and free enterprise are better values that offer young people far more hope than going off to be part of the difficult. multiple speakers: here! >> owen smith. >> deep condolences to all of those people who will be affected in tunisia. may i mass the joint -- the prime minister join with me in adding our admiration for my constituents are you will have read about in the newspapers who threw himself in the way of the bullets shielding his fiancée in an extraordinary act of selfless bravery and may i urge the prime minister to do all he can to ensure all victims receive all the support they need. >> can. >> can i think the honorable gentleman for his question. we all did read about the active this young man.

i will certainly give him the guarantee that we will do everything we can to help the victims and their families. there are people working around the clock to make sure this happens command we will keep it up. >> thank you you, mr. speaker. two of my constituents suffered from these attacks. went for a holiday. i was moved to tears. gunned down gunned down next to his life by try to protector from the ensuing chaos. a life-changing injury and my heart goes out to her and her family at this extreme difficult time. my right honorable friend assure me that she will receive the same level that she would normally receive.

>> i think my friend for raising this case in the way he did it. all those who are being looked after our medical team is on the ground. those that can be repatriated is medical evacuation using a c-17 with all of the technology and medical brilliance we brought to bear with bring casualties back from afghanistan is available for british citizens into an as engine as you command if it is possible to move someone to bring them back to birmingham that is exactly what will be done. >> i think the prime minister for statement. i spoke with my constituents still missing following the attack. there has been public consent about the time taken for authorities to update families. i fully understand the governments are working hard to get good quality

information as quickly as possible. possible. thanking for the opportunity to set up the challenges being faced. multiple speakers: here! >> can i think the lady for the way she put her question. i share the frustration of the families and communities. the deputy first minister of scotland was on the covert conference by video link and has raised some of these issues himself. to bring home the importance of not making an announcement before you have the information, there were two people who we were concerned about and turned up back in britain today and have come home under means we did not know about. about. the reason is taking time is twofold.

people who were on the beach quite understandably did not have passports are means of identification and secondly it is difficult to identify people after the horrific attacks that took place added to that quite understandably the corner wants to make sure that no mistakes are made. the full pathway from the moment of recognizing the victim and all the subsequent actions that must take place. >> the indians indians transition to indians transition to democracy with a one-way a political like coming out of the arab spring. however, it is as fragile as its economy and security. while welcoming measures to support accessing democracies economic and the security aspirations we ensure political aspirations also received support. on some accounts more than 20,000 to divisions have been intercepted, some

bouncer reached libya. is there any evidence this attack was coordinated from outside to visit? >> first of all, i agree that hoping to his you ms. you on his political journey is as important as helping to ms. is economy and civil society. we will do that. i i met with the ambassador to discuss these issues. in terms of the linkages of this attack, i think it is too early to say. more work is being done now plaintiff is anything else to tell the house i will come back at a subsequent opportunity. where there is no doubt is that libya with its failed state and lack of government has become a place where terrorists have got a foothold. while that is the case of the countries in the region and indeed other countries in the world are at greater risk. >> david anderson.

>> she lived. six years since he suffered in afghanistan. i urge that their wishes are kept in privacy. as much help as possible. help the families. i also urge the prime minister to ensure all the agencies have the utmost compassion, sensitivity, and understanding for particularly from things like education, health service. the help is not always there. this will help with this situation as quickly as possible. >> we think the gentleman

for his question and for paying tribute and can say we will give as much help to members of parliament as we can. if people want to know what more information is made public, public they can speak to the foreign office help desk. and he is right. in terms of showing compassion and sensitivity and common sense and how we deal with these things there are lots of difficulties. you must start with the next of kin and sometimes family structures can be quite complicated. i know the staff of the foreign office and the family offices are doing everything they can to cut through bureaucracy and make the right decision. >> i represent a couple of constituents on holiday. now they have escaped unscathed and never returned. the prime minister mentioned

