i would like to ask you just a few questions on those lines. one, a little over a week ago the d.c. circuit issued opinion on the network neutrality order. what do you think of the dpk circuit's opinion, and how do you think the rules that were lost out by the d.c. circuit kind of lined up with your more concept of regulation? >> he mentioned we had a chance to work together on the tell telecommunications act of knicks. we had an opportunity to work specifically on section 706. so we're quite familiar with the provision how it was drafted and crafted. what it was meant to do and not meant to do. i have articulated a couple of times in the last couple of weeks i think should have happened in the court case and obviously i have deep reservations. i disagree with the court's decision. i believe the commission did not

have a authority issue the rules. i think 706 has been abused. and it should be returned to the original intent we help frame years ago. so i have difficulty with that part of the equation. it makes it harder to get to the second. the fcc rules weren't thrown out. i learned long ago not to try to guess what other people do in d.c. in the environment we live in. i don't have an insight what the chairman may or may not do. he articulated the authority he believes he has. the commission has and what they would like to do. so i have taken the word and see

what comes from that. but i hate to guess more than that. house energy and commerce committee is beginning to hold hearings about a possible rewrite of the communications act. i'm sure you've been following this closely. what advice would you give to the house energy and commerce committee as they look at rewriting the communications act. >> i would say first and foremost, i defer to my friend and former colleagues on the house and the senate on timing and structure and the format of any type of consideration of a rewrite of the communications act. but i'm also made myself available in any way i can to help them as they proceed on the process going forward. in term of advice, i think it's unfortune me to give them advice. it if i should come from congress to me. i look forward to working with

them in any way they can. i hope they take thoughtful approach to this. it looks like it may take a little bit of time. t probably a good thing. i have to say it's refreshing to hear they are going to get advice from congress or the other way around. [laughter] speaking of which, senator rockefeller is proposal to substantially expand the school and library program. there's been discussion, as i understand, at the fcc about that. is this an area with the fcc is actively working? how do you see -- how do you see a possible expansion of school and library program the overall universal framework of 254. >> i articulated i'm supportive

of the chairman rockefeller's effort to modernize service programs specifically the e rate part of it. i am open toking in youring how best to do that. they have an mprm in the space and examining how best to do that. i favor moving to a less complicated system. i would like for one that also addresses the total cost going forward. if we're going tin crease speeds how can we function, budget that previously talked about. so there is common ground in term of modernizing the program. it will be down to specific going forward. how it relates to the other three pieces. in your talk commissioner, you

mention about the importance of z periodic review regulations to see whether or not they're working. the commission has in fact communications act 11 require the periodic reviews. the commission is fairly sure apply it across the board. i don't think there is anything excluded from it. we should look at every rule and make sure that it consistently goes forward and still relevant

collection of information and

requirement on team communications carrier. >> well, i should start by saying at this point i don't have security clearance in any fashion. imron anything. something that will weigh in. i think we ask provide advice to other agencies and other government departments involved. i'm not sure the commission spent considerable amount of time going forward. i was amused by your description of the block buster/hollywood merger turned down. there are others over the years, world come sprint in 2014 got blocked because of an opposition something called long distance telecommunications market. what do you see as the role of the fcc in the review, and how

go you see that playing out and coordinating with the antitrust agencies? >> so first i would suggest this is something we spend a considerable amount of time when i was in as a congressional staffer. we figured out how to simplify the process make sure it's they are row. you don't duplicative agencies reviewing the same information. they have different statutes depending on the agency. there is an overaggressive attempt to gather information duplicative to the work done in other agencies. beyond that i think the commission has an obligation under the statute and the public interest to ensure that mergers are in the best interest of the consumers. there is a level of i review that sometimes gettings exceeded here. i would like to see a process simplified while providing

thorough review. >> you were a staffer at the highest level of congress for many years. what sort of issues do you think capture the maiming nation of member of congress and the senate the most. when someone tells a senator something is going on at the fcc. what are the issues that immediately jump to find for senators and congressmen? >> in complete fairness to my former employers. they have at lough issues going on and committee of spend their time on and things that happen on the floor. they have a lot of responsibilities specifically and my last closing day of my time on capitol hill. i was working on the most pressing matter before the congress. so communications issues are seemly important. i acknowledge that and happy and pleased to be the in the position i'm at. i suggest members have to balance it with the other items they have to consider and have to work on and some of those can be a little bit more timely

