump in her breast and couldn't go to the doctor because she had no health insurance gumshoes like i'm willing to pay something. i worked, i just don't have benefits. i'm willing to pay something. i just don't, i can't pay why can't afford. i think co-pay is not an ideal solution but it's definitely something we be willing to live on the table but we have to be careful about not running away with a co-pays and becoming so out of hand. then obviously the private option of using the medicaid expansion money to subsidize folks to buy into the exchanges is definitely something people are willing to leave on the table. so for us it's about the political will and it's about solutions that can work, but with protections that they truly do -- they really are affordable because the folks that are not poor enough to qualify for existing medicaid in texas, yet be extremely low income to qualify for, but don't make

enough with exchanges, those folks in the middle, there has to be some plan and they're willing to put some of that skin in the game but they need to be protected. >> and in washington, as things are changing in other states, does that have any application for you? >> certainly it could. at this point i don't think there having been conversations -- this particular legislative session to look at other options, last year's their certain water conversationally get so many similar programs like other states are proposing. i don't anticipate it, least issue. it could happen in the future. i think a lot of it is depending on watching behaviors of individuals, what the utilization looks like, how the plan gets rolled out, who's involved, who's engaged. so for me it's too early to answer that question. i think it would be something

perhaps a year from now to think about because there were not be this period of time where we can see what's happening, whose enrolling, who's left out, who was not coming into the system and why. and our folks even using the system in a way that is how we would like health care delivery systems to be utilized, folks understanding the delivery system, how they enroll with their primary care provider, how did it again look to achieve better health going and getting their prevented kinds of exams, that kind of thing. these things will make a difference. i think over the years, not for us it's really more about how we get the delivery system up and running and working and making sure that folks can have access they are entitled to and not so much about whether we're going to institute co-pays or things like that. >> one quick question before we bring questions in from the audience.

alan, the role for advocates, and i want to go back to what you talked about medicaid protections. in states that are doing something that is a little bit different in terms of financing and putting people and exchange plans, what do you see the role is for advocates in making sure medicaid stays a program that provides really robust access for people and includes the protections that have made it such a good health care, health insurance program? >> you know, i can't put myself in your shoes because as ginny described, is that the first place i would want to go? know, but if that's the choice between getting people health coverage and not, that's a decision you can make locally based on what you're hearing from your own folks and with the political environment is that you were in. i just don't feel comfortable saying you should draw the line here because you got to draw the line where it fits best for your folks. what i want to caution comment

and i'll keep it quick by want to caution is that i think the more we wall off medicaid and say they're a bunch of protections over your, what we are forgetting is that the world over here is changing. target just announced dropping coverage for part-time workers, and you can say oh, that's terrible, but you can save what, only 10% of the workers even thought that plan was good enough to pay for? maybe we ought to be more worried about protection over here. because it firms up in offering such lousy coverage, that might be a bigger problem than whether we have $5 co-pay for a portion of our medicaid enrollees. so i just think the trick is to look at it as a package, both substantively and politically. and if we draw a line in the sand and say this is the old medicaid program and we're going to fight to the death cannot touch anything in the medicaid program because after all, it was an change in the statute, and the rest of the health care

system falls apart, i don't think we won. we just got to be a little bit more dynamic in our thinking, even though i, as i said, i wouldn't walk away from protections lightly, but you've got to make a judgment call. >> okay. we've got some questions coming up. how does the private option affect the bottom line of private insurers? >> would anyone like to take that one speak with well, i'll just quickly say it really depends, because states have a broad range of approaches they use arrays setting -- ratesetting and medicaid. and states that run their own exchanges have a narrow but i think over time growing range of approaches they take in the scrutiny that they impose on

bids submitted for coverage options within the exchange. the interplay between those two determines the margins that the plans can earn. how competitive the insurance market is also determines how they did and what kinds of margins they will achieve. on not a big fan of getting a whole lot more money to the bottom line of insurance companies to a so-called private option. my only point is that that horse left the barn a long time ago when three quarters of moms and kids and medicaid already enrolled in private plans. so it's not a question of is a good or bad. that battle was fought a long time ago, and i think it's a little bit of a mistake to pretend we're fighting it from the start now when it's really the same story. >> and we have another question here, that i would like to ask you, maryanne. it's a question that i have as

well. newly enrolled beneficiaries, making sure they're getting into the right of benefit options so that medically needy people get into the program that is best for them and have the opportunity going in medicaid. what he doing to make sure that happens? and i know it's only been a couple of weeks but are there any lessons that maybe he of learned, from the past, lessons you learned? >> i think what washington did was i think wise in the decisions we made in outlining the benefits. so whether you're in traditional medicaid or whether you're newly eligible, yet the same benefit design. so there really isn't a choice that you have to make in terms of whether either one pathway or another pathway. i think the issue will become and something we'll have to watch is for the newly eligibles, there's an array of waiver services if they need long-term services and support that they would have to go into traditional medicaid to receive

those. that's something i'd watch because the population that we're seeing in terms of the newly eligible right now aren't really those individuals that are sort of painting going into long-term care, have those long-term care needs of that's something we have to watch. but i think making a decision to have the same identical benefit package has made it much easier so we don't have to do those -- you go down a frail path versus enrolling in the regular program spent and you get the perfect choice to make. alan, you have any thoughts or states you haven't made the same choice, for the benefit package is not the same? there may be advocates in the room. what people should be looking for as the program unfolds and keeping track so that has advocates you to make sure you're getting engaged to make the systems work. >> i think the emerging issues are going to be returned and

renewals, and part of the issue is to make sure that we are ahead of those issues, but again, i mean, the alignment is just the flipside of the protections question, right? because you can't align things that are two different, and so the choice to align means being willing to give up on a little bit of the pressure he might have for a more comprehensive benefit package. i think alignment is a tool for better administration and more effective engagement with the public. i think it's going to end up being a big problem for people. medically, clinically as was financial he. if they're changing in the affordability options change and they don't know what. so those are the places i think we are seeing the leading stakes after they get the operations up and running, that's where they're putting their attention. >> ginny, a question for you. can you give the audience some

information on how to get hold of the univision documentary? with some advocates in florida who would like to show it. i'm sure advocates -- >> good question. we have some dvds perhaps we can mail you. and i really, i would need to communicate -- we don't have a public way for can be downloaded that i know of, but the only thing i could say is go to the texas organizing project website, find me and will get you what you need. because it really is, it was broadcast on kerry member, they put on univision and it went nationally. or you might be able to contact univision spent okay, great. this is for maryanne. what is the recourse for consumers met with major gaps in washington pathfinder plan? >> i had an example.

