paso i have been there twice. it is really a deportation facility where families come , 8303 family members so far all but two have bonded out one of $25,000 because the 25 year-old guatemalan woman is a national security threat and over 250 deported back to countries of origin. they are fleeing very violent situations and also trying to reunite with family in the united states. we owe it to ourselves and our country to honor the traditions of the united states to make sure they're taken care of. we can afford them due process with the most humane option possible. we have done this for many peoples over many decades. this is the latest opportunity for the country

to put its best foot forward. . .

a strange question because it doesn't work with the framework that you follow. you are from el paso so maybe you could -. >> i think the reason is chief of police and the community that supports law and order and law enforcement, they do a great job and the crime is different. it's entirely different. bridge cases is a major problem. >> we have time for one last question. >> i had the opportunity to talk about that at the end of july and work with refugees. i think they have been pretty poorly portrayed by the media.

there are a lot of desperate people trying to flee bad circumstances but my question really is, because we have such a polarized nation, what are the representatives of the state of texas doing to let homeland security and every other representative and senator from every other state in the union understand that we will never be able to build a wall along the entire edge of texas that will keep people in our out because if you want to know how it felt to me it's like a police state for america as much as it is a police state for the mexicans to stay out of where the central americans. my dad grew up in the rado. the question is, do all of you ever make a point in your commentary to people to let them

understand that border security can just be a wall? there are people that think a wall will take care of it. it won't take care of it. it needs to be much more holistic in the answer. so i mean is that something that you are getting? >> the wall is the 14th century solution to a 21st century problem. i'm waiting for the mexican president to get on the other side of the wall inside mr. president tear down the as well as present reagan did some years ago and again we have to look at what is security, identified the threat, find the best way to address that and then make sure that we work with their international partners. >> folks, we are out of time. thank you so much for hanging out with us today. [applause] [inaudible conversations]

the house homeland security committee will hold a hearing friday in texas about the state's response to the ebola virus. officials will testify before the committee in the dallas-fort worth area about thomas dug in a liberian national who died this weekend was the first person diagnosed with ebola in the united states. live coverage of this hearing starts at 1:00 p.m. eastern on c-span.

>> health and human services secretary sylvia burwell spoke at a kaiser family foundation event on thursday. she talked about health care policy including the administration's ebola response in the next open enrollment period for the affordable care act. this is just over an hour. >> good morning welcome to the latest in our series of kaiser health news health policy newspaper breakfast. we are the leading journal at the intersection of health care and policy regarding his show today will be julie rovner at kaiser health news. you all know her from her 16 years of health policy.

the star of our show today in the reason you are here is sylvia matthews burwell who is the nation's 20 secretary of the department of health and human services. as you know she came to hhs after serving as the director of the office of management and budget with previous dense at quite a few places but most recently as president of the palmer foundation and the global development program in c. uh-oh of the bill and linda gates foundation. we are pleased to co-sponsor this event and i will now handed over to julie rovner. >> thank you ellen. good morning. thanks everybody for being here. thank you madam secretary for being here. i'm going to ask the moderators opening question and then i'll open up to the audience. we do have tv cameras here so please wait for a microphone to get to you before you speak and please identify yourself when you ask a question. madam secretary i think pretty much everyone in this room still has ptsd from last year's open

enrollment. what can you say to reassure us that we won't be having a groundhog day when that rolls around? >> in terms of that i will also remind everyone that a year ago on this date i was still running a government shutdown in terms of the question for ptsd. with regards to open enrollment i might start with a broader lens and come to that issue specifically. first of course i want to thank kaiser and thank you for moderating today. i also should mention ebola. i'm sure we will have some questions about that issue but it is one that we are working on weekly at the department have been for many months actually in terms of the issue working from the office of global affairs where we have someone actually embedded at w.h.o. from hhs team to make sure that is occurring in geneva to all the work that you wall are familiar with at

the cdc is doing. the preparedness at home and attacking the epidemic epicenter in west africa. i wanted to mention that before we move into the affordable care act which was something that i knew when i was coming to hhs would i be working on. the end of my first 100 days basically and as i've gotten to the end of those 100 days between a bowl and the fact that there were 12,000 children in the care of hhs on my right with unaccompanied children i am reminded of a point in time before when i was in the equipment miss -- clinton administration. i was announced i would be deputy deputy chief of staff and helen thomas to many of you in this room probably know said erskine don't you think sylvia is a little bit young for this job? he looked at helen and said in this place a year is a dog year. i'm sure you all realize i'm

reminded of that story not because i'm young anymore in terms of my first 100 days but with regard to the affordable care act and how we are thinking about that and being ready for that it's obviously one of the top priorities. when i think about the affordable care act i think of it in terms of three measures, quality, affordability and access in this particular question about healthcare.gov marketplace is focused on access. it's important we recognize whom for me talk about access of the most important measure their is a reduction in the uninsured. with regard to the axis question as whether legislation was passed. let me think about the measures by which we should judge ourselves it's a question in the reduction of the uninsured. the marketplace is a very important means by which we get there so is medicated and so was employer-based coverage. with regards to the marketplace i think there was a conversation here yesterday about these

issues. there were a lot of lessons learned in those lessons were both positive and negative. in terms of some of the positive things we learned a lot about how consumer behaves and reacts in terms of the consumer workshop against deadlines. they learned a lot about the importance of his technology and from this lesson we put together a plan that we are working on every single day and have been since the day i arrived in before i arrived. as part of that plan there have been a number of pieces. one prioritization in terms of making sure we have prayer denies deadlines that we are meeting on a day-to-day basis and second i think many of you know that we have focused on management as a part of that going forward. many of you i think yesterday had an opportunity to spend time with amy as well as kevin and laurie lewis. those are all new additions to an already strong team that we brought on. finally we are deeply focused on technology so continue to make progress every day on this issue

and we are looking forward to continuing to do that day by day. we are deeply focused as i think you heard yesterday and quite a bit of detail. >> i have my own question. the gao put out a report that suggested plans were not necessarily doing a good job letting people know when there was an abortion cover. this is obviously one of the last issues settled when the law was enacted. here's one plan that doesn't have abortion coverage and one that does. what is the department doing to make sure that i get straightened out? >> first to think it's important to reflect with regard to the federal on the issues of federal funds there are no federal funds being used for abortion in the case as the law states of rape and and the life of the mother. i think that's important is context. it's an issue where we need to make sure the laws in force and

cms's working on a way to work with the states and make sure there's clarity about what the allies. [inaudible] >> with regard to the question of open enrollment working through the plans are in place for the most part. we are finalizing those plans on terms of how the communication is going to work we will have to see how quickly we can get the communication out and where we are. i think the gao report was based on the previous year's plan enough this year's plan. >> let's go to the audience. >> be met with governor mike pence on monday to talk about his alternative proposal for expanding medicaid and they were still disagreements after that meeting. what are the disagreements confident are you that you will be able to -- medicaid? >> with regard to medicaid

expansion everyone knows there are 27 states plus d.c. that have done the medicaid expansion. we are in conversations with a number of states and each of the states as we think about this issue and are working with each state individually there are two things that are the guiding principles of these conversations. the first one is that it is important to listen and hear the needs on a state-by-state basis and the needs of indiana and how that governors approaching it are actually different than tennessee which has also been reported in utah which has been reported in terms of my conversation with the governors. the second issues we have to think about what flexibility they need and what they think is the best approach for their state. if the second thing is there are some core parameters that are statutory and policy in terms of what medicaid needs to provide. that is where we are having the conversation. we are continuing the conversation. the governor and his team and our team have been working over period of the year in good faith on this effort.