the power to track social media. is he agreed of the time is come to accept and understand that the current privacy policies are completely unsustainable. >> my friend makes an important. we are we are urging social media companies to work with us and help us in terms of dealing with terrorism. britain is not a state that a state that has tried to serve through everyone is e-mails and invade their privacy. we just want to make sure terrorists some have a safe space to communicate. it is the that is the challenge that will come in front of the house. just as we have always been able to sign a warrant to intercept phone call or mobile phone call or other

media communication, the question is, as technology as technology develops are we content to leave a safe space that could mean new means of communication? my answer is we should not. that means that we do have to look at all the new media being produced and make sure that in every case we are able to get to the ball was going on. >> condolences and heartfelt sympathies being expressed. given the possible link between the terrorists in the ideology of the prime minister commission and publish reports and what's that on was in brotherhood on the role of the teachings and fueling the support for violent actions against non-muslims and muslims? >> i think the honorable gentleman makes a. if we accept this we have to work hard to understand its true nature which is why

commission the report into the muslim brotherhood because that organization has an uncertain relationship with movements that condone violence, and i think we see the same with some have caliph's fused. anything that can be done to further our understanding of where the narrative of extremism is coming from is a good thing. >> john redwood places in the economic and social down -- social damage being done demonstrate that britain is right to seek powers fast so that we have on the democratic control the things that matter to uk prosperity. >> he pushes his case powerfully. in many ways what this shows is that there are different sorts of memberships. we are not a member of the euro but when it comes to

cooperation over foreign security policy it is often written that it has been the need whether arguing for sanctions against iran or russia or better coordination of counterterrorism policies. we should not be frightened. as i put it, having the flexibility of a network rather than the rigidity of a block. >> mr. speaker my shock at the events. our thoughts and prayers. i welcome the steps the government is taking off to offer support and assistance to the families at this time the prime minister has been speaking about the challenge of the confrontation and i agree that this is the talk ahead of us. however, how we do this is an important debate. debate. the thrust of comments today unjustly infer the dealings

with citizens, british muslims must step up and call out those who are privately condoning. will the prime minister agree that most ordinary british muslims have no more knowledge and divinity to step up to the plate and call out in this way than any other ordinary british person? what he further agree that it will be an on acceptance of our combined lack of understanding of where this is that we all need to step up to my can better work together to find a solution. multiple speakers: here! >> let me thank the honorable lady. the answer i would give this is a actually a actually the british muslims, imams, mosques, community centers are stepping up and saying that they condemn utterly what i sold does.

the the knot in my name #was something praised by the president and his speech at the un. i am afraid we all must go on doing that for as long as this poisonous ideology is there and would say to british muslims the fact is these people are taking your religion of peace and perverting it which is the reason for standing up and saying you must not do this. this is not what we believe, not what we are about. the british government will back all muslims who do that. a second topic is that i think we have they to mistake if we just say it is those that support violence that we need to confront. there are some people and organizations and we know who they are the go along with some of the narrative. i think a caliphate may not be a a bad idea and christians and muslims can live together and democracy

is inferior to some other system. those people we must call out. i want us to have an appeal to young british muslims about what this country can be for them. i think this is a a great multiracial democracy in a country of opportunity. we must also raise our game as it were, and make this a society that people want to integrate into. it is time to speak out on both fronts, the need for integration and the need to confront a narrative of extremism even if it is stopping short of violence. >> thank you, mr. speaker. i join the prime minister in his strong words of condemnation of the slaughter of british citizens and others in tunisia and his condolences for the bereaved. my right honorable friends today rightly reaffirmed british courts and british

laws, sovereignty and accountability of our national parliament, and the fundamental change our relationship with the eu to which many will say yes yes, yes, yes. he is being buffeted by criticism from other european leaders who are clearly not listening and are demanding more integration and not less. hope springs eternal. given his firm objective and the eu leaders constant criticism what will it take for my right honorable friend to recommend the no vote? >> i i go into these negotiations as an optimist and believer. having now had meetings with all 27 other presidents and prime ministers in europe and in what has been dubbed something of an eating tour around the european union i am not saying they all said instantly we would agree to