one family -- health coverage entire costs -- trying to figure out clarification in terms of -- so, so i'm going to answer the question from what i think what the question is, asking about what families can do if they actually are in one of the qualified health plans as opposed to medicaid. so that's a little bit different because of course they have the array of plans they can choose whether bronze, silver, gold. we don't offer any platinum plans in washington. none of the insurance companies took those of. so it's a little challenging because folks are choosing what coverage or what benefits they see as affordable. i know that we've had individuals that have made different choices about, they don't want to be on medicaid even though they're eligible to

be on medicaid and there in that 100-138 -- or 133 where they can choose and still get a tax credit and have made a different choice because they want different options, but it is about individual choice, it is about the planned selection you make and that's the surface package that's available. and i know within the exchange their not the same protections while their benefit design is defined and you all have the same access to the array of essential benefits, what you paid for out of pocket can vary widely today no one here in a bronze plan or a gold blender i'm not sure that answered the question, but it's just a very different when someone has an exchange plan versus medicaid. it's very different. >> let me -- we have another question here on washington state. hhs has given states an option for online community based organizations to provide the best and services recommended by health care providers.

is washington state looking at this option? >> we are looking at it in terms of looking at who can provide those prevention services and get them paid for. so that is something we're looking at. we haven't implemented it yet but we think it is probably a really good idea that we would spread that across the state. that is on the list of many things -- is many things hhs has come out with in the last couple of years getting state options and that's one of the things we're looking at doing. >> okay. what do you think is the role of better utilization of nonphysician resources such as drugstore clinics and nurse practitioners? i'll start with you, mary ann, and then alan, if you have a thought. >> to washington and again, we use nurse practitioners. they are a major part of our

delivery system and in washington they can practice independently, unlike some states would have to be affiliated with a physician to our nurse practitioners can practice independently. so they are a major part of our delivery system and we use them in many of our clinics, pediatric care, behavioral health care already had as provided by nurse practitioners. they are a mainstay in our delivery system. in terms of things like drugstore clinics that's an interesting question because when we think about people going to the emergency room when they don't need to edit look at some other alternative, i would be even less costly to them or to the system. we think those might be good ideas. however, the one qualifier i would say is the whole continuity of care peace and people, we want people link to primary care provider. we want them to have someone who can provide that continuity. who knows their health care needs? so if you have the electronic health records could give ways of connecting to someone at 8:00

at night in a drugstore clinics because of strep throat, is probably a fairly good utilization of the system but to make sure the primary care provider that next day here's about it, knows how to follow up with that individual and again, having a more systemic look at the delivery system and not having a one off where people can go to but as long as the symptoms -- systems dr. ochoa, and maybe every efficient and effective way to deliver urgent care. >> you want to add anything speak was i want to say as part of the payment reform discussions that are underway in the country at the national level as well as in many states, there is an effort to move away from paying for each intervention or interaction with the health care system to broader payments for systems of care. and one of the hopes of those

changes is at the system level, you start realizing that there are providers, or even activities outside the traditional health care system, social services and the like, but relatively modest payments are lower payments for clinical services can yield very positive health outcomes. the idea here is to facilitate this shift, its gradual, but towards more systematic case of looking at care, which then creates more room for the examples the question asked. telemedicine can run into lots of barriers, sort of more social intervention, and it's an evolution process but i think it's going on around. >> we only have a couple of minutes left so i want to wrap up with continuing the last question that i had from what i prepared for, alan, on the role

of advocates and if you answer that really will and very much appreciated. i was going to use your term and i said i don't want to say long haul but you -- >> it is a long haul. >> if for advocates were in a state like texas, any particular words of advice, words of encouragement that you could give? >> well, i would just say dig in, because it is a long haul so be prepared that you need to become is going to jump in, don't come i you know, don't pretend that you're going to be out of this quickly. so dig in and be prepared for the long haul. and then i would say, look for the opportunities along the way, and search yourself and get some short-term victories and some tangible results to keep the momentum and keep the energy, and keep folks moving. localize it because people need to be able to work on something that they can touch and feel in their own communities. and for us, and i would advise

others, don't be afraid to connect to the importance of voting. we cannot pretend that these decision would not be different if the political leadership was different. and so we have -- you are able to tell people you are so-and-so's position on medicaid expansion, hear so-and-so's position. do whatever you want but don't forget to vote. something people really have to be willing to roll up their sleeves, work for the long-term, make it local, and don't be afraid to connect it to fund because it is absolutely critical. >> maryanne, and states that have expand, how advocates can work with the medicaid department and make expansion a success. >> absolutely invaluable to us. they have helped us along the way. they been helpful with the legislature. they been helpful just in terms of setting up our own program. how do we do outreach? how do we get the training?

what you are materials look like? just been able to be there with us along the way and i would say on so many occasions, just things like constructing forms can things that will be sent out to our members. they have been really critical in making sure that that communication is going out in a way that user from and helpful. they have just been -- just again been out there in terms of willing to be trained, the that linkage with individuals having difficulty, arranging services, just being part of the whole delivery system. so i think that, again, in our state we couldn't, i don't think we would've been as successful as we have been without those partnerships, the community based organizations, with other advocacy folks. the other thing they really have been extremely helpful with, even in last few weeks, they are the eyes and ears. they hear things before we do. they can let us know. which they have. of problems long before might hear of them otherwise.