i think everyone is coming to the table with a real desire to make progress and we will continue to work on that. >> thank you. dena jones from "cnn." it's a compound question and you touched on ebola's on health care sign-ups to have a goal that you can share for this year in terms of the number of sign-ups and i guess alternatively the number of reductions in the uninsured? is there a target goal and on ebola we all know the temperature screening at somebody major airports in america is going to start but what do you say to people who argue that this is in some cases all for show to calm the public's fears? i think many people could make it through the 21 day incubation period. >> with regard to the first question about our goal, our goal is for the consumer to have a quality experience in our open

enrollment period and we will continue to try to move those uninsured numbers and maximize their ability to do that. with regard to the question of a specific goal and a numerical one of the things that mayors of cb and number that exists is based on a trajectory that gets to 25. think one of the things that is different from on the number was originally put out is now actually have information about what happened in that first open enrollment. so how one thinks about the slope of that line is something we are analyzing and working on and working on from this perspective. our top-down number is how you get to reaching a specific member out there but now we have data and information and we want to try to build that number bottom up based on what we know both of those that did enroll and information we learn from that. that's something we are continuing to work on with regard to that specific question. in terms of the issue of ebola and how we are thinking about the issue of homeland preparedness and making sure

that we are ready as a nation as i think has been made clear by director fauci the important and most important place with regard to kate -- taking care of screening is at the point of departure. that's been in place for many months and as we know we have a case in that case sadly is deceased but for many months we did not have the case that entered the country and the screening, we know that screening has worked in a sense of 80 people have been pulled from the line in the screening and stopped in their home country. that's the most important place for us to do that. the next step with regard to preparedness as we discussed is having a system that can handle any case that we have and we have had one case. i think there may be other cases. i think we have to recognize that as a nation. that's why the preparedness of our health care system and

whether that's the fact that 8000 health care providers have been on cdc webinars or the fact that literally hundreds of thousands of health care workers have been communicated through our health alert network and the seven separate directional documents. those are the most important steps. at the same time we continue to evaluate and add steps that we think are helpful both to fight in west africa and to care for our people. the question of the screening that we will be doing at this time there are couple of things that we now believe and that is the importance of asking the questions, how a person may answer questions at the point of departure versus the point of interest may differ. the second thing is it is true it is period of time of travel. there isn't and i don't think we are making a claim that anything is 100% secure by what is most important is we know. we know how to contain and that is detect, contact, tracing,

isolation and that was what was implemented and we have seen implemented in dallas in terms of the tracking of folks. so we will continue and confidence is an important thing but there's also what will happen in terms of the questioning and what will happen in terms of that period of time. >> thank you. chuck with the post in st. louis. another open enrollment question. as you know there were three facilities around the country that were processing applications during open enrollment and one of them was in st. louis and there were allegations that there was the work being done there. i'm wondering if you can talk a little bit about have those situations been cleared up and have they been fixed and have you gotten a better sense of paper versus on line

applications as you go forward in the open enrollment. map? >> we are hopeful that we want things to happen and occur on line as much as possible. one of the things we are focused on deeply as the consumer and the consumer experience. we want to make sure that we have alternatives and places for the consumer to go and whether that's the consumer's ability to work with navigator some people want to work with a person in the fact that this is new and they want help in other people want to go on line. yesterday we previewed 2.0 which is out right now in terms of the special and roman period and we think tools like that will help people that want to do it on line. we would like to see more people on line. we'll continue to work to ensure that consumers, and consumers have different needs. the reason it's on a mobile app is because we know many people -- young people in that gap use those applications. that's why we try to move it to

a mobile device. we also know in terms of the filipino population actually there is a deep penetration of smartphones, deeper than the penetration of the nation as a whole. what we are trying to do with regard to the question of open enrollment is make sure we are serving the consumer the bus that we can. one, operational operational technology being sound and that gets to the questions we were discussing yesterday about testh consumer ease as we can. will there be imperfections? es. things will not be perfect but i think what we do know is we are aiming for a strong consumer experience and it will be done. >> we saw on the open enrollment period a lot of people signing up you really have low health insurance literacy and a couple of problems i saw crop up. one was people who had been

eligible for reduced cost-sharing silver plans never knew it because they never got past the first screen and ended up with plans with much higher deductibles and they were really entitled to. and the second is the inability of people, and this is not a surprise as we talked about before, really figuring out who is in their networks and i just wondered if you were contemplating any improvement in the interest of the user experience. >> with regard do we are working across-the-board in terms of bad user experience in making sure that people are educated about how to go on, one of the things is this is a complex space to begin with any mention many of these people have not been in the market. i think if i went person by person instead what is your premium and what issue deductible, the people in this

room are the single most educated people in the nation with regard to health care. you are the people that write about this everyday and you think about this every day in for me to go through and go through and tell me your co-pay for every single individual i think we might have some gaps in terms of each of you. so i think we have to put this knowledge question in the context of where we are in the nation. i think that we believe the marketplace is going to hopefully move the individuals who are talking about but i think the question of us as a nation and how educated we are which takes us to an important issue which is the issue of making sure we have high-quality care and affordable care. some people call that system reform. we are working to do that. in terms of the ways we are working to do that are stakeholders are an important part of that education process. having done that myself several times whether screwed america or

group of stakeholders as we are doing outreach with regard to enrollment there are two additional pieces about re-enrollment. they need to do shopping, education and the other thing and that's the marketplace but the other. peace that's the next step is making sure people know how to use the care. i think that's another part of of doing with regard to this question of access to providers. we are working with the insurers to make sure that when you click through a plan that there is a place where you can click to get to that provider listed to create a means. i think as a place where we are are all going take steps as we go. i think your point was about the marketplace was but it was a broader point. >> there are with bloomberg bna.

