[inaudible conversations] and good afternoon ladies and gentlemen, take you for being here today for the briefing. i have a couple of guests with me today. susan rice and the national security adviser that are here to give you a preview

of the president's upcoming trip and then we will take questions on that trip. then we will start with an overview of the schedule and ambassador price will provide a systematic overview then we will take questions on those topics areas. then i will stick around for questions. >> i will start with the interview with the president over the course of the trip on sunday night in arrived on it -- a 8:00 in the morning said he will go to the museum where he will meet with the prime minister of the netherlands. they will then have the

bilateral meeting there as well. following that the president will go to the soviet side id have a bilateral meetings to initiate the meeting with trade and this is the first since the g20 in september and they could agree to this is obama today. then the president will go into this session there will be an opening followed by the policy discussion in the afternoon and following the president will attend the g7 meeting at the residence this has been added on as of response to the situation in the you craig the president will consult with the leaders of the g7 out to

support the government in the media is part of the isolation of russia for its actions. paul levine does it g7 meeting the president will see the katy of the netherlands then have a working dinner. on tuesday the 25th the president will participate in the summit we anticipate the opportunity to have some beatings with additional leaders with the interaction said at the conclusion obama will have a joint press conference then following that will have additional meetings with a bilateral treaty from the united arab emirates, one of the key relationships in the gulf to discuss gulf security to support the opposition in syria have the update of the nuclear negotiations with

iran in and middle east peace negotiations than a very important trilateral beating with the private mr. of japan this is an important message to show the united states is allied with the two most important allies to signal the commitment of the security authorities station when the allies came together we are all much stronger. then the president will go to brussels and spend the night. on wednesday march 26 he will begin going to one of the most important battlefields of world war i. this is the centennial anniversary of world war i had is a critical history in the world hear the president will reach with the cane of belgium and the private

mr. so there will be a private meeting then a tour of the battlefield for people of united states and europe as well. following that the president will attend the united states use of it -- summit here we have a very broad agenda with the e.u. i am sure the situation of the ukraine will be front and center with the ongoing discussions of a partnership with the iran negotiations with the e.u.. following that seven and working lunch he will have a joint press conference with of peters. after that meeting the president will meet with the secretary-general of nato and of course, this is our single most joint security alliance frankly is as important as ever given the situation in europe and the

ukraine. so not just to discuss that situation but the steps we're taking to reinforce the security of our allies with the vice president's trip and to the baltic states and poland as well. there will be full discussions of the defense and the preparations. following the meeting with the secretary-general the president will give a speech in brussels the president will have the chance to discuss his vision of european security obviously the situation will factor heavily into his presentation italy reinforces the united states to remain committed to a strong alliance with the integration of europe with the values united states stands for including a probe

individual liberty but to make their own decisions to have the integrity respected. following that speech the president will the bar where he will spend the night on march 27 the president will begin his day with the audience with pope francis he has long looked forward to meeting him he has acquired his leadership as his first year as pope to address issues like income inequality and his leadership so that will be an important time to have personal interaction with the pope to hear about his agenda he has launched in his first year. the president will be to with the secretary of state to discuss what the vatican and is doing. after a visit to the vatican

he will meet with napolitano said he had them a good series of discussions with him on the phone to discuss the situation but also broader cooperation. , make that press conference the president will have the opportunity to tour the coliseum in rome and he is looking forward to that opportunity. then we go to saudi arabia the president will have a bilateral meeting with king abdullah with another opportunity to invest in our most important relationship in the middle east gulf region with a broad agenda in terms of our ongoing support with the syrian opposition with the ongoing

peace discussions as well as both the nuclear negotiations with iran but the joint concern for destabilizing actions across to the patient then the president will spend the night in saudi arabia and returning to the united states on saturday. >> good afternoon. over the course of this trip to the president will mobilize the international community and some of the most important partners in the world at a time when we deal with the number of important challenges. if there is a common theme is the fundamental strength id importance of alliances and partnerships. not that they can be overstated from europe to asia to the middle east it is essential to making progress.

to be but the most important institutional partners the g7 european union and nato to have bilateral engagements all traditionally strong allies these take place against the backdrop of the russian intervention of ukraine it is clear for the entire world to say -- to see it leaves the international community to support the government of the ukraine and with the imposing cost against ukraine. at the same time we are building a strategic cooperation by moving forward that was of vital engine. in job creation. by strengthening nato as the world's leading instrument of collective security by

advancing efforts to have nuclear arterial so around the globe through the president said pitcher initiative of the security summit. read while we continue to focus on the rebalance to asia. after tension through to the closest allies the republic of korea and japan with the trilateral meeting to send a powerful message about america's commitment to the security of north east asia but the president will also meet with the president of china to finance efforts to cooperate where we can on a range of issues from a climate change to the korean peninsula. we will begin enforcing our most important relationships in the middle east. on the margins of the nuclear security so that the president will have the opportunity to spend time with the crown prince of the uae bin to travel to riyadh

for a very important meeting with king of delilah that we are very much looking forward to. added time to engage in the nuclear negotiations with iran working to try to bring tuition to middle peace negotiations and it collective efforts to strengthen the syrian opposition. by a investing in the core partnerships to make progress on the agenda. we are investing traditionally with strong and flexible coalition the to these regions that are full small -- force will the players we should not bear all the burden alone and we