so that partnership is extremely critical in the success of the accommodation. >> coming up live on c-span todac-span2today we'll hear fros newest commissioner michael o'reilly will begin his first public speech as commissioner at the hudson institute this afternoon. that is live at noon eastern right here on c-span2. congress is back today after a week away, a short week this week for house lawmakers. republicans will be leaving washington wednesday for their annual party retreat. the house does have votes counted for 630 eastern today. a bill that would ban several funding for abortions. you can see the house live on c-span. the senate is back today at 2 p.m. eastern. they will consider flood insurance legislation. the bill would delay the scheduled premium rate increases. the procedural vote later today for 5:30 p.m. eastern. you can see the senate live here on c-span2. some news today, u.s. congressman of florida will

resign, this coming after the representative pleaded guilty last november to cocaine possession and was sentenced to a year of probation. in addition to his retirement, 30 current members of the u.s. house, 19 republicans and 11 democrats have announced they will not seek reelection in 2014, or they are running for other posts including the u.s. senate and governor. in the senate eight lawmakers are not running for reelection, five democrats and three republicans. on our facebook page today, we posted a poll asking whether or not you think hillary clinton should run for president in 2016. so far over 1100 of you have voted in the pulpit of those 457 are saying yes, she should run, 670 say no. also over 700 comments have been posted and among them, jennifer lee says hillary has my support in whatever decision she makes but if she does decide to run i hope it run i hope it is a to do so will be based on having something to offer our country, not unfeeling she is the parties

on how to win. also, doesn't the u.s. have anything better than this? when w. is becoming to family dynasty? how about no to bush and no to clinton? you can join in the conversation at facebook.com/cspan. >> bill and hillary, bill came right up to graduate from jail machinations any three and hillary came a year later. element claims group again right inside this building, the leflar law center where she was a professor and she taught classes such as criminal law, procedures, trial procedure and the prison project. >> hillary was well educated, ivy league law school grad that had worked in d.c. as part of the nixon campaign because at the time nixon had been impeached about two weeks before hillary sought her first class. >> first lady hillary clinton tonight at nine eastern live on c-span and c-span3.

also on c-span radio and c-span.org. >> as we stabilize the financial system, we also took steps to get our economy growing again. say as many jobs as possible and help americans who have become unemployed. that's what we extended our increase unemployment benefits for more than 18 million americans to make health insurance 65% cheaper for families to get their coverage through cobra. and passed 25 different tax cuts. let me repeat, we cut taxes. we cut taxes 4905% of working families. we cut taxes for small businesses. [applause] we cut taxes for first time home buyers. we cut taxes for parents trying to care for their children. we cut taxes for 8 million americans hang for college. >> watch president obama delivered this year's address. our preview program starts live

tuesday night at eight eastern with the president at nine. your reaction by phone, facebook and twitter. the state of the union tuesday night live on c-span, c-span radio and c-span.org. >> president of on your senior r advisor north korea said there are no indications of progress in relationship with the north. but the regime of kim jong-un has not gained anything after issues of provocations by the regime. this is about half an hour. >> [inaudible conversations]

>> thank you for joining us for the second part of a program today where we are very happy to have with us doctor sid siler. he is a good friend both personal and an academic college. and i want to properly introduce him for all of our guests here because he doesn't get out much last night in his line of work. he is the director for korea and the white house national security council. he is one of the most authoritative experts on korea on both koreas in the current administration. for the past 30 years he has worked in multiple intelligence disciplines including the

national security agency, the director of intelligence, director of operations in the cia and the foreign broadcast information service. he spent 12 of those years in south korea. previously served as deputy director of national intelligence manager for north korea, having joined the service when it was established in january 2006. prior to the dni, he served with the national contest in service of the cia. he's the author of a very good book, kim il-sung, the creation of a legend, the building of regime. i read that book doing the research for doing my own book and site it quite bit in that book. he received his in a from graduate school of international studies. is a graduate of korean link which program at young state university and did his undergraduate at the university of maryland. sid, it's a pleasure to have you

with us today. we will proceed as follows. he will have some comments to start a soft and then we'll have a bit of discussion and then we'll open it just for a couple of questions, in spite of the terrible weather while the rest of us will be going home after this, he goes back to work. he has a full day. sid, over to you. >> thank you for that kind introduction, victor. i thought i would take an opportunity to build some of the excellent discussions we had this morning to kind of look at the alliance going forward within context of largely to broad areas. first of all, what we see with the evolving north korea threat come implications for the alliance in the next 60 years, and what we've already begun to do to meet that threat, to deal with the threat and to lay a course for future cooperation to build upon the great work that

these three former commanders of u.s. forces korea, combatant commanders talked about. you know, the last five years have witnessed i think a sea change in the environment on the korea peninsula. it overlapped with the administration of president obama. it overlaps with appeared of one would say since we last had a meaningful six-party talks discussion. and i think it reflects a transmission of north korea that had been -- came about both in terms of capabilities and clarity of intentions. it's important to remember in january of 2009 when president obama was inaugurated with an offer to raise out a hand to those who would then clench their fists, that north koreans shortly thereafter responded by

making preparation for a missile test, that would lead to a presidential statement out of the united nations to get accounts which itself within lead to north korea's second nuclear test. the first one having been in 2006. and after the diplomatic dust settled and special representative steve bosworth went to pyongyang in december 2009, in 2010 north korea turned its attention towards the republic of korea, towards the south. and in 2010, as everybody removed from we had the sinking of the rok -- in march and, of course, the shelling of the island literally under one hour after i had flown over it with ambassador bosworth on which to china to talk about the north revelation of its uranium enrichment program. in three lessons really emerge on these two years.

first of all, on the security side, when you think about the events nuclear test, missile launch, thinking of a rok navy gaza, showing of an island, the u.s.-rok alliance demonstrated its resilience and grew stronger, deterrence was secure. deterrence was secure. and in the process, koreans, south koreans and people in the region were reassured in large part because the strength of the u.s.-rok relationship, seoul washington cooperation responding to the events. and the lessons on the diplomacy side just began to emerge, for the first time in many years the traditional cycle of provoked rush back to the table, provoked, gain concessions from denuclearization dialogue to give the appearance of for progress but in retrospect it was only an appearance, that

cycle was broken. pyongyang was taught in the 2009-2010 period that it will receive nothing from threats and provocations, only further diplomatic and economic isolation is separate to drive a wedge between seoul and washington. its effort to influence internal politics and the republic of korea. its effort to weaken the republic of korea's north korea strategy all failed. north korea began to learn that it's bad it will no longer be rewarded. at 60 years old, the outlines simply was too smart, too wise for that. the third lesson though i've like to take away and can focus on this because what it says about the threat was the analytical lessons. here i can risk taking off my current policymaker had going back to my old analyst days, but there's three real significant

lessons learned from these events that i think will have implications for years to come. first of all with a may 25 nuclear test north korea's -- second nuclear test, close the book on the question does north korea really intend to acquire a nuclear weapons capability, or is it simply pursuing nuclear capabilities to gain the attention of the united states in the world in order to engage in the dialog? nobody realistically after the second nuclear test believed that the north korea nuclear program was nothing more than a negotiating ploy, and negotiating card. the questions of north korea's intent in that regard were largely answered. the second analytical lesson was really seen as a launch. this is really -- we see it now but a number of other launches since then, an indication that north korea had intended to pursue and improve an icbm