are you tracking the number of policies that are being canceled because they are not compliant with obamacare and what are your expectations for getting a more normal risk pool this year? >> with regard to the issue of cancellations that's an issue i think you probably know that last year we put in place a policy that would leave the insurers with a choice extending until 2016 as the transition period. we try to create a transition to get to the issues that were raised last year. at this point a couple of things, one we obviously think the numbers going to be a much smaller number than last year. i think we need to recognize the issue of cancellations again in the marketplace before the affordable care act there are policies being canceled in employer-based care. insurers do that so there's the question of what's happening in the regular marketplace and those plants that need to come

into compliance with quality health plans. we believe we can place a transition and we are working with insurers where there are the situation should they have another alternative plan. working through the issue i think there will be a smaller number. >> with regard to the question of the risk pool i think when one sees that we have a large increase, 25% increase in the number of plans and insurers coming in to the system this year as we announced recently i think that is a reflection of the question that the risk pool is something that obviously the insurers believe is a risk pool that works for them economically or they wouldn't be entering and putting plans in the marketplace. >> i'm jim landers at "dallas morning news."

i had a question about the trance. the initiatives of the department. he just put out an open payment system for the links between doctors and pharmaceutical medical devices. you have had on the web for some time now medicare inpatient physician charges. there have been problems with the open payment system on the drugs and pharmaceutical device links in the last week but as far as the other ones go the hospital system say that -- aren't relevant to anything that's paid in the system so it's not really a good indication of what those prices are. what are you doing to strengthen the transparency that cms is providing the public? >> so continue to work and respond to comments. as you mentioned when we put the first set of information open to things we heard was making sure

the information in context. we try to provide more context in terms of their release and anything about that. the issue of transparency when we think about where we were four years ago with regard to transparency and echoes that were consumer question the question is what do consumers have about their benefits and their plans and with the transparency now they know what a qualified health plan as some of those benefits are and those are being clearly stated. across-the-board and provider information around consumer information we are trying to move on all fronts. it's also related to electronic medical records in terms of the transparency that an individual can actually have about their own health care. with regard to what are we doing we are working on all sides in terms of trying to move the information forward so consumers and providers have information

that they can make decisions about and we create a transparent marketplace where decisions are made. can we improve it, should we improve its? yes. when we hear the feedback on the most recent elements of open enrollment we want to do that. one of the decisions we had to make and i had to make the decision is the information wasn't perfect in the most recent rollout. there was data that was not as clean so we had to make a decision. it was better to get out a large portion of the information so that we can continue on this path of transparency. the transparency path because it's new to everyone it's going to take us time to get there. we need to continue to evolve that we think it's an essential part coming back to the point i just race which is the importance of information to decision-making to getting to a place where quality and affordability is about delivery

system reform. >> hi. i am filled with the "washington examiner." i have a question related to the risk partners which a few months ago there was a question saying that if the payments were enough to cover the out payments that hhs would find other sources of funding through appropriations and as we know the gao just released a legal opinion recently saying basically that depending on which language congress adopts that hhs won't be able to make payments using the appropriations language allowing for it. i just wanted to hear your understanding of whether or not hhs will be in a position to

take payments in fiscal year 2015 if congress doesn't put an language allowing at? >> i think that there's a distinction between what happens at the end of the program and the current bridge we have to the fee-based structure the gao was talking about. with regard do we don't have concerns in the upcoming year and as we have said and what we reflected earlier we will work with the congress if there are needs in terms of the question of appropriation. i don't think it's a question that will be need to be faced in 2015. we have been clear we will work with the congress on any additional language. >> maggie fox with nbc. your style and the style of your predecessor have been very different in terms of handlin handling -- than the previous administration.

you have had to deal with the crisis of the rollout of obamacare and now the crisis of ebola. i remember during the bush administration hhs was very much in front. you are taking a backseat this backseat this time. are you happy with that strategy and will it continue? >> i guess i would start by saying i would like to understand the definition of a backseat. i have a head in a bowl and meeting every single day since july 28. i usually have three day. >> can you tell us about that because the public and tony fauci who know and trust, we haven't seen secretary burwell. >> with regard to the sugar bowl i think everyone knows the nation is frightening people are frightened of this disease. they are frightened because it has a very high mortality rate. they are frightened because we need to understand what the facts are about that. thinking about trust and who you want to hear that information

from tony fauci has been working on this issue as he said friday, i think he said 38 years in terms of his work on its face. dr. tom frieden has been working in new york or his work at cdc and when one has such high-quality experienced physician and infectious disease experts -- dr. frieden also has a masters in public health as well. for me that's why i question what you meant. i think what you are suggesting is who is on camera versus the question of deep work on the issue is something i consider my responsibility and do and whether that's on a day-to-day basis making sure that our teams are working on this issue internationally or working on domestic preparedness, that is something i consider my responsibility. with regard to the voices and

the voices on a day-to-day basis i think it's important to have experts that we have been and are lucky to have in our federal government working and thinking about the issues. >> j. hancock kaiser health news. we have written a couple of stories about hhs and the value calculator which as you know is certifying as minimum value plans for large employers which do not include hospital benefits while at the same time for closing the employees who are offering these plans from getting subsidies in the exchanges. a lot of people are wondering if this is something that the administration intended and so far we have had no answer. can you talk about this? >> this is an issue and i'm going to be on this that i'm not

familiar with. the one thing i would say as i think you know the issue the administration is deeply focused on is making sure that people have access and affordable and quality access. within that context. >> these plans don't have hospital coverage. can i get back to somebody about that? >> we are happy to follow up. >> who should i follow up with? >> i think ben right here will be happy to follow-up with you you. >> okay, thank you. >> i'm rebecca adamson with roll call. i have an aroma question and medicaid question. i'm wondering if you are specifically involved in the coalition can you give us an update on the work that's going on with nih and the cdc and public health service and what do you anticipate in terms of

need-based funding that maybe you have asked congress for after this ear expires in my medicaid questions about the backlash between the applications such as california still has an enormous backlog and i'm wondering if you could address that. >> with regard to the medicaid backlog that is something that each state is different so that's something we actually -- so we work state-by-state and are working through that on a state-by-state basis and continuing to work with the state on a plan. think many people know we sent certain types of letters. you probably know we sent those issues and in terms of sending clear signals about the level important and we continue to follow. as i said its retail because each state as to why there are issues in the backlog and we are working on it literally on a

state-by-state basis. with regard to ebola and where we are i welcome that someone has brought up the fight in west africa because this is where it needs to be taken care of. this is what we do and that is why there is no public health system in place to implement the things that we know can contain ebola. with regards to privacy i would reflect when you look at nigeria and what nigeria was able to do in terms of their capability to contain that is a place where we have seen it work and we have seen a work in the developing world system. certainly nigeria has also the advantage there was a lot of polio infrastructure that was used in terms of contact tracing and some of those records in terms of rootsy operation centers. with regard to progress on the ground as many dean of the u.s. military started with the

largest deployment under cdc. we also have the largest disaster and response team that we usually use led by usaid and found a broadband the command-and-control and logistical capabilities that comes with the united states military. they are on the ground. progress is being made in terms of ebola treatment in terms of the construction of a 25 bed medical unit which is an important part of attracting health care workers from around the world to be willing to come and serve their, continuing to get the training which dod is doing and dod has already supporting several of the labs for testing and that's an important part of the detection. continuing along that line at the same time we are also working with the countries and w.h.o. on doing community-based