depending on the subject matter. it is tough to balance all the requirement for a member of congress. and so working through those type of things i think when people approach member of congress about the fcc. they take interest in the matter. they know how significants to the economic growth of the imriets. they certainly go have been tasked with this farther -- further inquire about the issue raised by the member we spoke to a member. so i have a ton of leg work after the fact. over whatever question posed to the member of congress. the area of interest may not be immediate timely to their schedule. i was both pleased and amewsessed to hear your list of the pressing issues you analyze. there are four issues. one of which if i am giving this

speech and new commissioner would have been on my list as well. which was media ownership. if someone asked me 16 years ago would the media ownership rules around two years later. i would say no. there's no chance and yet they seem more entrenched than ever. tell us where you see media ownership heading at the fcc. i sensed a little bit of frustration in your comment. but how do you see it playing out? >> in fairness, my -- it is frustration on my part. i believe the commission has an obligation under the statute i helped work on behalf of a member of congress. i worked on extending the time frame from two years to four years. i'm familiar what we expected out of commission. the fact we haven't seen a

number of activities recently is disturbing. we're obligateed to comply with the statute. i'm disappointed we haven't so far. in term of what may happen in the future. i'm hopeful the chairman and my fellow colleagues will tackle this issue in short order. in term of what may happen i'm open to listening to all the dialogue and the reading all the record and having as much information as possible in deciding going forward. section 11 requires the commission to review the act the rules every two years it's been revised every four years. you mentioned the media ownership provision every four years. there are other administrative law requirements. yet it seems like rules never

really are repeated. it doesn't seem like there's an awful lot of serious review in existing rules. what can be done to change that? >> in fairness to the commission, i think they have reviewed some rules recently in the chairman's tenure and repealed a number of rules. the question is are the significant rules probably outlive the usefulness. we probably have not spent enough time or work on to deal with those situations. i mentioned, too, that going forward depending how the ip trials go forward. i'm interested in looking at, you know, accounting and jurisdictional separations two universities designed long ago and probably great inspection going forward. you're right that the big issues have not been reviewed significantly by the commission. we should spend some time doing it. it's part of our obligation under the act and good steward

of the american taxpayers. i have probably overe tended the prerogative of the mood rater here. i should open it up to the floor for the questions and viewing audience,@hudsoninstitute on twitter. send your questions in on c-span and direct video feed. question in the front. please identify yourself in the microphone so our viewing audience knows who the question comes from. wait for the microphone. >> good morning. -- good afternoon, commissioner. my name is dee an. i'm with -- ginss. could you please give us your perspective on receiver standards, and how legacy receivers would play in to your perspective. >> okay. happy to do so. i am open to hearing from all parts of the industry and users in this base. but i'll suggest in many days

the closing days of my time on capitol hill receiver standards actually if come up. it was something we talked about at length. there is probably an opportunity -- to determine what it should be. there is some room to move forward on this item. >> please -- talking about it. i i understand there are no receiver standards. are you thinking of improving the rules or what? >> the rule governor receiver standards in some regard. we have some, you know, have had a number of fights recently over whether devices are meeting certain obligation and should be improved to help prevent -- there have been conversations on it i'm open to reviewing the record having a full dialogue on

the question. >> thank you. >> absolutely. >> question? >> commissioner. the competition you talked about the public interest test. that is one where it's originally a concept that came from railroad regulation back in the 1880 put forward and appropriate when it was a monopoly and the airways were viewed as government property. since then, the, you know, no longer have now belief and wireless can be a private property. what thoughts do you have on applying the public interest now that the underlying facts of monoonly and property how should it be applied, you know, doesn't seem appropriate you could apply it from the 1887 mind set. >> i would say i spent considerable amount of time reviewing the public amount of interest in a number of time.

we did go through a number of earths whether it should be continue order modified or eliminated. the truth is it isn't part of the statute. i'm obligated to comply with the statute. in term of how it complies going forward. we have to be careful on imposing abstract viewpoints. we have to be careful. it is part of the statute. i'm come -- required to comply with the obligation. but, you know, there are a lot of conversations in my past life. i'm sure thereby ones going bard on whether to change or modify or eliminate as people talk former commissioner talked about the rewrite of communications ak. that will certainly be part of the dialogue, i would imagine. next question.