capability. and ability to take whatever device they are essential able to build and deliver it to the united states. and, of course, to do so under the cover of satellite launches. the repeated attempts try to check the so-called boxes in what they claim to be a peaceful, legitimate, sovereign right of -- and finally the pyongyang island incident both demonstrated that north korea intended to continue to use provocations, genetic and even at times lethal as coercive diplomatic tool. of intimidation and violence. and as general sharp and later general thurman had to come to grips with this, counter provocation challenge, it had a

profound impact on the alliance as well as none of these three conclusions were particularly new or surprising. many analysts had long said north korea was not getting what said it was pursuing a nuclear capability that it was intended to be the delivery mechanism for the north korea's provocations were nothing new to anybody who has watched this for 60 years. but i do believe that the clarity with which they have now become the defining element of the north korea threat, the conventional threat is still there. the possibility of unification, all remain there on the table. but what we're seeing is an evolution on the capabilities, new intentions that the alliance would have to respond to. go through these one by one in reverse order. first in terms of provocation, the two of course of diplomacy. this really demonstrated first

of all the importance of solid deterrence to deter these types of action, but perhaps even equally so, post integrated real-time u.s.-rok cooperation. i really like what general pilelli mentioned earlier in the challenge of gaining a shared situation of awareness of any two or three people gathered in a room watching a single event have different ways in which they perceive it, how much even more so when you have two large countries, even as integrated as we're looking at develop within the country as opaque as north korea coming to a shared understanding, a shared assessment and a shared conclusion of how to respond. the incidence of 2010 really emphasized for the alliance and this is the the context in which we pursued the counter provocation plan. which in march 2013 was brought to a conclusion.

here we have the two sides, mechanisms in place, capabilities in place, and more important, ongoing planning that gives us, you know, an extra advantage, a multiplier to have the experience on the ground with north korea for not 60 years in armistice but the experience working together to respond to such type of provocation where north korea's intent is provoked and our intent is to respond. accordingly. u.s. commitment here i should add can never be any more clear. there will be significant costs to future provocations by north korea. pyongyang has a choice again to pursue this path and encounter greater isolation and crippling economic vibration, or take a

new path and find a true chance for peace, development and global integration. the evolving missile threat is another area on which the alliance's had to work together more closely to counter a threat that i remember when i first went to korea in 1982. it was three rockets over ground. i remember we used to say jokingly we all were hoping that we were the target of three rockets because their accuracy was so poor you would be certain not to be hit. kind of a flippant way but that's what privates talk about when they're young and inexperienced. at the emerging north korea missile threat is real. general thurman mentioned and long-range artillery which is also always been an existing threat to the seoul metropolitan area with north korea's pursuit of nuclear missile capability to even larger numbers come under threat. this was the context in which the alliance that this challenge with a revision to the new missile guidelines.

in 2012 we came to an agreement we now call the revised missile guidelines which allowed the rok to develop new ballistic missiles up to 800 kilometers in range. it committed to improved intelligence, surveillance and reconnaissance capabilities so if your going to shoot at a target you've got to know what it is and what it is. it included enhancements to our working together, command-and-control, so that when we face a situation which we have to use these capabilities to do so delivery and smartly. we are developing and we will continue to develop a comprehensive alliance approach to the north korea missile threat. this is crucial. given its evolution. and then finally on the nuclear side, i think there's -- ic for overlapping yet reinforcing lines of efforts, how we deal with this north korea's nuclear capability.

the first is the nine. denying pyongyang the benefit to build nuclear coercion. i think the most immediate threat that we face obviously is on any given day a north korea provocation would be some type of asymmetrical provocation or conventional provocation, always has in the background that concern, that there. north korea knows that, and the way to stand up to the bully on the playground who has this capability, alleged capability in his back pocket, is to have transparent and seamless coordination like we do with the u.s.-rok alliance. real-time, close coif version so that when we get into this period, any period of heightened tensions, there's no splitting of the alliance. we do with it smartly and the value to pyongyang of this nuclear coercion is strongly diminished. firm but calm responses. remember the words provoke is -- it means to elicit the desired

response from their counterparts. the best way to deny north korea the value of provocation is to not respond in a matter that they're hoping to get you to respond and. that's where close u.s. and rok cooperation at all periods of the propagation cycle is so crucial to note rewarding bad behavior. we talked about it earlier so i won't dwell on it but don't underestimate the value of even these diplomatic areas of having strong value in countering the north korean nuclear deterrent. and then finally to inflict political and economic costs on north korea to refusing to denuclearize. it takes away -- some friends of mine when we get into discussions, frank discussions, they say art we in essence, you know, being outfoxed and outmaneuvered by north korea? and i would just say, well, nuclear and missile capabilities

aside, look at the diplomatic isolation. look at the economic isolation. look at the number of countries who joined in condemnation of the third nuclear test. look at the support we get and the u.n. security council after each and every missile launch, each and every nuclear test, resolution after resolution. so in addition to the dying and disrupting, when it comes to disrupting the progress of the north nuclear program to train it uses a range of sanctions. these sanctions target north korean wmd keys and they're designed to curtail profit from weapons exports and access to critical technologies and components abroad. and have the effect of slowing the growth of the program. they will continue to be critical in npd both the qualitative and quantitative growth of these capabilities that north korea seeks. deterring, deterring is another way we counter this capability. we talked briefly in the last

session about tailored deterrence strategy and importance of extending deterrence. i quote from the communicate for the 44th held in october where secretary hagel rake from the continued u.s. commitment to provide and strengthen extended deterrence for the republic of korea. using the full range of military capabilities including the u.s. nuclear umbrella, conventional strikes and missile defense capabilities. these two phrases to focus on. full range and united states. full range, united states but i don't think there's much more to say as far as deterrence. you will get no better guarantee that we are prepared to meet the threat posed by north korea, it's evolving nuclear missile capabilities, then what is represented by the wording indicators deterrence strategy what is represented by, full range, united states capabilities. and then finally our fourth