care. it's not a full ebola treatment unit but while we are getting those up and running and for people who may not have access making sure there is community isolation. so that's the other piece that's being worked on. there has been progress on burials. i think as everyone is sadly focusing on in the united states today the issue of the bull is spreading through a diseased body is an important one. that is clearly being taken care of here in the united states but with regards to making progress there is a place we are making progress. that had to be a behavioral change because for many the burial process which is a cultural issue of how you treat your deceased generally involves touching. that's something we have to work through but there is progress being made. the numbers are going to increase before we can get to a

leveling off point but right now what is most important is that every day goes on the ground efforts that there is urgency. every day makes a difference in terms of number of cases that are contracted. so there is greater urgency on the ground. at the same time i think we are all very focused on the urgency here at home and making sure we are prepared. yesterday as you all know the president colon i was on the call with the governors and elected officials across the country. dr. frieden did another one with the state health officials. the urgency to make sure the country is prepared that we have to work every day to make sure we are standing up the capabilities for these countries to handle this. >> good morning, i'll alex wayne. i want to ask about the other plague that's in the news right now and the one that's a little scarier to parents the united states particularly, enterovirus.

what is your department know about how this outbreak began and what is your department doing to develop either treatments or understand any linkages to serious outcomes? >> the cdc is doing its traditional tracking and working with health departments across the country to understand when there are cases and make sure the appropriate whether it is that virus or not. we are doing the tracking in terms of the numbers and the numbers by state and locality so we have an understanding of that. the other thing the cdc is doing is communicating clearly about the things we believe are most important and i would encourage everyone in this room to step up your handwashing and if you have children to make sure you are encouraging that kind of handwashing. that's one of the basic things and something that before meals and before everything making

sure we are doing that. the last point gets to the core of your question is cdc is working with individual health departments to do the investigatory work to understand in these cases whether it's a question of paralysis or a question of visit directly related to the virus. we are part of that investigative process to determine this things the cdc is doing its traditional work we do with public health. as you are appropriately reflecting this much focus on the ebola issue. our teams are deeply engaged in this issue. >> that's a question i would refer to dr. fallacy. >> i am married with kaiser health news. just a couple of questions about healthcare.gov. you talk about how consumers public response to deadlines. what are you doing with the site to make sure we won't have

problems when we have a lot of demand particularly at the beginning of enrollment and at the end of enrollment and could you talk a little bit about building up the backend? >> with regard to the question of load that something that was spoken to a little bit yesterday which is we are doing a lot of different kinds of testin testih is something i think most people, that's what most people focus on. one of the types of testing we are doing is loads testing and that's trying to test the system with different amounts of volume to try and address the issue that you are raising it to make sure we are properly prepared for surges that would occur. with regard to the issue of -- there were a number of things, parts of the backend that were happening last year and that there are other parts that i think you are referring to may be payment issues or those kinds of things. we are continuing to work on some of the backend issues or

the irs issues that we are doing and continuing to make progress on each of those issues. as i mentioned in the beginning we are prioritizing as we go through and continue to make progress on the backend functions and whether the database learning what some folks have asked questions about before we continue to work in the case of insurers and their own systems on this. >> if i could follow-up for the next question. can you give us an update on the people who still need to get in documentation and how many people have been cut off and how many people have had their subsidies change? >> two different categories. one is the category of immigration documentation and documentation related to that and we are continuing to process that information. you can imagine more paper has come in.

the same thing with the income. when you send out the letters that say things will change that so may start to get the documents. where in the middle of processing those who may want to get all of that process as much as possible before we get to the final enrollment. good numbers continue to go down from the numbers made public in what we are trying to do and this is to the transparency point earlier split up the numbers. 15,000 letters were sent and that number will come down. similarly the number at the starting point was 1.2 million households that had income issues. we send out letters to that block. >> have you actually cut anybody off or change the subsidies? >> with regard to the subsea change of a cut in terms of how that will be implemented is him over a month to month. of linear cycle so that had to do with insurers.

>> hi, ricardo with ap and the focus is on people signing up for the first time next year. there's a lot of focus on that but i want to ask you what are your goals for retention for the people who are already in the system? what are your goals for a satisfying consumer experience for those people can particularly since for many of them it may not be a good option since the cost of a planned in premium and subsidy could change. can you lay out for us your objectives both on the consumer experience and the kind of percentage share for attention you want to see? >> enrollment is important to raise race with us as we think of the system and going through the process i think it's not

year to because the point you just race. this is the first year we will have free enrollment and aromas such as averse to do this cycle and to be honest it's the first year there will reconciliation cycle. i think the focus on rare moment is something we are equally focused on. as i said earlier in terms of analytic buildup when i think about whatever number we think is the right number we have to derive this number to macs are right now we are working with the insured and their analytics and are on analytics terms of what percentage retention will be there. continuing to work through to try to get to the right place in the right places based on this is a new product and this is the product that has not been used in trying to get to that right number.

with regard to the deep focus on making sure to things happen that the people want to do auto enrollment are able to do that in the easiest way possible and we want to encourage those that that's part of what the marketplace is. our communications are targeted for exactly what you just suggest a which is make an sure people know the importance of going in and shopping. i think it was outlined yesterday and i think we are going to spend time and come back and i think andy and i will both be talking further about the specifics of the rand roma process but let me say a few general things. encouraging people to come and because we believe it is best to shop. that's an idea of the marketplace to make sure you get the best deal. kevin mentioned yesterday we want to make this a as simple as possible and doing simplified instructions that are easy, usable and very simple aren't

important part of the process. the other thing that's an important part of what we are going to do to make sure that the consumer has an experience and make it easier for them with the question of free enrollment is making sure they have alternatives. different people will want to do this different ways. some people will want to put in their plan and go shop. some people want to auto enrollment on plan. some people want to use help and guidance so making sure we have different avenues. one of the things i think is true and gets reflected as we get into the questions about how people should go and in different people have different needs than what we are trying to do is meet as many as we can. >> are you going to tell people who are being read in bold that their costs might change the mite change and they might get a better deal if they shop? >> yes, that will be part of the communication. communication will start with marketplace communication and

ensure communication as open enrollment starts. then we will go through that period in terms of making sure that people know and understand that in people who are auto enrolled velocity communication so they know they still have an ability to go in and change while we are still in the open enrollment. >> i wanted to know what you are doing, and sorry diane weber kaiser health news. we saw a big difference in states that had an insurer who sort of actively did a marketing plan like in florida through the healthcare.gov -- active in sure on the ground versus states like iowa or south dakota were the biggest insurers got out of year one. what do you know about insurers marketing plan and have customers, what can you tell us about that?

are they stepping up and planning to put the information out there? >> with regard to insurers i think it is the reflection that for those insurers that aggressively pursued market share solving impacting results of what they did and i think that is something that is at least understanding from our conversation that they are thinking about in different insurers are thinking about different ways to go about that for -- both in terms of the issue that was mentioned in terms of pre-enrollment as well as the issue of additional and roman. i think as they would would do if they each have their own marketing plan in terms of how they will go about doing that as it is about competition. it is our sense in conversations with the insurers that this is something they are each individually thinking about.