>> well, let me -- if it i can followup on scott's question just briefly. the public interest is part of the communications act. in times it seem like the fcc order it and has become a substitute for other part of the language. how do you see the public interest standard fitting in as sort of a final check on the other factor the commission must consider. do you think the public interest outweighs everything else? >> i mean in in all due respect. i'm obligated to comply. i do not believe that the public interest should be a grab bag for any type of additional vows

people would like to add to whether it's a merger or whether it's additional obligation on particular provider. i don't think it's something that should be a grab bag. however, i think it's something that provides some maneuverability how it fits with the other condition. i'm not sure one outweighs the other depending. we have the question is section 7 even still needed i have answered this recently. i think consistent my views have changed i do not believe that those entities that were intented to be releglated by the

commission they strurk down the riewlts in 706. the second part is whether the authority of section 706 and, you know, whether it exists for the commission and other things and whether i believe it should still be in play. i have to defer to my former colleagues in the house and senate. question in the back. wait for the microphone.

the first is something i dressed with julie. there are sites stealing people's identity and going on a wack mole hunt. are you going develop a set of rules that stop the practice? they are fosh countries that are taking the identity of american and tracking them. second question dresses the effectivenesses of the fcc in relationship to the youtube on the online channel.

we try to make sure that agency duplicate activity and something that in term of consumer identity being stolen. something they spent more time on. i don't want to foreclose potential involvement. i need more investigation. whether the commission has whether it be helpful. if i understood your question correctly. >> there are and i want to be cautious here. a lot of time helping members write statute going forward in the last twenty years. there was a conscious thought over the time that many instants we didn't include online

activity for jurisdiction for the fcc. it was intentional. they did not support additional involvement of the fcc in to online activities. there have been a number of things that have come up that other agencies have looked at and we just mentioned one where, you know, online identity theft. there are not a ton of provisions in the communications act or in other acts that deal that provide authority. we talked about 706 and oirp 6 is one where the commission try to use the language to help give them authority in the online universe and how far they take it to be determined. the commission's authority in an online universe is intended i congress to be rather narrow and that's something that congress has the right to extend or increase or decrease. it's their obligation as a representative of american people.

what do you believe is a best way forward for the commission in term of regulating broadband internet access. i believe in having numerous conversations both externally with providers with consumer groups, with a number of different folks and i think that a live conversation is still happening, you know, as we go. but initially i'm not expecting the marketplace to change all that much going forward. i don't see companies that are interested in significantly disrupting the current marketplace. i thinks in their best interest to serve the consumer. it's in the best interest to consumers as well. i don't see the marketplace dramatically changing going forward. i would be reluctant to impose new obligation in the space going forward.

the commission has requirement for annual report and competition in various industries. it used to be that for many years the commission consistently found there was competition in these industries. in recent the commission refrained from making that conclusion. i'm curious how you see the value of the annual report and the type of competition able cease that go on at the commission. i would say first and foremost, i know the congress is looking to whether to combine a number of existing report obligation

and change that the current structure. i would have to defer on that part of the equation. but in term of whether i think the commission has done on an actual basis. whether a i have, worried about in the many years past is the reports be used to manipulate data. we should tell a very factual story and let the chips fall where they may. i worry the data can be -- i'm not suggesting it has been. i'm saying it can be, you know, going forward as factual as possible and the information speak forristth itself. i'm worried we would change that equation. may have been more concerned than, you know, most people are

surprised the court can interpret it the way they did. you give us any color what you thought it meant when originally written and how it was reapplied and what potential kind of freedom voice you'll have as the fcc may go forward in interpreting the boundaries of 706. >> i don't want to say too much. it's something we may or may not tackle going forward. i'll suggest and hopefully my colleague will concur with me. the provision itself is, you know, generally similar what

people refer to congressional findings. the swaight should be similar. the they a different opinion. hopefully we can get back to the original meaning of the statute. the difficulty i articulated. i have difficulty with the court viewed. frankly, it's somewhat a perspective of to invention how 706 was written. you have to put in perspective of when it was written and who was writing it. we're talking about a republican house and republican senate working on provision right after the '94 election lead by gingrich in the height of his power. we would write that secretly gave the commission authority over the internet and never told anybody. we secretly and never wrote about it in any of our analysis or summaries. but secretly we gave the authority. >> shhh don't tell anybody.

then we turned around and started fcc reform hearings. we were concerned about the power of the fcc. somehow we gave them authority and then we, you know, secretly and turned around and we decided we had to review the authority we already had given the commission we were worried it was extending too too far. it's a difficult extension on the process part of the equation. i recognize courts have their on my gracious what is written. i know, there are different judges that look at different pieces. i'm wayer of that what they're tasked with. it's difficult for me as someone there to see provision interpreted on now what the complete declining what the circumstanceses were. -- circumstances were. >> i'll take the last question right here then we'll close the program out.