the things being raised but are open to the sorts of reforms that i believe are necessary. >> gregory campbell. >> welcome the prime minister statement. the sympathies of my honorable and right honorable friend but those who have suffered so terribly. the prime minister talked quite rightly about peace tolerance, and democracy. what is he doing to ensure peoples across the middle east as the people of the united kingdom want to see values defended and stood up for are united with the governments of their nations to ensure we never surrender to the type of activity we have seen. >> i think the honorable gentleman for his question. we are backing those governments that want to see an active and positive civil society and encouraging democracies to take other countries that are not yet democratic and put in place

the building blocks of democratic countries. countries. as we look at how we best confront terrorism, i am convinced giving young people greater hope participation, greater hope democracy and right is part of the way that we will defeat the narrative about which i have been speaking. >> i know that all of the members of the british to visit parliamentary group will wish to endorse the sentiment expressed by my right honorable friend and members on both sides of the house who lost constituents. it would be no service to the memory of those who lost their lives if we were to allow an emerging democracy today's you to fail and for the terrorist to succeed. so succeed. so when my right honorable friend receives requests from the tunisian government and i understand that he will only seek to ensure not

only the united kingdom but the european union has every possible support? make sure of that the european union pays the money. >> we will help. the offer is there. also because today not only the home secretary german interior minister and the french interior minister traveled together, i hope we can coordinate the assistance we are offering. otherwise i fear they will be overwhelmed with offers of help and may struggle to put them in place. i do want to stress this. we set the risk ratings for countries and the travel advice for countries we must take into account the capacity to mitigate against these threats.

the threat the threat is urgent. >> ufc mcdonald clicks everyone in our community people are saddened to here about the much loved couple lost their lives. by all accounts, caned and were due to attend the garden party this wednesday and recognition of lifetime service to the church of scotland and his many years as a brigade captain. the deepest sympathies of his house and the community will be with the friends and family. family. i am grateful to the prime minister for statement. understandable given the attack there will be members of the public who have questions about reliability of office travel advice. the prime minister said there are judgments involved but what further reassurances any provide that such information is made with the most robust

and up-to-date information available. >> let me add my condolences to the couple who have been lost in this terrible attack he asks the absolutely correct question. as i have said, there is no perfect way to do this. we basically base travel advice on the threat picture and intelligence we have at the time. before the attacks the travel advice did say there was a high threat from terrorism in the country and post the attack we added a factual update explaining that further attacks were possible. but the key decision is whether to move the travel advice to that level that recommends against all but essential travel. we are currently saying we do not recommend -- we -- we are saying only essential travel to some parts of the country but not proposing to

change advice to the coastal region. i think that is the right decision based upon the evidence we have today. where that evidence to change we could and would change the travel advice. the travel advice also depends on the capacity of the tunisian system, and that is the same for all countries. countries. these are difficult decisions. they want us to basically wipe out that in his in terrorist industry, 15% of their economists -- am sorry, tourists, the tourist industry. the decision we take puts the safety of the british people first and foremost. if the information changes we will change our advice. >> understandably we have centered upon the one young man who carried out this massacre and possibly others who supported them. should we not also put on record that dozens of divisions he worked at that

hotel risk their lives in protecting and helping our tourists and in fact that should be the beacon that supports the tunisian tourist industry and encourage people. multiple speakers: here! my friend makes a very good. stories of courage and heroism by local people who were appalled by what this meant was doing which is a great credit to the country. >> all decent people have in their thoughts and prayers the victims in tunisia and their families. everybody should criticize the actions. there should be no justification. they certainly can't bf what happened in london ten ten years ago. promoting and defending pretty -- british values. and i welcome these comments to islam from the perverted ideology. what more will he and his government due to work with communities to promote and defend british values?