element of our efforts against the north korea nuclear program are what we do in the denuclearization diplomacy realm. we in our pursuit of denuclearization under the six-party talks umbrella, in other words, all the diplomacy we do with people's republic of china, with russia, japan, republic of korea, all in accordance with the principles and spirit of september 19, 2005 statement, work to negate, reduce and deter the north korean nuclear threat. our work with china in particular has demonstrated that it as well as all five, all of the other four parties, three parties, subtracting north korea, all of us are opposed to nuclear north korea. all of us are committed to denuclearization on the peninsula. multilateral diplomacy is still the strong consensus and will continue to do so going forward. life for north korea will not be

easier as it tries to pursue its so-called policies come its policy of pursuing in tandem of economic develop and and expansion of its nuclear forces. my colleague, glyn davies, during one of our recent trips to the region called pyongyang a dating and i would like to reinforce that today. north korea is learning from the united states, republic of korea and, indeed, the entire diplomatic international community that it will not have its cake and eat it too. so best broadly the way we are dealing i think within the context of the united states rok relationship come with the new threats that we are facing with north korea, north korea will continue to test us. north korea will continue to push the limits. a lot of these cycles we go in and out of these so-called provocation cycles. we've seen them before, and as i

mentioned to a few of you during the break, it is not a trivial throw away talking point that we use when we say we won't judge north korea by its action. and not by its words. when we do so and we and we continue to the close cooperation we demonstrated through these last five years as north korea's program has developed and behavior has been, you know, so unpredictable, is that a strong u.s.-rok alliance continues to be the best deterrent to the threat that is going imposed by the north but and without i think maybe some questions. >> thank you. thank you very much. we have a few minutes for questions. let me start us off before going to the audience, syd. i don't think there's any argument that sort of in this administration you are the guy. the guy who knows most about north korea. the past five years you've been sort of doing it at the higher

policy level making. i'd like to ask you to put your analyst hat on, and what come to the extent you can in this audience, what you think is going on there now with all the internal churn and the own goal -- uncle. what is going on there? is this a path to stability or is it a path to instability? >> well, victor, if the social sciences, politics, economics formulations, international relations could be that good at predictive analysis, we would all be rich on the stock market because we have a much more peaceful world. let me talk -- since kim jong-un came in to take his position, that is from his father's death two years ago, i urge people to look at the continuity in north

korean behavior, particularly strategic continuity. sure, there's -- north korea has always employed the element of surprise in its actions and behavior and, therefore, you could all most say north korea as always is predictably unpredictable. but at the same time there's no particular element of north korea's behavior that are entirely out of character with the historical precedent so that there's nuanced differences, there might be some differences in style. one person might joint editorials. one person might join new year's speeches, but in general there is, regardless of what's going on in north korea there's nothing there that has a significant impact as far as a critical issue. as far as denuclearization but if you look at where north korea

is today on its denuclearization policy, it's consistent with what i call the strategic arc of the longer-term goal here and there longer-term goals were actually clarified in the proclamation of the policy last year. we always knew that north korea eventually was hoping that the world would just simply be worn out, acknowledge, tolerate to just learn to live with a nuclear north korea, and then it could begin to recover, its economy, restore some type of relations with the outside. in other words, have their weapons and other economic development. that's been a longer-term goal and he makes it clear anything going forward one would imagine that is what kim jong-un is shooting for as well. so redevelopment, you know, speculating on those, i don't know it would be particularly helpful, particularly when we get into intelligence matters relatively quickly, what is clear is that we see no policy changes so far. we see no policy changes.

we would love to see policy changes but we haven't seen any yet. >> speaking of policy, how do you think we're doing with china right now? >> well, you know, i think we've had some good cooperation with china. we have senior level interaction with the chinese of both sunnylands and st. petersburg last year. the vice president headed towards the end of the year. and china has made it repeatedly clear that it supports the utilization of the korean peninsula, that it supports real negotiations that get us to denuclearization. they see that the actions that north korea takes are destabilizing to the region, are not in their own best interest as we been able to make progress with the people's republic of china. we go, glenn davis and i go out with our counterparts, there was a shared understanding of the

challenge posed by north korea, a shared understanding of the urgency of the issue. so i think we have laid the foundation for cooperation going forward. i know that, you know, people might say that we, you know, that the united states expects too much out of china. and i can just say that we look forward to cooperating and working with china, but at the same time, you know, we know that we will have to continue as we have over the past several years to take action, and our defense and in the defense of our allies like the republican agree in response to the growing north korea nuclear threats. >> i know you don't have a lot of time so will open up, just take a couple of questions from the floor. yes. >> hi. i'm at phoenix tv. just today, china and rok

announced to you defense hotline as soon as possible. i'm just curious, how does the u.s. and the white house see this latest development? thank you spent announced what? >> china rok hotline. >> we certainly encourage cooperation and communication between all the parties in the region but anything that contributes to the reduction of tension. and ability to have that type of transparency, ready communication necessary to respond to the various contingencies in the region. it's positive. no reason not to be positive about that. >> is there any plan for u.s. government -- sundeck north

korea in the near future? and then, there are some indications under the table within the united states and north korea over -- [inaudible] can you explain what is the condition from the north korean government? >> that's a great question. you should be asking probably to the north koreans though at this point. let me just sum to say this. the united states has made significant effort, united states government has made a significant effort over the past year sense kenneth bae was detained, convicted and imprisoned in north korea. we have made a number of efforts, sustained efforts for his release, and as you know we have sought to have our special envoy for human rights, robert

king, travel to pyongyang so we can go in and secure kenneth bae's release. the north koreans have not been responsive to those appeals over the course of the year. we continue to ask north korea for their part in of kenneth bae and will continue to work for a. i think anything beyond that, you know, we have to wait and see. the challenge, you know, with north korea always is, you know, when they publicly articulate a desire for dialogue and yet, you know, trying to sit down and have a conversation, a meaningful conversation can at times be quite elusive.