>> thank you very much. deann again. i was wondering for you could give us a perspective on the prospect for the spectrum that is currently held by light square but somewhat in limbo because the difficulty surrounding that. however the company works out, i mean, that spectrum is out there and available for use by someone. can you offer your outlook on that and maybe the long-term perspectives might be? >> let me answer this way. first, i'm supportive of the spectrum being used efficiently. it's well being used to provide services to consumers. i will -- if i learned anything over the last many years, it is this is a particularly heated discussion specifically as it relates to light square and obviously there's a court case going on. i'm best to refrain commenting too much in the space. i would suggest it should be

used and hopefully get to that place where it is, you know, used for the benefit of consumers. beyond that i should probably keep quiet. >> and with that, please join me in thanking commissioner o'rei -- o'iriley. [applause] [inaudible conversations] [inaudible conversations] ..

. >> i would to introduce maryanne lindeblad from the washington health care authority that is home to both the state medicaid program and prior to her appointments in that position in 2012 she served as assistant secretary for aging and disabilities services in the administration and department and before that as the director of the health care services division of the medicaid program. she comes to us today with a lot of experience with the medicaid program but also clearly working with the

medicaid expansion in great deal. among her professional accomplishments she is a registered nurse so that also provides a direct care experience that i think is very useful to deal with the issues of the day to day basis. we have the executive director and founder of the texas organizing project, ginny goldman founded 2009 to bring together communities to address critical problems facing low income communities in texas. since its founding it has grown with the base of over 38,000 members his supporters with mini legislative successes and the zero leading voter turnout organization in the state. she works on to have texas to take of the medicaid expansion. our final panelists is alan

weil from state health policy that you know, is nashp and independent academy of policy makers here provides a forum for the agencies of state government on critical issues including working on medicaid expansion. he speaks extensively on health care issues on the editorial board of health affairs and a member of the institute of medicine board of health care services. and his role with nashp he can work with states across the spectrum so he can hear from different medicaid directors in state saturn a very different place. i want to thank our guests can start off with the broad question to get a sense of where the different states are. marion, king you give me a

quick overview of where it is right now with the biggest challenges as well as successes and what you see as a top priority? >> we are very fortunate in washington with the passage of the affordable care at we had support from the legislature with both the expansion and having the state pays to change a and that made the whole expansion process and discussion much easier because of that. the legislature saw that as an opportunity for significant savings to this day and this stage only health programs and room for additional jobs. we have been very pleased

with our success we've met our target to have the new eligible group we had 121,000 and also as of today over 150,000 and that is growing literally every day. we have the majority enrolled and care is being delivered. i would have to say this did not happen without challenges there has been some system glitches glitches, applications airing out, we have early on the health plan binder a brand new system time to get that up and running so there has been a glitch to get through.

so on medicaid to reach your those that apply their getting applications through. we've made a decision for all individuals on medicaid having them go through the health plan finder over the next year we have a hundred thousand to so to recertified with people not able to get in it makes it difficult for people to be recertified. so working closely with individuals that are having trouble i have to say has been a little problematic. also we had the issue of the state's recovery between the ages of 55 ince 64 a

medicated requirement the expenditures the state could come back to recover that cost. the federal government that we have to follow on long-term care to expand that to other services washington made that choice several years ago although not anticipating the expansion so very quickly we had to make changes in the state administrative code to ensure folks that if they were in that age group 30 years later rigo after their estate in working through that issue. i would say even so overall things was up -- work relatively easy as they try

to help clean up these problems but over four to 50,000 individuals have made it through the health plan finder on the medicaid side to recertified are those that would normally come into the program. said people are in rolling and getting care. for some of the challenges first and foremost, is the customer experience we want to make sure they'll understand the program with the materials and information that they need. to make sure we meet our enrollment target. to look at access to make sure the provider network is