don't because that group of alliances i and confident to manage the complex mix of international issues like the ukraine or ivory and/or syria. also continue in our ability to make progress on key elements like the a share rebalance with us at issue so with that i am happy to take refuge questions -- a few questions. >> is a your gold next week to get the europeans to agree to the same set of sanctions or the unwillingness of the russian

economy? and will you lay out clear lines for the steps they would have to take to trigger those? >> we aren't in constant communication as i talk to my counterparts we have been on the phone so coordination already we saw that yesterday when the european council on the same day we made our announcement came out with a strong decision of its own which included the only additional support for the ukraine but the designation of individuals as well as a strong statement of readiness to impose broad economic sanctions in the event the situation escalates. that matches the theory behind the executive order

that obama signed yesterday that it gives us the ability as needed to target sectors to be designated within the russian economy should circumstances necessitate. we are quite closely coordinated with our partners said g7 could deepen that coordination even as we have the chance to step up the collective support and consider the optimum disposition going forward in light of recent developments. >> the "wall street journal" said the white house canceled the planned meetings in saudi arabia because of a rift with the persian gulf leaders. >> that is not accurate there was never a formal meeting schedule. we had contemplated a few

weeks back to begin preliminary consultations but then the situation the members has grown more complex. while we maintain a strong and cooperative relationship with each country we did not think from their point of view the time was up the wall for a collective meeting. >> with that fundamental reassessment. >> in the years since the ending of the cold war with the international community we have made clear our

interest was a more fully integrating into europe and the fabric of the international system. that was predicated on the expectation that russia would play by the rules. economic and security rules and international bodies and the principles that governed international action. we have seen with the ukraine is a very egregious departure causing the country's in people in the international community what does this mean and what are the implications? use saw a stark example of the u.n. security council last weekend when the shell was alone. even without china with

there is no legitimacy the world said absolutely they reject they would not accept the annexation it was hidden blatant violation of the territory of the ukraine and will have consequences and it already has been back russia obviously is a big participant do you have an idea who is represented? i know there is some speculation of secretary kerry and is there anything you want to use to talk about isolation and? >> nuclear security is where the indicted states has an enduring interest with other important countries where the security of nuclear materials remains of a concern.

the nuclear security summit is an opportunity for countries to come together to levant's a very important agenda through this administration national security policy to make it harder and harder for those who may wish to use nuclear materials for terrorist purposes to get their hands on them. there is a series of steps that has led to serious improvement with the security materials around the world. they will cooperate with russia even if we have differences. the foreign minister that represents russia i think that was there plan spinet united states sends the commander in chief civic that is there choice to make it has been for a while.

i don't think there is ever the expectation that president putin or president ned did have one dash megabit have would come to this one. >>. >> ambassador bryce what do you think vladimir putin is up two? overnight he said they should hold off on countermeasures in response to sanctions is he trying to rewrite the end of the cold war through confrontation with the obama to elevate his status? >> i will live speculate about president threatens motives. his actions are clear. we have expressed our opposition to his invasion and annexation of korea with -- crimea and our view is that the situation in should

be escalated and resolved through dialogue and diplomacy and we believe that it can be of that is the choice the russian federation makes even as we impose cost to signal it could increase to support in the credible efforts. >> would the president delivered a message to russian leadership? >> secretary hagel has had two important calls with the ukraine minister of defense he encourage them to show restraint. how concerned are you about the ukrainians been pushed into responding to give putin an excuse to take more territory? and also a phone call to the russian defense minister that 20,000 troops are on the border. it was explained there is a military training exercise. do you believe the russians?

how do you believe them at this point when they said they had no intention in to take clivia of? >> i think we are characterizing what the secretary counterpart said to him yesterday i would not describe the value but what secretary hagel has been doing with close consultation with his ukrainian counterpart similarly to what secretary kerry has been doing with the prime minister and the foreign minister as the ongoing effort to to show support in partnership to the people of the government with diplomatic support a hint increased economic support and that is the reason for our efforts to work with congress to work quickly to implement the

legislation and the million dollar loan guarantee which is critical to support the ukraine. and is ongoing with russian counterparts. >> are you concerned about ukrainian restraint? he said are you concerned the ukrainians will push back to give putin an excuse to do more? than it this is a fragile situation but we have been an admiring of the posture the ukrainian people have taken to exercise enormous restraint in the face of obvious provocation and have made clear their interest is in the unified democratic future to live in existence with russia and western europe and the united states. the president said that is not necessarily intended to.

of the ukraine has a history to let it be simultaneously working constructively with russia. >> there are reports today there are more than the 20,000 number gathered along been the segments of the ukrainian border. what have you said to russia at? >> we have been taking note of developments along the ukraine border in the russian border. that was part of the substance of secretary hegel's telephone conversation with his counterparts becker things getting worse? >> it is not clear. the russians have stated they are intending military exercises and the gap between what they have said and done we are watching with skepticism.