>> i am grateful. what more we can do is make sure this duty is carried out and institutions work with us to put that in place. i think there is more that we can do to discuss with british muslims this issue of how we confront the poisonous ideology which means making sure we are talking to people directly and not always going through some self-appointed leaders who do not always represent british mainstream muslim opinion. sometimes that means we will be criticized for not engaging. i did not accept that criticism. anyone who buys into the basic standards of british tolerance and decency i will engage with. it is important. >> there can be no greater agony experienced.

despite what was said a moment a moment ago, more contrary activity undertaken to finalize this list of those who have been killed so that we can put their minds addressed. >> and entirely fair question and i can assure that is one of the most important issues we focus on. what more can be done. my understanding is that we have police officers for victim identification experts, consulate officials on the ground working hand in glove with the too busy in's and are going as fast as we can to get this vital worked on. >> neil gray. >> assists and are told by the airline it would cost him 800 pounds per person to get home early. the chief executive confirmed for me last night that they would get all free of charge in her home this afternoon. what advice can the prime minister offer to

those still trying to get home without sufficient access to staff as in this case? >> i am grateful for the settlements question which tells the right story, confusion to begin with lack of clarity and a good and clear answer and this couple returned home. my advice to everyone is to talk to the travel company first. also, they can ring the foreign office line and get assistance. in any case the foreign office sees they immediately look into to see if they can help and will continue. >> sir edward lee. >> his condolences to the family of the young colleague my constituent, 24 -year-old young girl who was shot down brutally in front of her fiancé traveling from a small town of gainsborough and did not deserve this. nobody deserves this. the the question is what do we do now.

this is not just there but everywhere. so will my honorable friend resist the principled voices trying to prevent them from giving the security services all the power they need and also make one issue, the british people view mass illegal migration as a kind of dangerous trojan horse. can i support him i support him in his efforts to support the convention so that we return migrants and deal with this problem. >> we will join with him. it is a heartbreaking story about this young woman gunned down in the prime of her life. it is a heartbreaking story. he is right to say that the threat is everywhere have a difference between the al qaeda threat that we faced many years and still face is there and we are dealing

with century court new plots which if you could get onto you could try to work out how to mitigate here dealing with a lot of self radicalized so-called jihadists who are being radicalized to the internet often from people in syria or iraq and hopefully in many cases will get advanced warning and be able to stop them. in some cases we won't and this can happen in britain as around the world. world. i do think that it underlines the social responsibility of the social media companies themselves but also the need for us to have the most modern capabilities to deal with these threats as for migration we want to make sure it continues to work. >> thank you, mr. speaker. to a half years ago at the prime minister's first speech he warned about the terrorist threat because of the disintegration of libya. i welcome the presence of the home secretary not just to reassure british citizens but also the tunisian

government and people. having bilateral discussions with heads of government. what is the international way, the platform and we that we can use to defeat those who wish to act in this perfect way? >> the honorable gentleman asks a direct question. i think that there are several platforms that can work. the g7 itself wants to have a clearinghouse for assisting countries like libya, tunisia, morocco, egypt, to make sure that not all countries offering the same sort of help and assistance but have more of a working out who should be working with which country and i hope that can be put into place and work soon because it makes sense for britain to partner with a country like nigeria and possibly libya whereas other countries may be better placed to partner with other countries. that is one network. the other is using the eu neighborhood program to make sure we get better

assistance and support in building up civil societies and economies of the countries in north africa. >> cooperation such as it has is focused on the military situation. in recognizing that we have failed to significantly disrupt the financial flows from arab friendly countries and pattern organizations that we failed to disrupt their prominence on social media and failed to disrupt their business activities. what more can the prime minister tell the house about concrete steps that will be taken to combat isys in other areas? >> i would not entirely

agree with my friends prescription of this. if you look at what i light air action has done together and we have shrunk the territory being held. there have been some very great successes in taking down social media and indeed a number of plots, prominent plots the touch as many as four or five in the last few months in this country prevented. it is important that we talk up our capability and strength and resolve in this way. ..