adequate and working closely with the state insurance commissioner on network adequacy for the exchange plan or medicaid plans with the providers that they offer. the way the of system works today that would be in managed care they are assigned a manage care plan but it comes after the aside there. we want them to have the same shopping experience as the exchange. so that with star jake 315 -- january 15. >> host: thank you very much. confronting a very different

set of challenges. [laughter] listening to those enrollment numbers. trying to push the expansion for word it is tough sometimes i am sure can you tell me about the coalition that works in texas and what the challenges sales successes last year for the upcoming year? >> thank you for having us here for this great conference. i see others from texas so this is a big issue for your eyes as we have the most to gain but unfortunately is refusing to except the fund so our coalition is broad. it is very grass roots of the ground immediately when

it was first announced they would reject the money be spun into an action we had press conferences to show that people would not just sit back to allow this decision to go forward without a fight. we have some close priorities we would not have that framework we have planned parenthood and some traditional partners. because it is such a crisis when happens when you have a crisis unusual partners come to the table so they don't agree on many issues but here we talk about the economic impact not excepting the medicaid

funding the number of jobs that are lost. the texas medical association and so that spectrum is very broad to continue to beat that drum that we are all in this together. soviet terms of challenges there are two challenges the names are ted cruz a and rick perry. [laughter] of want to apologize our challenge is sick of america's biggest challenges setting down the government so senator ted cruz has led the charge how the aspca will hurt texas when what we know is why you have six and leave people who are uninsured those who cannot qualify for the changes

could not be further from the pitcher's that is one of our biggest challenges and the governor is the bigger challenge because he has the ability to except the medicaid expansion money it absolutely says no. with the legislature we show there was bipartisan support for proposals that would create a solution to expand medicaid but there pleasure is the republican and democrat ready to push that to give leeway and a flexibility and rick perret's landor and said he would veto any bill that

came to him had no reason to walk the plague to put their own reelection in danger when rick perry said he would stop them. but in terms of successes we measure success differently but rick perry made the calculation he could reject the medicaid expansion monday and they would not know about it they would not vote or take any action. so we talked to thousands about the aca and we put their information into the voter files to make sure in

those elections coming up. to prove that's they do know he is rejecting this money and they will be taking more action some of those were very direct we organized a group of families from home health care workers because challenging the narrative is very important to say they got a job but the reality is they have a job. and they don't have an offense. so those that would confront governor period directly.

they confronted him at a breakfast and they stopped a press conference saying he had to answer questions. and of the first time he forced me in his office to explain his position in front of the press because of a bald review was speaking to the chamber of commerce and six members were in another room and interrupted so many times he said please meet me in my office. so challenging his narrative to say this is the truth of what is happening here is the family that is impacted they will tell their stories and challenged of governor. that is how we measure success right now. [applause]

we have another texas version with the navigator rules the appointees of governor perry making proposal on rules on navigator's where there already required favor have for the additional trading hours to pay additional fees it in an attempt to discourage organizations from becoming navigators' we just found out yesterday that we could switch back there will not be any additional fees to be navigators' brodie 20 instead of 40 and we just really want to do outreach and education at first they

were proposing we would have to register the the federal outreach now they have made it clear because our folks went to the capital five days before christmas to testify to put 79 people on record. that is another success. >> the key for your hard work. alan weil the states that are in the middle. it is clear those that have not expanded yet what to make medicaid expansion in their own. can you talk about what we see from states that want to expand or another waiver program that requires approval from the federal government? >> there are states that are not just ideologically

opposed but our concern to figure out of way that will work for them. go back to the beginning when the supreme court decision went down they said can we do a partial expansion less than 133 percent can we change our mind we got the answers fairly quickly you cannot do a partial but u.k. and change your mind to that led to the first year at the state level if they were in or out. there was a substantive than the political component to where they are. now we've moved past the first few questions you already talked about the private option. it changed the terms of the discussion about expansion. at a substantive level arkansas was looking to do the expansion they wanted it

through private health plans. for the bass majority -- the vast majority you're already in their private health plan but that was not the case of arkansas. the notion to be a big change that the expansion would be through a private plane and is not the case or would not be the case for rose states but was a big deal. that was the focus there subsequently we have seen other states cut did with request approvals iowa and michigan with additional changes that they point charging premiums or co-payments id of course, of lot of attention of work requirements id we will talk