>> you talked about the shares understanding with china about north korea, and what is -- [inaudible] shared understanding with china, the current unity or -- [inaudible] regime's development? that's my question. >> you know, when i spoke about shared understanding, i was talking primarily about the policy goals of establishing a

denuclearized korean peninsula that's marked by peace and stability and, hopefully, one day prosperity for the people of north korea when they choose the right path. the correct path. of denuclearization, integration into the international community. not necessarily that, you know, we have a shared intelligence assessment of the situation in north korea, but, you know, that shared policy goal, that shared outlook for the future of the korean peninsula, that shared emphasis on denuclearization is the basis upon which we can have a dialogue going forward, and we can begin to work very closely on this difficult issue. >> sid, i personally know how many hours you put in in this job and how hard you work, and i want to thank you for taking the time to come out and join us today in spite of the elements. and i wish you well. thanks again. >> thank you, victor. [applause]

[inaudible conversations] >> and a live picture from the hudson institute here in washington, d.c. where shortly we will hear from the fcc's newest commissioner, michael o'reilly. he'll be giving his first public speech as commissioner. it's expected to get under way in about ten minutes or so. we'll have live coverage as soon as it starts. while we wait, show you a conversation with a journalist this morning on the chances of hillary clinton running for president. >> host: is there a planet hillary? maybe so, according to "the new york times" magazine's cover story out this sunday.lary this morning we're going the talk to the author, that's amy, she's a political reporter for "the new york times."ho hey, amy, thanks for being withr us this morning. >> guest: hi, thanks for having me. >> host: we're going to go back" to this coverage in just a second, but if you could just walk us through your story and tell us what you found about tho

so-called clinton universe. >> guest: bill clinton in particular has been collecting people since kindergarten, and they all want to be heard, and they all have an interest in getting hillary clinton elected. in 2008 we saw that that led to a lot of voices, a lot of of cooks in the kitchen, chaos. so can you align all of these people while bringing in new people and making sure chaos doesn't ensue. >> host: amy, you mentioned bill clinton. what's his role here, and are there concerns about his legacy if his wife does, in fact, embark on another presidential bid? >> guest: right. people i spoke to said he's differential, he, you know, defers to what she wants to do. but, of course, he knows exactly what a loss would do to not just his wife and his family, but his own legacy, his people around him are very concerned right now with his legacy building.

that's part of his philanthropic work, that's part of him talking about the '90s and his record. and so i think he is very aware of that. at the same time, i think he's also very interested. i heard that ready for hillary, a super pac, you know, building up grassroots support for hillary clinton's candidacy was holding an event in new york, and bill clinton called one of the people attending to check in on things and see who was there and how it was going. so he's definitely feeling things out. >> host: we're talking with amy chozick of the new york times. amy, wanted to ask you about that cover. walk us through, how did that come about? >> guest: well, as you probably know, i write the words. i don't have anything to do with the cover, but, you know, from what i have heard from our art director, i've always described the story as sort of hillary clinton's universe. and if you'll read the story, there is a reference, one of her inner circle people describes sort of the old-timers who want to help to the movie space cowboys when clint eastwood and others go to save the world.

so i think there was always sort of like a space theme when we were talking about that, and that may have been how it came about. but i definitely -- i didn't see it until a couple days before the story ran, and i knew it would spark some attention. >> host: yeah, there's certainly been a lot of of conversation about that. one of the things that was most interesting to me is this idea who makes up hillary clinton's innermost circle, and are those old guard be people that she and her husband have known for years, or are there some new faces there? >> guest: yeah, hillary has inspired loyalty. maggie williams, cheryl mills, hugh ma ab dean, these are all people who worked in the white house. they're not necessarily on the aroll, but they are her -- payroll, they are her closest advisers, people who give her advice. and she's brought in new people, and i think that might be a promising sign in how a 2016 campaign would function. she's brought this people from

the state department like tom new yorks, jake absolutely -- tom knews, jake sullivan who works for biden now. it's sort of a mix, but i would say it's still made up of those core group of people that we heard about in the white house. >> host: one of the big questions if hillary clinton does, n., run is just how much help can she get from president barack obama's operation, the one that toppled her in 2008. what's your take? >> guest: yeah. i mean, so priorities usa, the pac, has already brought in jim messina and said it's going to work towards getting clinton elected. i think that they are going to bring in some obama people, but people i talked to said, you know, they don't even need that. they need the next david plouffe who's the 30-year-old david plouffe. campaigns will be waged in an even different, more data-driven, advanced way and they find that new generation. because if you remember, you know, they sort of snapped everyone up in 2008, and axlerod

described putting together obama's team as oceans 11, you know? they kind of picked the star guys who weren't already working on clinton's campaign, and it worked out, obviously, amazingly for them. so i think that is the challenge, go find that new generation. >> host: sure. talk to us a little bit about the reporting process. this is, obviously, a very lengthy story with a lot of sourcing. how much access did you get to it? >> guest: it was. they gave me pretty much access to her, you know, close advisers to talk about this concept of loyalty and why they had worked for the clintons or secretary clinton for so long. i also talked to some of the new people. i think that was something, you know, they wanted me to have that perspective from some people from state. i mean, something that they were happy to give me access to because they want this narrative out is that state department was run nothing like 2008, you know? 2008 was chaos, there was a lack of management, and the state department was not like that. so i definitely talked to a lot of people along those lines. and then there was, you know,

sort of interesting parts of the reporting process of going to arkansas, and i talked to a lot of their friends who have known them, you know, since the days before they were so rich and famous be and powerful. and so that was really interesting as well. >> host: amy, i want to ask you about something you mentioned earlier, the idea that in 2016 there will be these coders, and i think you called them code-breaking hackers in your piece. do those people exist in the clinton orbit now, or are those new faces we're likely to see merge the she does, in fact, run? >> guest: i think those are new faces. one interesting element, and chelsea clinton is not, you know, she's mostly running the foundation now. i won't say she has any kind of political role, although she, to me, seems like she could with be an interesting merging of old and new guards. she comes from this mackenzie consulting ap political background, so i sort of wondered if she would eventually emerge in some kind of role that would know how to find them

because she does have that sort of business, hedge fund consulting background. >> host: sure. also wanted to ask you the secretary has said, you know, she's months away from deciding about her political future. any idea of what that timetable actually looks like? >> guest: yeah. that's a good question. this is like a science of analyzing everything that she says along those lines. i heard that she had said in a private speech with a hedge fund in new york last year, the question was a good one, they said so if there was, if someone was to run for president, logistically how would it work, when would they need to decide, and she had said that person hypothetically would need to decide by the middle of 2014. so, you know, we'll be watching that carefully. >> host: we've been talking with amy chozick, the author of the piece on the cover of this week's new york times magazine. thank you so much for being with us this morning. >> and quickly, we have a facebook page set up to get your reaction to hillary clinton

possibly running in 2016. go to facebook.com/c-span. remarks now from new fcc commissioner michael o'reilly. this is just getting under way live here on c-span2. >> online audience from c-span, welcome to the hudson institute. if you have questions for our speaker today, please send them via twitter to @hudsoninstitute, and we will be incorporating those questions with other questions from our audience. it's my great pleasure and honor to introduce commissioner michael o'reilly today. you can find his formal biography at the federal communications commission web site. i will give you the informal biography which is that commissioner o'reilly and i were staff members together at the house commerce committee nearly 20 years ago, longer than either

of us probably cares to remember. and we both had the great privilege of working on the telecommunications act of 1996 for chairman tom bliley. i've known commissioner o'reilly for many years, and there are two salient characteristics about him. one is integrity. he is an extremely honest fellow and is known more that. and the other is extremely good judgment and discretion. and those characteristics have served him well over the past 18 years as a staff member on capitol hill which, capitol hill is an extraordinarily long career.