i am keen to accommodate as many as time recently allows for which purpose privacy will greatly assist me. >> thank you mr. speaker. firstly i would like to take the opportunity to agree and condemning the attacks in libya a sentiment shared across the country. what we need at home mr. speaker a strong communities not divided communities. will the prime minister agree to engage with all communities and will he recognize failing in his attempt to engage and will he commit in this house is systemically systematic review of defense strategy? >> first of all of course i commit to engage with all communities and will continue to do that. i don't agree with what she says about pregnant. we took the advice of an independent review to separate

the community engagement work by the department of local government from a home office feel to it and i think that's the right decision. >> mr. speaker the prime minister's tribute to the victims including my own constituents who with their partners scott lost their lives last week. but will my right honorable friend provide special and personal accommodation to those individual brave people and those who tried to warn against the attack to the doctors and nurses in the hospital who treated the injured because as we know we must be reminded that was not done. >> i also pay tribute to sue and scott as my honorable friend has done. he is right to command the two

nations where they are there doctors or nurses people confronted the terrorists. they are a credit to themselves and a credit to the nation. >> thank you mr. speaker. our thoughts and prayers are with the victims and their families. this appalling act of terror against defenses was holiday makers highlights the need to fight extremism at home and abroad to these terrorists seek to drive a wedge between the majority of the worlds muslims who have no -- with what they represent everyone else. we must all work harder to make sure they do not succeed. what steps will the prime minister take to make sure any international response includes action to help stabilize and rebuild post-conflict states like libya and others to prevent them to continue to be a breeding ground and exporters of violent extremism and will you reconsider my call from earlier this year? >> after much agree particularly

with rebuilding these broken states affected by conflict. as the secretary-general of the u.n. said its good governance that kills terrorism. >> thank you mr. speaker. with the prime minister agree with me that no security service in the world will be able to identify someone who secretly radicalize as himself, trained himself quietly and then operates largely independently and that includes the tunisian security services. >> my honorable friend is absolutely right that it reinforces the point that because you are not necessarily dealing with a network that anybody who has any information about someone who is going wrong in being radicalize to his visiting either extremist preachers were looking at extremism on line anyone who is

worried about that needs to act because otherwise it will lend the weight has been the last few days. >> thank you mr. speaker. obviously what happened is appalling tragic terrible and has to be condemned in every way. we should support those people in tunisia who are doing their best to build a free democratic and secular society where there is less unemployment and more youth engagement. i take you back to the point raised by the chair of the select committee on the situation in libya. is he not think that the destruction of so much of governance of the society in libya has been a cause an opportunity for this problem to get worse? >> the action we took to stop colonel gadhafi from massacring his own people, no i don't. the cause of terrorism is people choosing to take on terror. the same time should be built these countries and governance? yes of course we should but we should never forget where

responsibility lies. >> a powerful antidote would be conceived air of sony's rejecting and ejecting isil from their midst. would my right honorable friend redouble its efforts to find a political solution to reject any check isil from iraq and syria? >> my honorable friend is absolutely right that we need to build an iraq where the prime minister is clearly working for sunnis as well the shia as well as the but we also need sunni muslims in iraq to rise up and reject isil because without that it's always going to be more difficult to take this out of the country. >> thank you mr. speaker. can i press the prime minister on the question i asked a couple of weeks ago in terms of the sunni tribes in iraq?

the fact is the iraqi government is not reaching out another make them so without that we are not going to see the sunni tribes and the sunnis taking on isil. what is he doing along with european parliament to ensure we have pressured to do that ensure the sunnis are involved? >> he asks absolutely the right question and i have personally raise this with prime minister abbas including in the g7 summit in southern germany and will continue to do that. we have to encourage them to be brave in reaching out from the shia base. we should also work with sunni regimes in the area that themselves can work with the sunni tribes to encourage them to accept the offer of an inclusive iraqi government and to reject isil. >> mr. philip davis. >> every year the e.u. is a smaller and smaller part of the world's economy.