>> you said russia has not followed the rules put over the last couple of days? how far is the white house willing to go beyond sanctions when it comes to russia and the isolation and? in the quarter you implying beyond sanctions but the united states has been leading the international community to the point where we are now there brushup finds itself by the isolated from the exhortation of the international community from the united nations security council and europe, the united states and other countries coming together outside europe to impose economic cost to indicate it will escalate if the situation on the ground escalates. we support the ukraine an inactive and affirmative way

to be able to conduct the upcoming election. this section which is coordinated among the entire world is emblematic and increasingly of the isolation russia is facing. >> with the request for hardware whether the options of the table? >> the national security team we have to view of wide-ranging but it remains on the diplomatic instruments at this point. our interest is not to see if it escalates or evolves into conflict but a diplomatic resolution tuesday escalation and economic support for the ukraine to the extent to it

continues to be necessary with those further cost imposed on russia for its actions. >> what about economic sanctions? moving to the next bubble? >> -- level? >> thank you. can you point us to the impact you have seen so far is the next step sanctions for the russian government? what does that mean to have a global impact? >> first of all, these measures have had an initial impact looking at the market's and the currency in the major preteens agencies over the last 24 hours that

these steps are consequential. the executive order signed yesterday is a tool that allows even broader action should that determined to be necessary including for the secretary of treasury to impose sanctions in various sectors of the rush said the economy. we have not taken in that decision that is not our profit and one dash preference but if the situation escalates that is a tool at our disposal. >> what would you say is the primary aim? is said achievable in do we expect in the cage with syria? finigan i think the meeting

obama plans to have a study rubio will cover a broad range of issues and the strength of our cooperation and counterterrorism a regional issues. this is long stephen king it to both countries and in all opportunity to affirm that to find opportunities to strengthen and deepen. with those nuclear negotiations beyond the nuclear issue of security issues and commitment to our partners in the region i imagine the situation with the middle east peace process is the range to mention iran in particular is a topic of the importance

>> what is different so far? part of our cooperation is excellent and we expect to deep bin if further. >> talk about the division is there rubles for the u.s. to bridge the differences during the meetings with saudi arabia? >> first of all, we have good relationships with each of the countries and be the poorer to maintain those with a pattern of cooperation between the united states as a whole. i don't think mediation is the down i would use -- the

noun i would use that we will hear from our partners from saudi arabia and the uae for all rappers to encourage the continued cooperation with those partners that we think is mutually beneficial. thank you. >> ambassador rising and bin roads i am here to take questions that you may have about 15 more minutes if you need me. >> the ambassador said the relationship with russia what is the effect of that on the talks with iran? >> we view it is in russia's clear interest that iran not

be allowed to pursue possession of a nuclear weapon. thus far russia has been an important part of the up process and we hope and expect that collaboration and cooperation will continue because of the shared interest of all members that process have a and russia has in particular. . .

christie. >> given everything that the ambassador said about the changing relations with russia, talking in terms of a new cold war, is the president thinking now about talking to the american people on this subject, but in this and some larger context? >> you read the president begins to them the subject. he noted very clearly that

russia has acted in ukraine, specifically primary -- crimea, violating a sovereign nation tearing up to about territorial integrity, violating the commitments under the united nations charter and its commitments through agreements with ukraine itself. it also is at odds with what has been a 20 year effort, mostly, not entirely, but mostly in one direction toward integrating russia further into the international community and international institutions to my into the fabric of europe, the global economy. so what we have seen obviously represents a serious step away from the integration. it is concerning and problematic. it is not good for europe, the united states, the world, but it is least good for russia and the

russian people. we have seen the impact already on the russian economy that ambassador rice noted. further escalation will result in further isolation and higher costs that russia will incur because of these actions. i don't have a schedule for them next time the president will address this issue, but it is clearly one of concern, one that he has been speaking about regularly for the past several weeks and they expect he will in the future. we pursue this matter with a clear i'd focus on our national security interest among our commitments to our allies the than an all-out is to file alliance and our commitment to the ukrainian people and they're right as a sovereign nation to choose their own future. >> a quick question about that expression of support for the ukrainian government.

how much to you feel it underpins the masses of the loan guarantee is were stalled? >> we believe that there is broad support on capitol hill for providing direct assistance to the ukrainian government in order to help ukraine get back on its feet economically which in turn will help it move forward especially toward all the elections that should move forward quickly through congress we also believe that part of that commitment to the ukraine in the new ukrainian government is the need to ensure that the quota reforms for the imf for past as well. lawmakers of both parties believe is the president as an

aide to maximize your assistance we can provide, the way to do then is to pass legislation that includes these reforms that the and left because that will increase the flexibility and leverage the imf as. the assistance that we envisioned providing and that congress supports generally in providing the loan guarantee program is a piece of and a complement to the most substantial assistance to the imf can and should provide. a lesser. >> this survey by the russian federation imposed travel restrictions. some members on the hill to it that lightly. i have two questions. did the white house read the response by taking it lightly as some of those on the hill did or is the white house concern about the reaction from the russian federation signal that this is going to be a pain pawing of sanctions back and forth for some prolonged time? >> the way we look at it here,

alexis, is that it is certainly unfortunate that an action like that would be taken in response to the firm commitment the united states is made to the sovereignty and territorial integrity of an independent nation. and to the effort that the united states has participated in and led to provide support to the ukrainian people and the ukrainian government and to oppose the a clear violation of the national law that the russian military intervention in crimea represents. but we are focused on everything on the back half of the paragraph which is what can we continue to do to support the ukrainian people? what actions can we take as necessary to insure that russia understands that there are serious costs associated with the decisions that the russian is making.