later it where this might go we also see a lot of states there is a trigger word the state will automatically withdraw from the expansion of the government changes the terms back to the scaling there is a lot of mistrust so substantively what we see is all then grow wait efforts at the state level how to kraft a medicaid expansion for what the state had in mind but i do want to remind people this is not just opposition of people who would be covered but a sincere effort to put that into the

existing trade of private coverage for low-wage workers is almost nil but has more of a presence as what the rules would be in the insurance exchange were kashering is a part of the picture. as for the politics did the fall between the extremes represented here those to embrace the expansion is a part of the law and those who oppose from the outset. a lot of political leaders looking for a way how they could be against obamacare but to save those said to mix played out the human consequences is the most coveted political frame is

we want a solution that works for the state. it is the very exciting tuned positive development. a long time medicaid director said something to me i thought the court taking away will be positive because states to do the expansion go through it and the process to embrace it not because they have to. but over time i start to see the wisdom of his reflection that every state that boosts for work now has a deeper understand the of the program it is harder to fall back on welfare or people who were not working when

the reality is surveyed working families that it is delivered through private plans. don't get the wrong i have a lot of concern about the pace of the discussion of the that we have state specific discussions in a way that would not have occurred in we ec states say how do we make this six you to work for us as opposed we have to do it? that is the discussion in a lot of states right now. >> some states propose the new sat they say you cannot do that. it cannot get into the head zohar of the governor's but what if they are not

approved? would use a happening in that space? >> it is hard tear generalize. and i don't know but i am struck there is a somewhat new conversation go we space where the six fugitives wanted to 33 but their premium tax credits start at 100 so you would have people who would be eligible for the tax credit a year did the exchange there are premiums if there is cost sharing of both of those and i think what is saw hard-line to hold is to say if you didn't do the expansion those that would

have access to coverage with previous and cost sharing but you cannot charge previous to that group that is a hard slide to hold. what we see is some little bit of wiggle the blended petri traditional medicaid through the core population covered by the exchanges. you so very issues like work requirements will be strongly resisted because there is no room in this statute to permit rules like that but the wraparound coverage one that people fight about all lot but the buber the medicaid expansion is eligible for the benefit package that is very close

to the essential benefits it although there are differences they are small that they will negotiate so that grew is over with those core elements would you put others fade as of the table how that will play out at the state level those are harder questions. >> maybe you could speculate for us. [laughter] seven casket and hater. [laughter] log dash ask again later. >> but one big both washington and in texas you have to deal with is

messaging a and outreach so let me ask you first. . . to read it is important to have the messages of medicaid expansion and could you talk about your strategy and to when you reach out to? with mr. j talk about the broad public message even though those that don't have health care we have been the gig about how to read talk to people in texas how we are in this together. this is a bad decision for texans. we pay for this freeway is. they go to public hospitals, and emerges aerobes -- emergency rooms.

so we have extremely high premiums this is why it affect share am the third is the federal taxes go to another stage but to hear that their states go to massachusetts. [laughter] that is very offensive. so the broad picture is we are in this together we pay three times settled think rejected this movie is helpful. but 60% death the and church so there are some things but to put a public face of say

good the symbol of what to do texans to talk about how this impacts the hell they could general in medicaid. we have a construction worker who does not make enough to be a shade to eligible but his brother in ohio is already eligible. we have a creative wonderful partnership leading up to the a molded period they did a week-long evened to with a different age go on health care and they had people who could speak spanish with the issue with a different example every night of the week that they did in all

major media of markets. so they bring in three pro calls of the broadcast that night so we talked to thousands of people and your division and was so excited that luis veloz had to drop fat of college because they had been a cold that so they first wanted to interview a few but they were so impressed what happened to his family that they to a camera around the country cms and entire documentary with the health insurance of a cms said he was interviewing and having conversations and had him talk to the governor of

florida so we have been doing scribe's of this documentary so people can add have a simple conversation about health care. it is about taking a the favors that seem complicated or too political. [applause] >> with the states that have expanded the a breach that does nonstop can you talk about what you have learned in to with access? with that messaging it kayhan come with a stigma torrey to get the bill sets