its currency is a basket case. it's on democratic and free movement of people makes it easier for terrorists and other criminals to enter the u.k.. rather than a renegotiation where we know the prime minister would get next to nothing can i suggest the prime minister would be better employed negotiating the terms of britain's withdrawal from the european union? >> i sometimes wish my honorable friend wouldn't speak in riddles that be clear about what he really wants. i hope to prove him wrong by bringing home a substantial package that will make a difference address the concerns of the british people but in the end they will be the judge. >> mr. george harris. >> condolences to the families who lost members of their

families. also the recognition of the need for counter terrorism to violent extremism. there are many pathways into violent extremism and anti-musky based on a proper understanding with those various pathways are. would he undertake to set up will we do know in the intelligence and security services and through open sources so andy -- and a counternarrative can be based? >> garble jena say valid point. we have set up an organization to better identify and understand not just the violent extremists but the various extremist groups and organizations. i would accept and agree that we have to look into the pathways into extremism but they cannot or the fact that there are now young people who have been to

good schools who have good strong family background who are not suffering material deprivation who have nonetheless chosen violent extremist path and that says to me that while course we must go on attacking deprivation, we must go on making sure we are a more inclusive country and attacking inequalities areally looking for here is the cause of the ideological linkages that people are making and those that we need to go after. >> a single short question could represent a parliamentary triumph. [laughter] >> could the prime minister explain how a mere promise of treaty changed can be made legally binding? >> in very much the same way that in ireland when they had a treaty changed and they had a

protocol addressing that treaty changed the referendum to place in ireland before all other 27 countries that pass that treaty changed through their parliaments of this is happened on previous occasions across the european union. >> thank you mr. speaker. prime minister in my right honorable friend's across the house thanking -- the mubarak attack in tunisia. the group we recognize as muslims. these people are not muslims. this is gone on in islam for a long time. these people continue and what we have to do and this is where i agree with him as we have to take responsibility for our young people not to be -- and islam for them because these people are not muslims and we

have to take responsibility for dealing with that across the muslim community all the other communities and institution as well. >> be honorable gentleman speaks with great knowledge about this and i've admired what he is said about this over the years. he is right that these people are bastardizing and perverting a religion but we can't ignore the fact that they are self-identifying as muslims and that makes it even were important that we were just what they are saying improved to young people including young muslims that they have nothing to do with what the true religion is about. >> thank you mr. speaker. and not that -- [inaudible] does the prime minister share my view the one thing that can be done is for the e.u. to reach out aspen institute with all the nations which seem to -- and

they need to start again on that. >> i think my honorable friend is right to monies being spent in countries like tunisia but i suspect it's not enough than not focus on the map things to make a real difference to the tunisian economy and the tunisian people. >> i welcome the prime minister's statement and can i also asked that we join in sending our condolences to my constituent claire wind gust who tragically lost her life in tunisia. her family issued a statement and they saved claire was so warm and kind-hearted woman who made friends easily and was loved everyone who knew her. she will be deeply missed. i wondered if the prime minister could assure me that lessons have been learned from families that have been in similar circumstances to this in the past about the kind of effective support that is best needed to meet requirements over the weeks and months to come. >> let me join the honorable

lady in mourning her loss. lessons have been learned from previous tragedies and i think that's why if you lost a relative in the bali -- as a country we have developed better ways of making sure families are kept in touch. they're still more to be done in lessons will be learned and we will be as sensitive as we can. >> thank you very much mr. speaker. my constituents lost his life last friday. can my right honorable friend assure me that he and those others who have died and their families will never be forgotten forgotten? >> i can certainly give that assurance to my honorable friend then again mourn the loss of his constituent. it's very important we speak with families in the coming days and weeks to think of the best way to have a fitting memorial to their suffering into what this is meant, one of the largest losses of life in a terrorist incident that britain has suffered in many years.