[inaudible] >> we are encouraging whether it's our stakeholder partners or insurer partners to partner with us as we going to open enrollment. that has to be with free enrollment in how we communicate what we are trying to do as much as possible to communicate with the insurers. our communication in terms of what they will contain so they know what we are doing in the same thing with the stakeholders making sure people know what we are doing so their efforts can be complementary in terms of getting people good information about re-enrollment which is a challenging thing for many people who have never experienced it in the insured population as well as people in the marketplace. the thing that we we are trying to do is make sure we are clear. >> joyce frieden, one of the things that is, but that plans on health care.gov is the issue

of narrow networks. some plans offering only one hospital in very limited choice of doctors. i know some states are developing for the niac is developing a model standard for what constitutes a network but i wondered if hhs was thinking about putting in any more standards for that? >> as you appropriately reflected the role of the state insurance commissioner and the regulating of the networks is the place where there is the core of the plan. we want to listen and understand how the marketplace is working. a 25% increase in the number plans that are coming and we are hopeful that that's going to increase more competition in the types of plans it will be in place. it's the kind of things who want to listen and understand in terms of how people are bathing in the marketplace as well as we continue to let what people are doing in the park it -- private

marketplace so we understand how consumers are bathing and we are continuing to do that but also providing any support recanted efforts of state commissioners if they have questions or need help if they're working through this issue. >> dan with the cbc. i'm i'm curious where do things stand in terms of web brokers like the health insurance being able to enroll qualified individuals directly without having to go through healthcare.com interface? that was supposed to happen last year. there were problems and was going to happen as far as i know it's not happening on an equal scale. >> in terms of the specifics of where they go through that's a question i'm going to defer to andy to make sure exactly what they are able to do in terms of

the click through and whether or not they can do it individually themselves. i want to make sure we get that right but with regard to the welcoming of the issue of brokers and intermediaries as a part of that this is part of the system and we think it's an important part of the system. i think kevin mentioned yesterday that we think it's something that we welcome. i think with regard to our ability to make progress in terms of integrating from a systemic there's a balance on consumer friendliness and making sure the functionality is there with regard to making sure we have the space. have we have made -- as we have made decisions as the balance of those two things. >> hi, tomer the "washington times." i just wanted out you could give us a status update on the states

further on exchanges. it was a shaky time in the first round as first transitioning to the federal platform and states have their own technology. where do you see things and are they going to stabilize and then this next go-round? >> there are a number of different statuses in terms of what the data is doing is different from what maryland is doing and massachusetts. each of the states on a state-by-state basis. this is another one that is retail because of a different city to the states. we are continuing to work on a state-by-state basis and whether that's making sure the folks in nevada have an opportunity and how they are going to reenroll as we work with them or in the state of massachusetts and maryland and making sure there states are ready. we are working on state-by-state basis and the support is different in each of the states. what we do as we continue to

track it and work with each of them directly. again the issue of communication and clarity is one that i think is a tool that we are trying to use from a management perspective in terms of being clear about what our expectations are and making sure we are communicating with them about what their expectations are of us and what you are reflecting is the point where we have crossover with the states that have had challenges. [inaudible] >> we are doing everything we can to ensure. we work with them on it day by day basis in terms of progress for different states. there were different issues and we continue to work with them on a state-by-state basis. >> arthur alex from politico and i want to ask a slightly more obscure area of policy but on health i.t. there has been a lot

of dissatisfaction by some provider groups about the meaningful use of -- and also on the other side there's a lot of sword of the health systems and computers and hospitals aren't talking to each other as well as we would like yet and i'm just wondering whether things have reached a point where you consider talks with the lnc your cms changing the focus or altering the incentive program at all? ..

>> >> it is the providers what we do is link to that. that is how we get that information to get access to that information. >> continue to work with the insurers on transparency not just a market issue with employer based in terms of the entire market.

transparency of the entire health care state because the marketplace had so many questions but the issue you are racing this is -- raising is a lack of transparency. issue way across the board reached try to encourage the hope that would encourage the providers to provide the information what they need for decision making. >> doctors and hospitals with the increase of high deductible plans with later stage cancer is the middle-class worse off or better off with their plans

and what about the nation's health? >> that is something we want to see if there is evidence of what you described but with regard to the important part of with the affordable care act is in terms of prevention and screening and the the thing sadder very important because of the affordable care act people can have access to any number of cases without a co pay or to understand how to use health care. route those that were space entered into the marketplace. the most educated group if i ask everyone to write down the top six things that you could get to do because of the change of the affordable

care act is three do need to know that they're not taking advantage of that with their own health care but the issues of plans to charge more for women is no longer there that is the important issue you chose to make good decision to change your employer right now if there is anyone in your family with a condition you can now do that without fear you will not be covered. and with regards to the middle-class. and the employer base system but what it is are the benefits. >>.

>> i am with the huffington opposed. a little over a year ago. down the line to talk about the experience would be and it was not the case so what can you do to assure the public that how though website is better? >> that the experience would be better and we know there are issues raised as to go through the process. with the application up and running since last july that reduces the number of screens from 76 down at 16

in terms of the application that everyone can use that b.c. we have that in place and second with the experience one is the functionality they were reflecting the problem as well as the consumer experience with a the functionality outlined in detail with regard to the testing we are doing of the functionality has that capability with the functional testing and all the testing. those are the pieces of evidence that we reflect. what we want to work is not talking about expectations that is what we're focused

on. >> as secretary you feel you have a firm grasp where you stand what is working and not working because it seemed the people at the top of the change did not know that the web site would not work. >> what i said it will continue is every day we work through the debt by two -- the deadline to have a good consumer experience and each day we did that we look of the technological side and also the consumer experience. >> if consumers do the homework to track down which providers are in which plans providers can drop out during the plan year. other than requiring the

dance notice as well as medicare a vintage other than requiring an advanced warning what can we do to address this problem? with very limited problems we may not have a lot of options. >> it is an issue for the entire marketplace. that is a decision that a provider's make so our ability to control the provider what we want to do is create a marketplace that the competition would make those decisions. >> web rissole last year to see it in the private employer place they do make that decision based on price so as we continue to move

forward we will learn what the consumers are making choices on. but this is the marketplace and that is a part of the system that we have and support. >> hhs regulates the plan so if your doctor leaves should you be able to leave? >> u.s. skiing the question should you have a special enrollment period if your plan changes with you? >> i have had that before with that specific issue. as we work through this to understand what the consumer wants that is what we will incorporate into our thinking. >> thank you very much. thanks for having me. [inaudible conversations]

>> not one democrat did i see from the marine from the of mexican prison many times in the last month it seems to meet the president could have picked up the phone with one call to call for his release. >> i just had done watching your c-span i need to complement you that this is

the best evidence i have never seen or heard about the corruption rehash you deal with them particular a the president and what he is doing wrong in particular when he allows to happen on the border between mexico and the united states. >> i was watching the town hall meeting earlier from the veterans administration. my heart was just broke all of veterans and what they are going through. is just a mess. it was interesting that each

and everyone and the heartache that their families have gone through and i pray something will be done to help these people they fought for our country and our freedom.