we are also focused very much on strengthening already what is the strongest alliance and the world, nato, taking the steps we have taken with increasing our deployments in the baltic nations and poland because of the importance of that alliance and in having the kinds of collaborative consultations with the european partners a you're going to see the president participate in a person's coming weeks. >> has apologized for questioning u.s. commitment to israel. trashing john kerry, can you confirm that he did apologize? is the u.s. conference or have their received any assurances that minister yahoo will no longer be an obstacle to our efforts? >> i'd obviously speak for him. the was quite clear about our view of his previous comments

which are simply inconsistent with the truth when it comes to this country and this administration and secretary carries commitment to israel's security. i would point me to the affirmation of that at trimester netanyahu as may when it comes to the singular nature of the specific and concrete commitments to israel security that president obama has made and is the ministration has made and would point you to comments of other leading officials in israel to that effect as well. >> can you flush out any details about the who, what, where the meetings? >> i can tell you that the president looks forward to having that meeting in which you will sit down with the number of executives from tech firms to continue his dialogue with them on the issues of privacy, technology, and intelligence following the president's january 17 speech.

we will have more information after the meeting if we can provide it. i can tell you that the following ceos are attending. rita hastings, drew houston, dr. karp of palin tear, aaron levy of fox ameritrade of the will and mark zucker burden of facebook. >> how did the meeting with the chinese president it set up? is it about anything special it want to discuss? the east china sea, what exactly? >> i don't have more on the agenda for that meeting them ben and susan outlined in terms of how it came about we like georgia and opportunities for president obama whenever practicable. as you know, they have met several times now including california. this is an important relationship that includes a panoply of important issues,

economics, security, and environmental issues, for example. so the -- i am sure you can expect a full range of topics to be discussed. >> the healthcare deadline will be coming up. just returning from the trip to utah to talk about what kind of preparations a going on while he's away. obviously. can you address of the critics have been saying they you have not released numbers on how many people or not -- were previously uninsured to arnelle being injured as part of the five million-plus that have signed up ? >> let me -- on that one in terms of that break down, if it is being calculated that would have to refer you to cms. but i think it is confusing to some viewers out there depending upon the l.a. pontefract that this system that the affordable care act created, the system of

private insurance, specifically aimed at the individual market to most americans to get and have felt concerns receive it through their employer. others, of course, senior citizens on medicare and other americans receive health care through medicaid. the private insurance market is set up by the affordable care act and the state marketplaces. they are aimed at the individual market and in that case that insured within those marketplaces. so i know that the, you know, the sort of criticism is a movable feast. each straw man in this debate knocked down, there is a new one that is set up. maybe this is it the result of the fact that in some places somebody in as state is finding out that through the marketplace is the insurance is available,

more affordable and higher quality than what they have before which is certainly often the case because the standards are higher than i set by the hca. that would be a good thing for the individual who's able to get that insurance and an improvement for them. so we are going to focus instead on making sure that the system is working so that americans can get there options and avail themselves of the insurance plans that they can find on health care website and said further implement the affordable care act because millions of americans are demonstrating through the federal estate marketplace is that they want this product and, you know, i am sure that no matter what the number is on april 1st, no matter what the demographic is, no matter what we will still here from the critics. >> on the march 301st deadline , is there going to be

any kind of grace time at all for people average trouble with the website on that last a? that could be a lot of traffic. >> actually, the deadline for enrollment, you have heard us make that clear. and, you know, i would refer you to hhs and cms for procedures that, you know, might be in place for dealing with low will probably be an increase in interest toward the end of the enrollment time frame. as you see in all kinds of enrollment and how that volume will be handled. but the march 301st deadline is the deadline. >> if you sign up on april 1st -- >> as was the case for the december deadline, we want to make sure that people who are already in line confess their roman. but for how the process works i would point to what happened in

december and have the play out. i would refer you to cms and hhs for have to explain how that works. again, we want to make sure, as we did in december on that deadline the folks who have begun the process i will to completed. we certainly expect naysayers not withstanding that there will be continued interest-rate up to the deadline and will probably increase as we approach the deadline. yes, sir. [inaudible question] >> the united states is of deep concern at the turkish government has boxes as access to basic communication tools. we oppose this restriction on turkish people, access to information which undermines their ability to exercise freedom of expression and association and runs contrary to the principles of open

government that are critical to democratic governance and the universal rights that the u.s. stance for around the world. we have conveyed our serious concern to the turkish government. we urge turkish authorities to respect the freedom of the press by permitting the independent and unfettered operation of media of all kinds, and we support the people of turkey in their calls to restore full access to the blocked technologies. >> jay, is the white house considering a change in and smart phones, leaving blackberry and going to some other brand? >> i can tell you, the reports on this are somewhat -- i don't want to say misleading, but they create the misimpression. the white house communications agency is part of the department of defense. veterans like you know. for questions about their devices i would refer you to them. i can tell you that the executive office of the president is not participating in a pilot program with regards

to hand-held electronic devices. john christopher. >> can you comment today on a statement from the u.s. ambassador at the u.s. is preparing military exercises in poland which will include the polan said republican moderate, slovakia, romania. >> i would refer you to the state department. >> some briefing at the white house about terrorist action regarding the missing plane? this second question is what is the definition? >> lara did not submit that question in advance. and the answer i am about to give i am going to make up right here. >> watching some. >> well, what i would say on this first question is, as you

know, the united states is providing assistance to the malaysian government in its investigation and in its search for the missing plane. and we have not here in the united states reached any conclusions about what happened to the plan now where is. we are as part of that investigation that is being led by the malaysian government engages in an effort to try to our look at difference in areas and make decisions about and conclusions about what happened, but we are not there by any means. this is obviously a challenging situation from malaysia and everyone participating in the investigation and the search. on the other 11 man's breaking news is another man's news of the day to my would say. i'm not sure that means anything. i know. i have to go in a few minutes.