>> thank you mr. speaker. i would like to add my condolences to everyone affected by this tragedy and asked the prime minister the government with traveling insurance companies to ensure that all of those in tunisia that want to come home may do so free of charge. >> my understanding is the companies have offered travel back to the night he came them. a lot of planes have been laid on. we believe the system is working. where there cases getting onto the company concerned and trying to make sure the problem is fixed. where france is the issue of people who have been injured or returning the bodies of those who tragically have been killed that is where we are stepping indirectly with transport to try and help. >> thank you mr. speaker. the prime minister pass on my thanks to his fellow european union leaders?

every time one of them refuses to agree to one of his very modest request in the renegotiation process, because every time they do so they make our task for those of us that are arguing that this country would be better outside the european union just a little bit easier for you. >> i don't want to disappoint my honorable friend to much but the reception i've had from from my fellow europeans has been more positive than they might suggest. >> my thoughts and prayers are with those caught up in horrific offense in tunisia including those in cardiff. what consideration has the prime minister given to reviewing and perhaps upgrading security forces in other countries where security interest might be at threat and will be but those considerations at the heart of str like. >> i think the honorable gentleman makes an out -- a good point. the sdsr should be about these issues as well as the more

traditional issues of protecting and defending britain herself because we are we are a country where people work and travel and live in different countries and making sure we work with those countries and security is an important part of what we do. >> jake very. >> thank you mr. speaker. my constituents from darwin were injured in the attack last friday by a hand grenade. they have now returned to the u.k. and are being treated. will my right or a friend assure me that all our hospitals will also receive support including use of extended counseling for victims? >> i will join miles per gallon b. to his constituents caught up in this terrible attack. i'm sure there will be assistance made available because what happened is a deeply dramatic event that will

affect people for many months and years to come. >> the prime minister said he wanted to follow a treaty change. how can we take these negotiations seriously when he is dropped this reasonable demand in the first round of negotiations? >> i haven't dropped its demand that all. >> mr. speaker with my constituent john mech off recovering from his wounds in tunisia can i strongly associate myself with my right honorable friend's remarks and can i strongly welcome the direction of travel he has set out for european reform but can i ask him how my european friends justify political integration from non-eurozone member states in order to achieve free trade? >> the point i would make my uncle friend is different european countries do have different views about integration. there are some absolutely sign up to the idea of the union wants to see every country take

every step pretty much at the same time. there is a growing awareness in europe that actually we can have the europe of different forms of membership. as i said countries that are in the euro countries in -- and indeed we sit around the table discussion issues like libyan security worry of some countries that are leading members of nato and some that are not members of nato. i think we should be relaxed about this flexibility and encourage it further. >> ian paisley. >> thank you mr. speaker. this atrocity serve to provoke many hideous memories of atrocities of mass murder in my own country. countless atrocities that have taken place. i welcome the statement by the prime minister and he has publicly been on record and i welcome the fact that -- as a nation to pay tribute with a minute of respect.

could i ask the prime minister with the dash given to tunisia how much is being directed towards education of people away from fundamentalist believes? >> i think the answer to his question is not enough. the aid and assistance has been much more about trying to build up to nation democracy and institutions of this fledgling democracy but i think given the scale of the threat we face we will have to look again at these partnership programs and obviously education should be part of that because of the danger of radicalization which the two nations are looking at themselves but i also think we have to try to make sure that these countries who often have parts that are healthy and successful and parts that are falling behind we need to address that issue to matt reid c my right honorable friend is already said that the threat here remains severe.

he and my constituents will regret have read the report in the times this morning that scorpion automatic weapons may have been imported into the united kingdom. what comments can he make regarding that which will reassure the people of this country? >> i wouldn't comment on the specific report but he is right to say the threat in britain is severe and said independently by the joint terrorism assessment center. severe means that an attack is highly likely. the pointy braces is an important one. we should continue to do everything we can to keep the trade and weapons including replica weapons out of britain. the ncaa is doing very good work elites keep up the pressure. >> thank you mr. speaker. mr. speaker i'm ashamed to think that this summer many of us will swim in the sea where people are drowned because they have simply been playing more violence and poverty.