and his bosses in the house and in the senate have valued both his integrity and his judgment over the years, and i think those are extraordinarily good characteristics to have as a new commissioner of the federal communications commission. i also want to congratulate commissioner o'reilly. on his recently announced engagement. please welcome commissioner o'rielly. [applause] >> let me begin by thanking my good friend and former colleague harold furchtgott-roth. as harold mentioned, we worked together helping to craft the bipartisan telecommunications act of 1996. he went on to serve with distinction as a commissioner to the federal communications

commission, and other the years he's been a thoughtful adviser to me on many issues. i also want to thank the hudson institute and its exceptional scholars and work including my friend ask predecessor, former fcc commissioner rob mcdowell. as has been previously mentioned, i am the newest fcc commissioner. i was fortunate enough to be confirmed alongside our new chairman, tom wheeler. we have become known for competition and freedom. the chairman has, on a number of cases, articulated what he means by his term. today i would like to explain more about what i mean by mine. i wring to this position -- bring to this position a core belief that the most enduring value of america is freedom. our nation began with the desire to be free from the paternalistic monarchy in britain. to preserve these freedoms, our

forefathers 'em wedded into the constitution -- embedded into the constitution certain protections that the government does not abuse its power or harmfully restrict individual liberty. these principles of a free society such as freedom of speech, religion, assembly and so forth are also inherent in the concepts of free markets. from which we form the basis of our economy. if our system of free -- in our system of free enterprise, we hold the belief that consumers and businesses should be able to freely buy and sell without needing the permission of government and with minimal restrictions placed on business activity or asset ownership. to illustrate why this economic freedom so important, let me relate a story from my youth. one hot summer day near buffalo, new york -- it actually does happen -- my younger brother, a good friend and i decided to start selling delicious lemonade to thirsty consumers. to be clear, this wasn't your cute, adorable kids sitting on the front lawn selling juice. instead, it was a brash effort to make real money. the three of us did what every

good business does; we obtained necessary beverage supplies, designed and built a mobile stand and did market research. we even reimbursed our capital provider, my dad. at our major rollout, we hit the town's annual tennis tournament because who doesn't like a cold link after completing a tough three-setter? initial success prompted us to think about what to do with our many millions. but it just so happens this that the vast number of tennis courts were in parks owned by the city. our prime location was the local high school, also owned by the city. it bunt long before we hit -- wasn't long before we hit a nerve. by the second weekend of the tournament a local official informed us we couldn't occupy the location right next to the tennis courts and the planetarium. the world was deprived of our refreshing product. admittedly, we were kids, and i was able to focus on a aper route instead, but -- paper route instead, but this is lost

opportunity that occurs when the government restricts entrepreneurs. there was a loss to the would-be seller, buyer and society as a whole. as a staffer on capitol hill, i saw the same theme play out time and time again in a setting with far more serious consequences. the most absurd example that comes to mind was back in 1996 when the fda tried to tell sonny cloud, a single mother in atlanta, georgia, that she couldn't market at-home drug testing kits. these were the exact be same kits that were available to employers. the fda's rationale? the belief that parents may not react appropriately if their children tested positive for drugs. until public and congressional outreach ended this rule, the federal agency was allowed to target a small business that was trying to empower parents. who knows how many young people have been saved from a life of drug addiction due to early detection through the use of these home tests which are still available. more often, however, such

constraints are more subtle and difficult to spot. take, prescription, the failed merger of blockbuster and hollywood video back in 2005. after the federal trade commission signaled a likely rejection, the companies abandoned the deal. about that time regulators were concerned about the anticompetitive effects of one company having a significant percentage of the home video market. but they failed to account for the rise of videos delivered true vending machines, mail and internet streaming such as netflix. both block buster and hollywood video declared bankruptcy in 2010. who knows how much longer a combined entity could have lasted or if their combined assets would have allowed it to innovate and better adapt to the changing market. policymakers in washington, d.c. should be constantly on guard against unnecessary restrictions that interfere with the freedoms of any willing buyer or seller in our economy because, just like the examples i provided, we

have no idea what type of products or services our regulations may discourage from coming to market. championing economic freedom will be my guiding principle when it comes to overseeing the communications industry. to inform my decisions, i will consider the following: first, the commission must consider whether it has the authority to regulate as well as realizing the confines of that authority. there is no place in the rules for policies, even ones that are well meaning, that have no basis in the statute. the commission exists to implement the statute, no less and certainly no more. second, the commission must have verifiable and specific evidence that there is market failure before acting. in many cases competition and industry self-regulation are sufficient to insure that services are provided and consumers are protected, and it should only regulate when there's evidence, bona fide data, that an actual problem exists resulting in real harm to

consumers that the commission can solve. third, when the commission does intervene, its solution should be carefully tailored and apply only to the relevant set of providers or services. we must guard against overregulating by analogy. fourth, the benefit of regulation must outweigh the burdens. even when rules are grounded in the statute, based on evidence, addressing a real harm and targeted at a specific problem, there is still a cost to implement through intervening, and they must consider those costs as part of our analysis. let's accept the reality that costs are always passed on to consumers in one way or another. we often hear it said that the commission's rules have not kept changes with the marketplace, and that is true. the communications sector is in the midst of a digital revolution. companies are innovating and thriving. they are investing billions each year in new networks and technologies, and consumers are benefiting from a vast array of services and products not