out so the individuals at the low was didn't come medicated as their insurance project. we now call in washington apple. a due date but the whole idea this is the whole continue of if you of the qualified health plan and it should not matter. so too has a eddie fontaine to take food to a judge of every opportunity. we started into the summer to strategically plan to do the kickoff in september with advocates in the

summertime to generate interest to make sure there were lots of different stories about communities. in the opportunity to piggyback so they did a bus tour did across the stage of those typical since to get posters every possible place community colleges, four year colleges, and free clinics, to work with the local jail. so we could find ways to touch the spanish speaking radio stations to get public service announcements out to target populations you been

in it and we did it. to every group we could touch. be traded over 2,000 community workers. so we provide their trading on the medicaid program, but we gave them tools to help get them in rolled to sign them up event that helped us at that time they could help people fill out paper applications so that was it valuable as we moved out with the emerald and it -- a moment now with that medicates staff weld we had

an outreach workers but they have expertise with the indicated movement with other sites across the state. so one of the figures -- the theory says tracking by county on a weekly basis if they get the enrollment we expect to get that interesting phenomenon where there are my grant workers or hispanics peaky we think there are some barriers there for those individuals who could not reach them affectively we will work on ways how to target that population in the rears still working through that. what is the effective means to get people enrolled in working with community partners to help us do that.

we cannot let up we have to continue to do whatever strategies we have to find other ways that might be effective to reach populations. we are putting in the legislature for dollars to help us do that. but we acknowledge there are popular issues harder to reach so to rethink the strategy. >> host: in terms of states that have expanded are there any the you would like to highlight that they are doing it? been back this is tried to simplify the eligibility we started to focus on what

kids before the aca. i would focus attention beyond the direct alrich of first is i hope people blow shortly before opening moment t2 gave guidance to facilitate a settlement under the aca there are a buber of options but to the most exciting is the opportunity to streamline the enrollment of those who were already snapped eligible and a handful of states ticket to digit is the correct way to bring people into the program but i want to say something different that i think is critical with that conversation we just had that there is clearly be a reports they're doing a better or worse job with the

and ruled that the number is higher yields lower and that is all worth tracking this is critical to review bird that in the states whether they give medicaid expansion or not or do the schaede or not, there are reports to the steps they are required to take. the conversion and to the magi rules is significant of the eligibility requirement to transfer data between the exchange ended medicaid system to determine the eligibility as quickly and efficiently as possible is a requirement to whether or not you ride your own and there are officials that work deep in the bureaucracy that are trying to figure out how to view those changes as effectively as possible in states where the

overall deal is pretty native. what i want to richer is not just look at the high profile opportunities for its will bid to but behind the scenes is the basic function of conversion and eligibility standards and data transfer if they work well, that will have a huge impact on efforts for a moment to do change the experience so they go tell someone else. they did not have to fill out the forms seven times or they did not lose said. they told me to go here then answered my question. these are very important steps that get less attention they could be

important to the long term success were like the traditional of reach effort. >> '84 reminding us of that. keep rigo reid -- keeping going, people thank you have to keep your coalition and together. [laughter] can you share your thoughts it sounds terrific but to keep people past this year to keep pickerelweed? >> we're already rete now about the 2015 the legislative session of. we don't know who will be covered with a bill that iraq perry will not be. obviously there are stark differences between wendy

davis santa craig and a bit of that issue. but there is a coalition of the beats regularly and betty r. groups of a bid to an earlier zero talking about what it looks like 2015 b-2 revitalize these proposals with the of last legislative session this there something we can do to push through medicaid expansion. we are also launching a website is a collective effort to keep the gauge egos the fall for the? and what they q due to be active. the other thing we're doing texas is a large state so we have other coalitions in the valley and other parts of the state cubing together for local solutions so we

could come up with solutions in the county's. for what they have the pay or play ordinance you have to pay additional money so as we know you have to have some wins along the way. the has to be at the health care level. >> into make sure it is for the edge of a sustainable. kim view talk about that? beer recto whole sustainability question with

gate at medicaid as a program we have a number of different vegas but we just completed a five-year plan that how health care is delivered the medicaid is a large portion of so that part of the plan is completed and the focus of that is about value. how do we look at that reimbursement system that goes on in our state where most providers pay for service? we don't have the innovative pay the structures to pay for outcomes for