i'm not going to way into that debate. [laughter] >> no, i have a meeting with my boss pretty sen. i will take one more. [inaudible question] could be deployed in the event of evacuation and the crane now that russia has formally annexed crimea. what would constitute an escalation of that moving into the rest of southern ukraine? >> that was certainly constitute escalation. >> would there be escalation -- do you need -- without russia moving into the southern ukraine could as economic sanctions be imposed? >> i think that you could follow the road a long way and try to create specific parameters. what i can tell you is there are a variety of ways that

escalation could take place. recently hope that it does not. the scenario represents an escalation. what if it were to happen. but the fact is it is not our preferred path to have to resort to the imposing the sanctions on sectors of the russian economy that the president described, but we have the authority to do so should russia shoes to the further escalate to, you know, make the situation worse. instead what we hope is that russia will choose the path of the escalation and the one that recognizes ukraine's sovereignty , recognizes that it has an opportunity to engage in a dialogue with the ukrainian government about any additional concerns that they have and one that understands from the beginning of the world will not recognize the illegal seizure of

territory that was part of an remains part of a sovereign nation. >> if nothing changes on the ground for a certain time, would that -- >> i'm not going to speculate about that. we obviously, as you will see in the president's trip this coming week have worked very hard with our partners to make it clear to russia that sustained this disposition, continuing this kind of action will result in further isolation and further harm to the russian economy and the russian people. and will erode the authority and prestige that russia could have if it were to choose the abide by the rules of the road that ambassador arrives discussed at the top of the briefing.

thank you very much. [inaudible conversations] "washington journal" continues. communitythe unity health center is located in washington, d.c., just a few miles from the capital building. vincent keane is the president

and ceo of unity health care. mr. keane, first of all, what is unity? guest: good morning, peter. unity community health center is ain washington, d.c. network of community health centers that provide health care, social services, a whole people whorvices to has shortly do not access health care on the mainstream. basically our commitment is to the underserved, to those who are marginalized, including the medicaid population, including the immigrant population, including those who may just identifyt be able to with mainstream health care. federally qualified health center, and it enables people to get health care in

their site come in their local community, and also addresses whatever their specific needs are. we serve about 100,000 patients a year. we have 1000 employees, and we provide health care to the homeless population, to residents of the jail, communities within all wards of the city, as well as how centers. we are a large network. there are over 1000 similar type programs in the united states under the community health center banner. host: mr. keane, what is the definition, the official definition of a community health center? au spoke of unity being federally qualified health center. what does that mean? well, the term federally qualified health center comes from the legislation, which really -- to fully understand, you have to go 1955 when the concept of

a community health center was first established. that was established by president johnson in his war on poverty. there were two health centers set up an very impoverished neighborhoods. one in mississippi and one in boston. 1000 of them basically have been replicated over the last 50 years. what defines a federally qualified health center is several things. one, we must provide hombre heads of health care services, so in other words, it is a whole ability to serve, and ability to serve the whole patient. we must provide services regard as of the ability of the patient to pay. we must be open to all comers. and if you do pay, you pay on a sliding fee scale. and i guess a third and very important parts of what constitutes a federally

qualified health center is that you must actually have a governing board that is at least 51% of the consumers who use those services. .his allows for community input it is locally owned, locally governed by the community that we serve. host: mr. keane, where does your funding come from? today our finding, and this is true of community health centers national wide, we started out in the earlier days receiving federal funds, and we still receive direct grants to provide care to the uninsured, to those who were at a certain level of poverty, but most health centers now also use medicaid, they use medicare. a lot of health centers actually because of the need to -- some people will pay based on their

ability to pay. in the case of unity, we receive revenues from medicaid. the district has been very generous in medicaid coverage, unlike other states. we sit receive money -- we receive money from medicaid, it is attached to the individual, we receive money for medicare, we receive money from the satient's themselves -- patient themselves. we also receive grants. in the case of unity, we also receive private money from foundations and individuals. in that sense, we have a very broad-based funding and support system. i would say at this point, with the expansion of medicaid through the affordable care act, medicaid is one of the largest sources of our revenue just now. host: does the community care

center operate like a hospital? can it be used as a clinic? an an emergency room, a doctor's office? guest: i would think the latter, peter. it is probably more akin to a doctor's office where in fact it is not a hospital, and those of us with experience in hospitals, that implies a long-term -- a longer stay. it is not an emergency room, although unity health care and several health under throughout the united states offer urgent urgent carey offer from the perception of longer hours of service so that people can gain access, but it is not a hospital. it is not a minute clinic. it is akin to a doctor's office aere you weror i might go for range of services.

it is not just a one-on-one doctors visit. the patient is the focus of the service, and that patient may caree with their primary provider, which could be a nurse practitioner, a doctor, or a physician's assistant. they also engage with a nurse. they also engage -- many of them because of the complexity of their illnesses will need what we call case management and care management, and the focus under the affordable care act today is what we call patient-centered medical home where the patients literally is that the center of his and her care. that patient is also educated to take responsibility for their health care. that is more than just a doctor's visit. the doctor is critical to that, but he or she has a team that surrounds them in providing that care, which does not -- it actually starts before the patient comes in, and it continues after the patient

leaves the office. there is follow-up, there might be referrals. and in some cases to doctors, hospitals. it is primary care focus. in other words, preventing illnesses, or venting folks from going into the hospital, but being able to recognize when that we haveh care access to get them in there, peter. host: we will put the numbers on the screen. for the rest of this morning's "washington journal," we will be live from unity community health center in washington, d.c. we will begin by talking to vincent keane, president and ceo, who we are talking to now, and then we will talk to a couple of doctors from the health center as well. if you live in the east and central time zones, (202) 585-3881 for those of you in the mountain and pacific time zones, and medical professionals, particularly if you worked in a community health center, we would like to hear from you as well. (202) 585-3883.