>> thank you for coming to the press conference. with the world bank and imf an annual meeting. dr jim will give the opening statement that we will take questions. thank you. >> good morning will come to the 2014 world bank and imf an annual meeting. i have three topic somewhat like to talk about denial take your questions. i just came from a meeting focused on the ebola epidemic and we had an extremely productive discussion. we had the president from new guinea with us in president on video conference they not only

addressed us but made extremely specific request. baseon what they need now in the country to focus their response. the crisis that we now could have the enormous impact yesterday we had a better understanding of the economic damage from the help break. releasing a new economic impact assessment is not contained and spreads to neighboring countries the to your impact could reach 3.$6 billion by the end of 2015. that would be catastrophic for west africa. one of the things of the secretary of state that the united kingdom points out every day that we don't put money into stopping the crisis is many, many more

dollars and pounds we have to use later it is an extremely good investment right now to prevent this kind of loss to put all the money on the table right now to get the response going. said in a ratio estimated liberia alone needs 364 medical staff today to treat those infected. one of the speaking points giving staff into these countries is a lack of medical evacuation. we heard this morning from the european commission and the united states that both of those groups have now committed to medically evacuating health workers and others. this is a major roadblock we're now on a better path to be able to have a faster response. and lp happy to talk about

the other outcomes. today i will launch a new partnership initiative to help tackle the massive and infrastructure deficit now facing developing countries. they need $1 trillion per year of extra investment through 2020. the extra facility has a unique collaboration between the public sector especially institutional investors and donations for billions of dollars for infrastructure projects in virginia economy it is significant with the world's leading institutional investors to sign up as partners with the gif having 82 in assets was

1% of infrastructure projects have been hearing a loud and clear the money is out there it is not a matter of money but bankable projects. commercially viable the new concept that doesn't require tens of billions of new resources or more potentially sitting on the sidelines waiting for investments we can bring that online by addressing issues like risk. to date of rogue bank replacing $50 million to help pay for access to all haitians preventing waterborne diseases later i will be chairing a meeting

with the objective to raise even more donor funds. now i will take your questions. >> please identify yourself and your organization. >>. >> is there a microphone? >>. >> dr. kim i have a question about the investment bank. what is your comment compared to the world bank? day think it can cooperate? but also avoid? >> minor understanding the

business model is still being discussed. i've made it very clear from the very beginning with the discussions we think we can be a strong partner. for example, we have 70 years' experience with project proper rate -- preparation and also the safeguard that we bring to the table would be helpful to reduce risk for investors this is the major concern not one to suffer the reputation no damage with those social safeguards. we are already in close discussions with this new development bank and our intention and expectation is

looking very closely but just as i said there is said lead for more investment and infrastructure than any organization focused on infrastructure to fight poverty is our friend. >>. >> with the emerging markets the world bank has progressively with drawn from infrastructure and coming from engineering and finance but it will stop up again? >> we actually do have a large portfolio of

infrastructure projects it is relatively smaller of the overall portfolio day and decades ago. on the other hand,, we did over $60 billion in business last year. a and as rescale out global practices groups on particular areas, if we need to bring in more experts we will do so but we're already doing quite a bit of infrastructure. but the platform is very important in a new sense that as we start to put projects together will be people from the world bank to have expertise. with the multilateral development banks and also from the private sector. this is the platform to bring together the expertise what we know of spain will

projects without the preparation that makes it clear there bankable projects we're looking to draw on expertise from all over the world. >> your projection, i am from nigeria. but to go 5% to for the country like nigeria. but we don't know to the extent the growth rate is aren't the action policy. thank-you.

>> i am not sure that question in. i am sorry. >> what i am saying is given the growth rates in africa to what extent? >> is the question to what extent is the growth rate in africa impacting? to make this is an important question. in 1990 the number of people living in extreme poverty in east asia and africa was about the same. 55%. and less than 10% but africans remained at 46%. one of the things that is a bit of a disappointment poverty rates have remained high despite its proposal very specifically in africa we work with countries to insure the high growth rates are translated into lowering

levels of extreme poverty. many african countries have new discoveries of oil and what we know it in so many cases do not lead to direct benefits. this is one of the most important priorities to ensure rework with african countries to take these new wonderful important discoveries of mineral and oil wealth to translate into the deepest levels of poverty. all of the ministers of finance that i speak with there very committed to reduce extreme poverty to reassure the prosperity is baird. with the solutions from around the world. >> i and jennifer with

hongkong tv. in your remarks you mention to but could you elaborate more on that and we're doozy there could be the spill over effect? >> one of the things we did as economist we look what are the impacts economically ? and what we've learned is the impact of sars only with 800 deaths but $46 billion. the impact it is not from the virus itself but from the aversion to lessen the

economic impact to have systems in place so responses are quaking in defective. one of the things we talked about this morning we know exactly what it will take not only to stop the virus but the aversion behavior that leads to the huge economic impact. that is good news that doing the right thing that'll identify cases to provide treatment for those who are ill all things are the right thing to do do to prevent the spread from the public health perspective and also to adopt the year that causes the enormous economic impact so everyone redoubled their commitment for the

adequate treatment prevention identification system in place are there other spillover you fax? -- effects the to workers that died in spain had have been they already see the economic impact. . .

>> and are from "bloomberg news." dr. kim can you clarify that the 32.6 billion geography come in as i cover western job -- western africa? >> is western africa and the surrounding countries. i can give you a list of the countries. it's looking at what will happen if the cases began to spread and the point that we were making is that right now as long as it's not under control, let me put it this way, right now because we don't have adequate treatment services and you know if you think about it from the perspective of a person from kenya sierra leone or liberia

the public health, the public health imperative is to stop the spread that the human imperative, the individual human imperatives to get treatment so the incentive right now is to go wherever you need to go to get treatment so you can live. right now we don't have the services in place so that the first thought of the people from those three countries is i need to go to my local clinic because i know they will take care of me effectively so that's what we need to do. the presumption of the $32.6 billion as things get delayed and delayed and delayed and the people inside the country to the rest of things for themselves and try to find care elsewhere and that is where the impact is going to happen. we see this impact already with two or maybe four cases in spain we know that historically the aversion behavior does fear factor can spread very quickly.