imagined years ago. but while some advocate for automatically applying antiquated rules to new, cutting-edge technologies, i do not believe that legacy rules or constructs are entitled to live on after their usefulness. when it comes to encouraging competition and consumer choice, i start from the premise that removing regulation where it is not needed will better serve these goals. to insure that participants in the communication marketplace are as free as possible to meet consumer demand, i believe the commission must periodically re-examine its rules and the justifications that underlie those rules. over time those justifications may have eroded or changed. that is why i will consistently advocate for sunset provisions to force the commission to make sure our rules are sill relevant. -- still relevant. now, you may be wondering how does this apply to specific be communications issue is. -- issues. let me share my thoughts. i'll begin with a topic that is

not only of immediate importance, but also a longstanding interest of mine, ip transitions. our nation's quickly moving from analog pots, plain old telephone service, to voiceover internet protocol. we're also relying more and more on wireless voice, texting and broadband. as we leave the traditional telephone network behind, there are some unanswered questions about the potential implications of an all-ip world. the commission is poised to embark on ip trials to help answer some of these questions. when it comes to ip transitions, i believe the commission must insure that its policies and regulations do not impede this innovation so that providers are free to implement the latest technologies and services. when it comes to governing the forthcoming ip trials specifically, i suggest the following criteria. first, any trial should not interfere with choices consumers are already making every day to go with ip services. let me give you an idea of the magnitude of these choices.

by the end of 2008 when the commission began certain tracking of residential voip connections, subscribers already had 20% of the residential wire line market. just four years later that figure grew to over 34 million representing over 43%. web growth is even more notable when you consider that total wire line connections went down by over 24 million during that same period. in other words, the ip transitions are well underway x the commission should not allow these trials to obstruct industry innovation or consumer adoption. second, trials should not delay the commission's work. the trials won't resolve many important legal and policy issues. therefore, they should not serve as an excuse for delaying appropriate decisions. separate from the trials, i doubt that many of the old rules will be necessary going forward. we should take this opportunity to see how many regulations we can live without.

such as arcane can regulatory accounting and jurisdictional separations. finally, it should be made clear that the commission establishes -- made clear that any rule the commission establishes in the trials will be nonbinding on what is happening outside the trials or for future decisions. these trials should be exactly that, trials. not stocking horses for new regulations. next, the commission must continue updating its universal service programs. universal service is a fundamental and longstanding principle of communication policy. it should be approached in a thoughtful manner and with recognition of the differences in our vast nation. some regions already have access to modern communications services somewhat as a result of universal service funding. others remain unserved. the challenge we face is taking finite rate payer funding and targeting it effectively to preserve an advance universal service. i'm encouraged by some of the reforms already adopted;

subsidizing multiple competitors is declining, high cost support that was not well targeted or serving the intended purposes is being phased out, and the link-up program has been eliminated in most areas. i also support the chairman's commitment to revis the kwan tile regression analysis, the qra men be. marks. when rules are not operating as intended, then those rules should be replaced. as we move forward, we should consider a variety of approaches to complete universal service reform consistent with our 2011 order. for example, i am interested in deploying the remote areas fund which was intended to bring basic voice and broadband service to extremely high-cost areas through a variety of technology platforms including satellite and fixed wireless. we must fully explore, again, consistent with our 2011 order all ideas to insure that consumers if hard to serve parts of the country do not get left

behind. we must also remain mindful of the size of the fund, because a burden of paying for these programs ultimately falls on rate payers. the size of the fund may be down from last year, there is no overall cap. as we continue to reform the various programs, we should look for ways to offset the cost of modernization within existing budgets. budgets make for hard choices, but those hard choices force efficiency, encourage innovation and benefit rate payers. to put this in perspective, the contribution factor this quarter is already an incredible 16.4% and is likely to increase further in the coming years. therefore, contribution reform is long overdue. however, it must be addressed in a manner that is fair for everyone. providers, recipients and american consumers. and it should not be reformed in a way that dampens internet usage or increases overall consumer costs. finally, we need to take a close look at program management.

projected requirements, which drive contributions, are consistently much higher than actual disbursements. what makes some sense to plan for future expenses, the reserve should not be more than absolutely necessary at any given time. we also should review administration expenses which have been trending upward. one of the last pieces of legislation i worked on as a congressional staffer that was enacted into law was the middle class tax relief and job creation act of 2012. it directed the commission to hold a broadcast spectrum incentive auction. providing this platform to transfer spectrum from willing broadcasters to wireless service providers is a great example of further injecting market forces into spectrum policy. as congress directed, the resulting revenue will pay for first responder network authority, the next generation 911 programs and deficit reduction, among others. this will be the most complicated spectrum auction in our history. technically, we need to be able to simultaneously integrate the reverse auction to obtain

spectrum with the forward option to allocate the spectrum for wireless use while repacking remaining broadcasters. in order to be successful, we need many things to fall into place correctly, including broadcaster participation. because without them, the auction simply fails. educating broadcasters about their options, whether it be selling spectrum, channel sharing or moving from uhf to vhf will be an enormous challenge. there will be an even greater uphill climb if the auction rules and processes are complex or confusing. similarly, we must remain attentive to the concerns of those broadcasters interested in being repacked. simplicity and transparency are paramount to providing broadcaster ors the certainty needed to decide whether to participate in the auctions or continue to serve their communities. failure to do so may deter broadcaster participation or lead to legal challenges that could significantly delay the auction. i also feel strongly the commission must not implement

rules designed to preordain auction results or place undue restrictions on licenses. such efforts have failed in the past, and now more than ever we cannot afford to diminish participation or revenues. instead, the commission must allow licenses to go to the highest valued use and insure spectrum flexibility. if, as i hope, the auctions are successful, consumers will benefit enormously as wireless providers use the new spectrum to build the next generation of networks and provide faster and better service throughout our nation. last but not least, media ownership is also anish area where -- an area where the commission needs to take action. section 202h of the telecommunications act of 1996 mandates that the commission review it media ownership rules every four years to determine whether they're still necessary due to competition. if they are not, we must modify or eliminate rules that are no longer in the public interest. we have failed to comply with this congressional directive.

specifically, the commission hasn't released its 2010 order, and it's arguably behind on its 2014 review. when congress extended the media ownership review from a two-year to a four-year requirement, the intention was to insure a thoughtful, competitive analysis of the space. instead, what has resulted is regulatory paralysis. i'm aware of the difficulties in completing this task and the corresponding legal challenges including the third circuit's ruling. ..