you can also send in a tweet as twitterspanwj is our handle. mr. keane, how has the affordable care act affected unity health car community heal? guest: well, the affordable care act is one of the most significant events probably in the last 100 years in terms of providing coverage for folks who lack access to health care. for the most part, the aca, the providese care act, opportunity for people who were previously not covered by insurance to get covered. ways.as in two by the expansion of medicaid and by the exchanges. that helped health centers

nationwide to serve those who were not previously served. in other words, yes, the answer is the aca has been a very significant -- has had a very significant impact in increasing access to care for those who had liked it. how does that impact health centers? it increases your patient load. and also we have to be prepared for that influx of new patients. committee health centers nationwide serve over 20 million people, 22 million people. i the time the affordable care act is fully implemented, we serving nationwide up to 35 million people. here in d.c., we expect our population to come to our community health centers to grow. however, the district, as i have said before, has been very generous in terms of its coverage. as you realize, in many states, they are not covering medicaid, which was the original intention of the affordable care act, and

that is going to limit some of those who could have coverage if they were open to that, but you will hear later on from one of our physicians that's one of the challenges that health centers how are weface is -- going to have the manpower to take care of that influx of new patients? dr. robinson later on we'll talk about that in terms of some of the creative ways that unity and other health centers nationwide are affecting that. so definitely the aca is focusing on the right things. number one, it is focusing on prevention. onit makes us focus more prevention, getting people into care earlier, and also if they focus on primary health care to prevent the issues you addressed earlier about admitting people into emergency rooms and hospitals. of course, in addition to that, there is great advantage is in untilof covering kids

they are 26 years old on their parents -- so a lot of opportunities in the affordable will benefit health centers, but more port it will benefit the people we serve. host: mr. keane, any downside for chc's and the affordable care act? guest: the potential downsides, again, are probably -- you know, we have historically relied on federal funds direct from the federal government. those funds are still necessary, and i think it is greatly important that our congress realizes that even with the affordable care act, and it is wonderful, it is still not going to cover all of the expenses associated with running a health center, taking care of a population who have chronic rate thanat a greater the general population. as i indicated earlier, peter, a patient comes to our health center with chronic illness --

they need more than a doctor. they often might need language translations. they will often need mental-health services. these are services that are not always directly reimbursable, so we are pleading to the congress to recognize the ongoing funding through these trust funds for health centers, which was established under the aca, but needs to continue, needs to be refunded so that as well as drawing on the affordable care act reimbursement system, that we can always -- also get federal response to continue to fill the gaps that are there. so i would say it is not a downside, but it is a worry that the federal government continue its direct funding to community health centers as the needs expand. fundingextend that to for teaching health centers, where we can teach the workforce of the future, and i would extend that to something like the national health service corps, which is a key workforce

pipeline for young men and women in the country to work in underserved and rural areas, and they get grants from the government to do so. so increase funding, sustained funding as well as all the other advantages of the aca will ensure access for 35 million medically underserved people throughout the country. can anybodyt keane, go to a community health center? to anyone.re open our primary focus is of course the medically underserved. those who historically have been cut out of the mainstream system. those who are perhaps economically disadvantaged, linguistically, other challenges. so our primary focus would be on that level of population, the underserved in whatever category, whether it is financially or not. however, with the affordable care act, we are recognizing

that there is a new covered population, and that would be the folks above 200% of poverty. i hear them being referred, some of them to the invisibles, -- invincibles, the young, 26, whatever the invincible age is, i don't know. that is the new population. it is good to get them into care both from a risk reduction for the system as well as for improved outcomes because that is a general demographic that young people do not seek health care during that time, yet that is often a time when chronic illnesses, other social issues impact theirreally long-term health. so we are saying yes, we are open to take care of those that historically been part of our mission, however that mission starts to creep a little but as we can see people a little but above the poverty

line. with medicaid expansion, people are actually going to be flipping back and forth between medicaid and between the insurance exchanges, so at unity and community health centers will be there for them regardless of their covered status. is ourincent keane guest, president and ceo of unity health care. (202) 585-3880 if you want to preserve a, east and central time zones, (202) 585-3881 out in the pacific, and medical professionals, we would like to hear from you as well, (202) 585-3883. david in glen cove, new york, good morning. you are on the "washington journal." caller: yes, good morning. i have a couple of questions. i have a feeling -- what if somebody comes to the health center and gets diagnosed with, let's say cancer, and they are

told what at that point? are they told to go seek a hospital? and how to they pay for this? host: if you can hold on for just a minute, mr. keane, we will get the second question as well. david? we are listening. go ahead with the second question. caller: the second question is is the health center really targeting people below the poverty line? care, how do they pay for that the health center cannot provide and are told well, you have cancer or you have a terminal disease that you have to go to hospital? host: all right, david, i think we got the point. vincent keane. guest: david, very good question, and is a challenge that many health centers it turns on a day-to-day basis. the answer to your question,