>> with two clarified you have a global figure at this point? >> not yet. we have time for two more questions in the back there. >> michael with -- dr. kim on tuesday you held an improvised town hall meeting to hear concerns and questions from staff about the ongoing reforms at the world bank group. what was your biggest take away from that meeting and do you expect it will lead to any concrete changes in either the implementation or communication of your reform and then sorry just a quick second question. you are undergoing a strategic staffing exercise to the global practices. how do you know where expertise will be required before you have seen demand for your services under the new organizational structure? thank you. >> thanks michael. first of all we are undergoing the most thorough, the most

ambitious free urbanization in 20 years so it's not a surprise to me that there is anxiety and that there is concern. more than anything what this staff were saying was that they wanted to talk to me directly. they wanted to tell me what the problems are that they were seeing. i was aware of some of them. there were some that were new to me but we had an extremely good discussion. my take away frum, the most important thing was the thing that kept coming up is that they wanted to talk to me more. we will have another town hall next week and we will do as many as we need to until people feel that they are being heard. this is what happens when you try to re-organize a multilateral institution. i've done reorganizations before but the complexity of this institution is enormous. we work in many different languages and work in so many different countries. on the one hand i'm not

surprised but i would also point out look at all the things we have already gotten done. for example we have been able to double lending to middle income families. we have a record last year. already the global practice are providing information and support for example to prime minister modi of india that caused him to tweak out immediately after my meeting that they don't need our money but we will be their information bank and the reason is because what will be able to provide such interesting insight as to how we can bring solutions to the problems. there are a lot of good things are ready but anytime you undertake something is enormous you will have these kinds of problems. in terms of strategic staffing we know it a lot from what we have been doing so we have some ideas about the kinds of staff we will and won't need. what i would like to stress is that the expenditures and the strategic staffing and all the stuff you have to do as an organization of matter what, we

haven't been doing it for quite a few years. so when you start the process of asking questions from what are we spending on different things? are we spending the same amount in their redo the same thing here is over there and when you're asking the questions for the first time it's really tough to go through but it's just something that everyone should go through. every organization should ask itself do we have the right step in our we fit for purpose for what we are trying do? i'm glad that we have done it and we will continue in the good news is we are almost done. >> i'm looking for some gender balance please. >> thank you so much. on the chinese economic slowdown it's been a year since the chinese government has carried out measures to make the economy more stable so what is your view

on their farms have been carried out the form and how would you integrate the slowdown? do you take them as cyclical changes or his changes brought out by those reforms? thank you. >> china is trying to go -- undergo a massive change in the growth model and this is something that my predecessor bob zoellick i think worked truly brilliantly with the chinese government over several years to put together a plan called china 2030. if your intention, china going from some of the highest investment rates that we have ever seen, 46% of gdp and then to try to focus much more in consumption and services to move up the value chain if you will in terms of economic productivity this is a very difficult thing to do. we have been watching very carefully and there has been a slowdown from traditional rates

so high rates of 10%. and i think the important thing as we watch is that china continues to be committed to that reform process. we believe that reform process and moving toward a different growth model is what china needs to do. so it's a very delicate balance. they have two on one hand be ready to move to another growth model but on the other hand you need the growth for the job entrance on the market. we have faith in chinese leadership. we think that they very clearly understand these trade-offs and we will continue to work very closely with them. for example one of the things that after the china 2030 report the chinese government has continued to ask us to help them solve their most difficult problems. last year we launched a report on urbanization and as an

example of what a global practices now able to do our many different global practices got together in support of the best models in the world and in china for how china can handle the next 300 million people coming into the city's? china will be the first country in the world that has 1 billion urban dwellers so we looked at everything from how to reform the system to provide health and clean energy, how to increase the density of cities so that we lowered the carbon footprint and china is already undertaking the recommendations that we came together jointly to provide. right now we are working on an assessment and a plan for the health care system. china spends 5% of gdp which is a huge amount but are not happy with the amount of health improvement that they are getting from these expenditures. this is so healthy for a country to be able to say we want to do

better in a particular area and we think if we can help them to make the most of their current expenditures and make those expenditures as efficient as possible so we have healthier people that this will be a way to spur economic growth. it's difficult for many people to watch china has lower growth rates but we feel doing in a way that's very much with a tremendous awareness what they are trying to accomplish. >> thank you very much and we will be putting out a transcript later today. thank you. [inaudible conversations]

her remarks focused on the imf reform package awaiting action in congress. this is 45 minutes. >> good morning everyone and thank you for coming today. and welcome to our 2014 annual meeting. we look forward to your questions this morning. i would ask you to be brief and we can try to do as many as possible. let me introduce to you this morning are managing director madam christine lagarde and we have with us our first deputy managing director david lipton. without further ado let me turn to the managing director for some opening remarks and then we will come to your questions in the room. please identify yourself before asking the question.

>> good morning to all of you. i hope you all are well and i would like to welcome you but include you in wishing this institution a happy birthday. it's seven years old and have brand-new relevant energized machine i can assure you. i will say a few words about the current economic outlook as we see it for those of you who have not followed previous press conferences by our terrific team and i would like to say a few words about the institution first. as i said it is 70 years old, founded in 1944 and i believe that it is not only relevant but in a position to respond to the challenges that the world is facing. as a sign of that i would like to mention a couple of examples. i said this morning in the

presence of a lot of the members of the community working in trying to help the three west african countries that are plagued by a boa i said it's absolutely fine if those countries increase their fiscal deficit. david was a bit concerned actually and i'm sure that we have some colleagues that would be a bit concerned but it's just an indication that we are capable of mobilizing resources. they are not grown and others will have to put in significant numbers. there are also capable of revisiting traditional standards. we have done the same this year concerning some of that restructuring. as you know this is a model we have studied where we have come

up with proposals, revisions of certain sovereign bond issues and we will continue to work on those issues. in the same vein we are also helping the fsb following up monitoring and helping with profound changes and regulations applicable to the financial sector. there are areas where we were not expected and at the age of 70 it's not bad to actually look at the fiscal side of climate change and what can be done about it and we have made proposals concerning removing subsidies in a socially responsible way. we have made proposals concerning price-setting and including externalities in the price of fossil energies.

also responsible in my view to assess the sustainability of growth in light of strongly increasing inequalities becoming excessive and therefore likely to have growth and it is not irrelevant either for the imf to look into growth and jobs and the inclusion of women in the job market. now those are areas that some might argue are not absolutely core business and yet we pretend that it is part of partial of the imf to look at issues that are macrocritical but touch on topics that we are facing that in many ways can be more acute. in addition to that we do all the normal things that we have to do. so sir vance, the intersection

of the two, of course lending, of course and we have done more lending then maybe might have been considered. we extended a significant -- to ukraine earlier this year. we are negotiating with a couple of african countries that are looking at support. the arab countries in transition are also major client of the funds. and the third areas where business is expanding if i may say as technical assistance, capacity building and training. we have opened our fifth training center this year and technical assistance is an area where there is massive massive demand from all corners of the membership.