accountability to changeup the figgie to be more outcome driven. looking at the community level is what happens is so bereft of the policy tends to be for the delay did but what happens to make health care work with that model that the build of powers the community for what we call collaborative of health into infrastructure with their rich more involved with decisions and much better with the delivery system. then start to focus medicaid differently but what is the thank like housing in a deployment with the health outcome getting away from

health care but talk about health if they another roof over their head and are diabetic and will be difficult to be successful with health care if they don't have a place to live also to do better integration with our system in washington and is not well integrated floor those that have significant behavioral health the best or physical health of the so how do we agree that system is the way that is more integrated to gauge communities? also are the major initiative in the middle of we got some of the fund did to develop services for the dual eligible looking at ways to better serve them

with better integrated care to have delivery systems with another aspect is some of the highest the individuals that have significant health issues to have day care, where did peter that gets into the services that they be to help them with their own health care to get them more involved the with the population fake of it differently that but a kid plays up part. >> you provider access comes

up a lot. what is washing to do reid to ensure there are enough providers sam specialist? >> always the challenge but before the implementation of the affordable care act we did significant survey work of the work force and for the most part it looked relatively good in did the areas of the state be found where that was a problem but just for betty kaye did the betty with that community. of course, still were key to find ways to engage rehab of workforce peace how we can't grow the workforce also with

the implementation of the medicaid side to bring some new planted to the state they could negotiate so pro league that the number of providers at has been helpful also with the accountability with a bandage care plans to have an adequate the work will look to have a half providers there is not much we can do it to the community but with the ongoing work. also a cms granted the increase to primary-care providers 2013 / 2014. that was significant in washington.

on the adult sides have got a 70% increase the you can see that we have a bad blow for medicaid but we will have to evaluate what the effect of that has spent we start to do that now and then what will happen at the 2015 also located at providers to serve populations with a primary-care providers somehow they can't take it like before to look at those to break them border accessible also delivery and the prospective to be sure we are in kgb anyone -- and

kgb anyone there is no easy answer it is one of the major questions over the next couple years if not longer. >> and you were to read perry innovative say this. are there programs he would like to highlight? >> there is not a lot to add to sell this but there are pretty states that are not doing everything and the tide is important to. marianne over the bridge and cramps and transformation projects through bribery care infrastructure and the development the only thing i can't take of is there is a

lot of attention into birth outcome either you were saying it will dash do we get cut arkansas it gets a lot of attention for private option but there with the ted initiative in tennessee is located at arkansas so the point i would make rather than the list were programs it is hard to remember that the interest of the health care system and spending money on individual services if that is not partisan then how to do that is not simple in the

long term process there is different levels of encage routes around the country but bob that i take is clear with the states that we work with his medicaid is a critical part your of then the effort to build up the primary infrastructure or improve population and health outcomes because of the size and the role the plays of the health care system you buy fake the art of the evolution over time some of that day shift in policy for those business interests say that we're losing because if you have the agenda if you don't use

as up tweet you will blow me as effective. this is where the pieces come together if you have a broader health system of the tools of the exchange are ones they you cannot afford to leave behind a of the more staid said to the combination of the clearer it will become huge lead all of these forces. >> that is the nice segue to the next question talking about where they this might be going in the future. earlier you talked about private auction and the exchange plans what are the of long-term implications of that approach?

directed to be a very realizes that the private options and terminology is more political the effective communication van substantive because the vast majority of you a interstate's medicated will lease or already in private plans. if you do the been the case fugitive is a private auction of whether vindicated for structure or the schaede to infrastructure it has pros and cons but it comes together and to it is biased to the bracketing in the system and schaede in june issues of a bid to lead is the expansion in the kid to the move of options available depending on resources is said to a place

where the chance to reach 72 ocher takes shape around individual choice have to competition they think can help move the health care system? ic more allied berndt instead of the a program or a system medicaid here a.m. their overtime reseal what were mundane to me that creates opportunity on the message side isn't that would create opportunities to have more leverage.

it helps to break down the barriers. don't get the rob i do have concerns about erosion the patient protection to move to the vatican a bottle so i do very attuned to to the importance of those projections put the fight over public/private will create more important if they have coverage. >> thank you for cleaning -- for clearing that up.

>> what they called the strait expansion, it might not happen it will not have been with the texas solution are there in the types you fade katchis o lot of lake said texas? . .