david, will depend a lot of times on the state in which that person resides, but in terms of unity in the community health 's responsibility obviously is for the whole person and for their long-term continuity of care. so a patient comes in to our health center, is diagnosed with cancer, here in d.c., thankfully, we have a system. medicaid is generous. we also have a city run program called the alliance. generally speaking we can get that person into a hospital for diagnosis, procedure, and treatment. i am not saying that is true in every state. each state, each health center has to come up with with the continuity of care land. a lot of times these are based on the generosity of hospitals who are willing to kind of make their resources available, but here in d.c., if you came in and would becovered, it

our responsibility at least to try to connect you to the care. 90% of the time, and i am sure one of my physicians can be more clear on this, 90% of the time that person would be able to be connected to specialty care and hospital care. david, that is not true in every state, and i think you said you are from new york will stop in new york, medicaid may be more generous, but i certainly can assure you that it is a challenge. at the same time, a health center needs to be connected to other medical institutions to , thatthose relationships actually address serious problem for the help center is not capable of addressing. i hope that answers your question. host: john is calling from houston, texas, a physician. hi, john. caller: hi. guest: hi, john. caller: hi.

i served in the early to mid-1980's in a community center migrate clinic in south texas on the border. my experience with that it was like we were a full-service health facility, and basically a one-stop full-service place for -- and iation, however have not been involved with the community health centers in a long time, but i do recall at that time it was up the thatning of my career there were, how shall i say it, local medical political influences, at least in the way we practiced in our community, and i was just wondering if that has changed over the years werese even though we

colleagues with our practitioners in the private sector, there was always a little bit of tension about and we always had to kind of be kind of careful issued referrals because we relied on our doctors and the private sector to provide specialty services to our patients. i would say the people that needed services that we could not provide, we had a very strong social services department that were able to individually evaluate each person to see what sorts of services that were available locally or reasonably that would

solve whatever problem it was that we were trying to address. host: all right, john, thank you very much. mr. keane. andt: thank you, john, thank you for your service in texas. i have a lot of friends in that area, and brownsville and others that have served in a community health center, and the national health service corps through which you came is still a critical element of our workforce resource. the answer is exactly as you said, john. buildhealth center has to relationships with its local services, other private practitioners, whether it is hospitals, and particularly specialists. you are absolutely right. sometimes we have to rely very much on generosity. is there competition? well, yes. generally speaking there are not competition for those who are not covered and are uninsured and do not carry a payment

mechanism. i would say the answers your question right now, john, is there is more competition today because with the affordable care act, all of a sudden, many entities are coming into this market that historically have not played in this before. historically did not want to see our patients because they do not carry a payment mechanism. so health centers are going to experience composition, but i am confident that the quality of care that you get at a health center is second to none, and we kind of welcome back competition. thank you. lancaster, is in ohio. jenny, go ahead with your question or comment. caller: my comment is i think it is ridiculous that every time you turn the tv on, you have all these commercials for , and people do not know with those medications are. only a doctor or pharmacist

would know. and the health care gets attacked up skyhigh. up skyhigh.ed i think that is what make a lot of the medicine go up in price. host: mr. keane, as a medical professional, what is your opinion of that? i would probably venture to leave that to one of my other guests. let me just say, there is no doubt about it. there are many factors that are contributing to rising prices and rising costs in health care delivery. no question about it. our caller reflects the certainly, youd know, there are people alive today who would not be alive without medication, and sometimes those medications are expensive. health centers deal with very hard allele patients, so that education plays an -- health

centers deal with very chronically ill patients, so medication place an important use. that is where our care management comes in. there is real i love about that. the other issue she brings up his medical malpractice coverage. generally speaking, in some cases, medical malpractice coverage increases the overall large as quite as , iple tend to think, however do think that there has been a tendency in the past to practice expensive medicine, but generally speaking i think our doctors are there to take care of patients. they are committed to that, and yes, you want to be sure that your patients always have right of redress, but i think the two issues she mentioned do have an impact on health costs,

medications are important, of course being able also to educate the patient because a lot times a patient may be on multiple medications and is not really know enough about them to address that issue. host: mr. keane, how many physicians do you have a unity? are they full-time? are they volunteers? actually, when i say physicians, we include in the physicians all providers, that is psychiatrists, nurse practitioners, medical physician assistants, dentists and podiatrists. we have 180 in our network of serving 100,000 people a year. and these are various levels of discipline. we focus a lot on primary health care, we focus on pediatrics, so we have a very diverse array of

physicians and providers. see a very diverse population ranging from babies preterm all the way up to senior citizens, so our services are geared toward that, as are most community health centers. we have grown significantly in the last several years and taken on additional health responsibility, particularly in the jail, that requires us to increase our workforce, which we are always excited, and we invite any young or middle-aged or older practitioners who might be out there, wanted to come to d.c. -- unity would be a great place to come to. rich, brodheadsville, pennsylvania, you are on "washington journal." caller: since the aca came

about, i am now covered under my wife's insurance. she works at a state university. under the aca, we still have our same doctor, same coverage. we have not lost in the coverage. we get an x or $30 on the paycheck every paycheck, so there is a plus. thee the other thing -- other thing i'm noticing since the aca came about, it looks like a lot of committees, right down the road from me, there is a satellite medical center. that is good, that is providing jobs and helping the economy, but the entire thing of this is, you know, with the whole aca, 69% of people who haven't now are satisfied. they are content. yes, there are problems with it, but how can people be against something that is giving people health care who never had a before? and the right wing, the republicans want to take what is helping people's children and cut it and leave those people