so it's with that background that i wanted to wish us a happy 70th anniversary. now moving to the more traditional comments that you might have expected from me. for those of you who have seen the world economic outlook or watch the press conference as you well know we have trim their forecasts for 2014 and 20153.3% in 2014, 3.8% in 2015 and what we have noted clearly is more and more countries specificity in the cup knowledge that we work. it's not emerging market economies where recovery would be lagging behind. within each group, some countries are ahead and others are lagging behind. the advanced economy clearly the recovery strip him by the united states in the united kingdom

where japan is lighting behind an emerging economies you have reasonably strong although slower growth out of china, better than what we had out of india and clearly a major slowdown in countries like brazil and russia. so very country specific and by the same token the low income countries are thriving. on a much smaller base granted that their growth rates are very impressive which is what makes the current epidemic ebola even more threatening because it might certainly jeopardize economic recovery was underway and entail a decline of those economies. that would be wasting the gains that they have earned as a result of their effort.

so in the face of what we have called the risk of a new mediocre where growth is low and uneven, we certainly believe that there has to be a new momentum and that is what we'll be discussing with the membership in the final days. i believe that you have received the global policy agenda a copy of which i have here somewhere. you have perceived that, right? so this is the document that encapsulates for the membership the strategic direction of the work that we will be discharging over the next 12 months. this is the document on which we seek their approval and their support. now this new momentum with hopefully more growth, more jobs, better growth and better jobs is what we would certainly call upon the membership to produce. what does it mean in practice

and i will very quickly touch on the three key topics. the first one is monetary policy where we will be seeing movements probably but we believe particular in the eurozone and japan more of that monetary policy is needed going forward in order to support the economy. while at the same time the fed is probably going to normalize its monetary policy and where we are going to continue to caution a lot of the emerging market countries and low-income families in developing countries to prepare themselves for a bit more volatility than we have observed over the last human spirit in on the fiscal front we believe that more growth friendly physical policies can be put in place and those of you who have followed the press conference of the new head of the fiscal affairs department and you will understand what

they mean by pointing to the potential labor reforms and fiscal policies adjusted to support job market reforms which we believe could make a lot of sense we also think that the financial policies must continue to aim at producing excesses, make the financial system sounder and strengthen its ability to help the recovery. now there is a third package that we have been referring to regularly which is the structural reforms and we don't believe that the structural reform is the third chapter. by the way we believe it's very important that it has to be country specific. at the juncture of demand and supply-driven measures, we have strongly held the views that

infrastructure and investment infrastructure can be a good way to support growth in the short term by putting it to work by launching major construction efforts or maintenance jobs but can also impact on the supply-side in the medium term by facilitating and accelerating the creation of value down the road. so this is in a nutshell what we are focusing, what we hope to discuss the next few days. i would be very happy to take questions together with david on any topic that you would like to ask questions about. thank you. >> thank you madam lagarde. let's begin right here with this lady. you had your hand up. >> i was wondering in your global policy agenda you said your analysis of the world looks uneasily familiar and a lot of your advice has been you have

been seeing it for the past three years or more since the crisis countries need to do the structural reforms and it looks like fiscal and monetary policy has reached some of their limit and that is why we are turning to restructure spending. would you agree with that analysis india think countries need to step up their game? thank you. >> we strongly agree and we hope to convince those countries to satisfy the various conditions. it's not investment in infrastructure at any rate under any circumstances. it's clearly beneficial and we believe that it can be not only growth friendly but he then got if it's done under the right conditions so that it picks up from there with financing situation that continues to be very accommodative and very low cost and we clearly have a need for infrastructure. on that basis we believe that it

is helpful and as i said it addresses both the demand in the short term and the supply-side of the economy. structural reforms, yes we have said that and in a way it's the common factor to many of the countries in the various regio regions. though what we are seeing is that they have to be country specific. they have to be well-adjusted to the political of the accessibility, the multiplying effect that it can produce on those economies but it's a question of doing it. not just talking about it. we can talk and we can publish reports and we will continue to do so and we will be as -- as we can although it's not necessarily our domain of confidence. other institutions can do that better but we can certainly incorporate with them and number

two continue to bring forward the question. the question of getting on with the job and doing it. >> yes sir right in the front row. >> hello. i'm with ap and according to the data released this week by the imf china will overtake the u.s. in terms of gdp. how challenging it -- is it for the imf and do you think the legitimacy is at risk and the imf would have to go beyond the 2010 reforms that is currently in tax? thank you very much. >> the reform is an absolute must. it has to be implemented and

everybody knows that it is currently stuck before the u.s. congress. we very much hope that the different branches of the u.s. authorities and members of the legislative members themselves will understand the relevance of having an i that is representative of the global economy and includes the people that should sit at the table. now, this has not happened. it was during 2012. it's overdue in 2014 and i strongly hope that under president obama's leadership and with the right understanding of the parties the role of the eye at math words that. who was first on the job

concerning ukraine? the i. who managed to disperse very quickly and put cash in the bank's of guinea, sierra leone and liberia? not to say that others are not doing the job but we are capable of dealing with crazy situation of that nature like no institution. now, i'm not finished. [laughter] i also want to say that notwithstanding that the reform has not been ratified we as management include a representative china. one of the deputy managing directors plays a full part of the management and we are delighted that he is sitting at the table with us. within the teams we have a lot of the underrepresented staff members and heads of departments.

the head of the i is a chinese national. you were talking about china in particular but i would like to enlarge the topic to say that those underrepresented in the quota are not underrepresented necessarily in the management circle and at the highest level and we certainly pay as much attention as we should to all and not just to the big players. >> i'm going to stay down here. the lady in the front row. >> we have seen a lot of countries speaking with the imf african countries and specific even working with the imf with regards to technical assistance. some have issued bonds tapping into international bond markets. to what extent do you think african countries are capable of pumping that into the right infrastructure projects are not making the same mistakes of the

past given the history of the conflict's? >> you are right in that quite a few african countries have lately issued sovereign bonds and have been very successful which is fine that there is progress, there is more stability, they are more reliable borrowers probably is seen by the financial markets. i think it should be done with measure like everything. no excess, no abuse and i would like to point out to you that we are currently working within the fiscal affairs department on specific research work to actually focus on how public finance, how civil service in each country can actually well served the discharge of major

infrastructure projects and we will make that expertise available to the australian presidency of bayji 20 and to all our members of course to make sure that they appreciate how good management of public finance for good governance of public finance and how focused project management can be in order to serve the efficiency of infrastructure. this is what we have advocated. it will work if it's efficient. it will be efficient if it is well handled by those in charge and there's a way to do that. >> yes, with the glasses, yes. >> good morning. my question is -- about greece madam lagarde.

the feeling in our countries that after four and a half years of the program there are at least enough austerity in enough pain. ..