who do not have insurance before -- now they don't have any health insurance, and they are back to where we are before. why would republicans want to do them? i find a heartless, senseless, and downright -- well, we know why they want to get rid of the aca. you do not have to be a brain surgeon to do that. your point.k we got did you want to ask another question very quickly? caller: dave medical centers we , if a patient goes in there that is not have insurance, is there funding, is there aca laws that help fund these patients, you know, that he not have insurance? host: we got your point. thank you, rich. mr. keane? guest: thank you, rich. i think your remarks from the aca from somebody who serves previously unserved community,

absolutely, everything you say is correct. i am not quite sure, and i think i mentioned one of the callers earlier, there is a competition coming up. some local pharmacies are setting up many clinics. some local institutions are setting up more like urgent care centers, where people can get access to the health center, to patients who were not previously served. if you are setting up a community health center, if you a federallyup qualified health center, nothing changes for that person who does not have insurance. the same for primary care based on their ability to pay and that is our mission, that is our charge. that goes back to our founding in 1965. you talk about something that i think is very important. we employ over 1000 people in the district of columbia.

that is a significant business initiative. some of our health centers throughout the united states and are economic engines within the community, and that is critical, as well as delivering health care because as we know, unemployment, poverty are contributing factors to poor health outcomes. host: smiley tweets into you, mr. keane -- how do you reach the poor, rural people? they have the highest interest rate and no health insurance. thank you. this is the challenge of every health center. how do the community health centers reach them? has anommunity center outreach program where they have folks, i mean, the best way of reaching folks is by word of mouth, getting the word out. some health centers are very creative about how they use, how

they educate and market themselves. some have established mobile outreach vans to go out into the communities. some health centers actually have home visitation programs where in fact they go out with resources. for instance, here in unity, we would have home visitation programs where those folks who find it difficult to come in. rural health centers have come up with very creative ways. i have not had that experience myself, but mobile outreach, , gettingtation transportation is often a barrier to getting people in for health care. these are initiatives that every health center takes upon itself to make sure they are serving the population that has been designated to them. now, i would have to say that part of our mandate really is

not to build a health center and hope they will come, but rather to actually build a health center and actually make sure that the community is being brought into that network of care. are their strength on how you can spend your federal funds? guest: yes, there is significant oversight responsibilities attached to receiving federal funds. to beare audits i need done on medicaid and medicare annding, and yes, our funds c only be spent directly on primary care is an all of those ancillary services associated with primary care such as social services, dental, all of that. for instance, going back to one talked aboutrs, we we cannot pay for hospitalization for people. we cannot pay for things that as

it were happen outside the walls of the clinic. we can set that up, arrange for , developnship agreements between hospitals and ourselves, however, we cannot pay -- in other words, there are our designated services that are allowable under our grant that we must be responsive to and consistent with. oversight.lot of i mean, this is not money that is wasted. this is not taxpayers money. we are very conscious of our responsibly to become good stewards of taxpayers' money entrusted to us on behalf of the indigent and those who are underserved. host: john in evansville, arizona, thank you for holding. you were on with vincent keane, president of unity health care community health center. caller: my grandson is a resident physician in annapolis, and he serves clinics for the

poor. being that loan is so, he is being helped out on that by the service. he recently said that that was going to be reduced or cap. -- capped. do you know who is responsible or what can be done about this? thank you. guest: ok, peter, there was part of the question i did not get. the: he was talking about education loans that his grandson received for his medical education. and whether or not those are forgiven. or reduce. guest: yeah, i got that, and actually, that is a very significant concern we have. when i spoke earlier about the federal funding, he may have been served through the long repayment row graham, the national health service corps. it is quite possible that that

is reduced, and there is an issue that several of us throughout the united states are coming to try to address this week. there is a national meeting here in d.c. where we are trying to cross the fact that another 15 million people, you cannot put them into coverage without providing them access through your doctors, physicians, nurse practitioners, so a significant component of that is loan repayment and scholarship. we just have to really advocate strongly for that not to be capped, not to be reduced. that is a challenge, and i agree ath the caller that it is worry, and it is a worry for those young men and women coming into the medical health system, and teaching that their support may not be there be on the next couple of years, and it

a criticals recruitment issue for health centers and indeed for the medical system throughout the united states. host: vice president joe biden will be speaking to the community health centers organization association today. that will be live on c-span at 10:15 a.m. eastern time. kathy in santa fe, new mexico. caller: good morning. i called to see if i can find carehy dental and vision is it better paid for by our older people. we need our teeth to chew to get good nutrition, and we need our vision to read the labels on whatever we are buying. host: thank you, ma'am. mr. keane, are those services that you provide? guest: thank you very much, and i certainly identify with her as i am getting older myself, and with teeth and vision problems.

in early speaking, she is correct. dental and vision are very difficult and expensive to cover under private insurance, however, here is where the community health centers come in again. community health centers offer dental and vision services. in addition to that, they often will build -- like in our case, i can only speak to what unity does. we actually do have ophthalmology, we do have vision screening. it is very cripple for people who are diabetic -- it is very critical for people who are diabetic. much of our population is diabetic. so having that service available and then having the proper reserve system. not every health center will be able to do that because it is an expensive resource, however, it is critical, and we are very aware of that. dental is similar. most health centers will provide dental services. there is funding to do that, but it is always, we need to embellish that funding, additional funding, and build