is the reason why the u.k. is failing to take its fair share of refugees because this government finds human suffering easier to bear if it is made someone else's problem? >> i don't agree with the honorable lady. britain is fulfilling its moral obligations by picking up those people so are the 4000 people in the train rescued by the royal navy could we are one of the only rich countries in the world is kept its promise about its aid budget being used to help those countries. do i think it is somehow the correct acts to be part of a relocation scheme for people who have already arrived in the e.u. e.u.? no i do not because i believe it would add to the business models models. the idea that you could only have a moral upright position on this if you take part in a european scheme that i believe to be misguided i think is just

wrong. >> thank you mr. speaker. i'm delighted to report that my position calling -- his girlfriend and family on the fateful beach and at the time of the shooting were offered shelter by local tunisian in this house. would my arable friend agree that shows the innate kindness and courage of the tunisian people? >> i would absolutely agree with my honorable friend. there are many examples of this courage and kindness and they are a credit to the tunisian nation. >> i associate myself the comments of the prime minister in relation to the terrible events in tunisia. on the european council specifically on the issue of migration to the prime minister take the opportunity to discuss with european leaders the situation and does he think the e.u.'s proposals for relocation systems will help or hinder the efforts they are? >> the short answer is they

won't make any short-term impact impact. in long term in my view they might make a worse by encouraging more people to make the journey. i did have a brief discussion about the situation in my honorable friend the secretary's meeting the french interior minister later this week because there is more we are going to do in terms of spending money and providing fencing and other action including sniffer dog teams and the like to help the french and work with them to address the problems. >> thank you mr. speaker. it is part of our strategy we rightly banned -- from coming to the u.k.. sadly there are ideology is being directorial people by social media but also by satellite and community centers. what further action is my honorable friend doing to prevent this from happening? >> we can ban the preachers but we have also got to look at their use of media not just

social media but some of these individual television channels and make sure where there are messages that are endorsing extremism and violence that we have the way of stopping it. i think this is very important. >> thank you mr. speaker. before this terrible incident in my constituency and neo-nazi was convicted of a machete attack on an individual in a supermarket in broad daylight on the streets in north wales. radicalized by internet content which is equally as bad as internet radicalization for those who undertake islamic attacks of the nature that has happened this week. could the prime minister generally look at i welcome what is it that could be look at with the internet providers that we can stop that type of information being brought into people's bedrooms where lone wolves can use that information? >> i will certainly do that. with the internet watch

foundation we have acted to take down a lot of pages of extremism. the point he makes is an important one. just as his argument about violent and nonviolent extremism also applies to the extreme right. we have never condoned in this house the idea we will tolerate the national front but go after the combat team. we will never do that when it comes to fascism and we shouldn't do it when it comes to islamist fascism either. >> the right honorable lady rightly highlighted the appalling treatment of people and women by those who subscribe to this evil belief. is there not something powerfully symbolic particularly to young muslim women that is a female british home secretary who in the aftermath of this attack are standing in solidarity? >> i think my honorable friend makes an important point and indeed in tunisian democracy i think actually the role of women

is a very important one and moving that country towards the democratic future that we'll do continues. >> can i give my best wishes to matthew james who was an engineer who took three bullets in protecting his fiancée in a cardiff hospital. in talking with the imams both shia and sunni from bangladesh and pakistan and iraq there is is -- in saying that the dais are imposters, gangsters and murderers and last gamers and will the work side-by-side with the mainstream muslim community and give them the resources they need to combat radicalization. it's our problem and together we must solve it together. >> the way the honorable gentleman put it is absolutely right. they have a role to play and we should help them play it. one of the challenges has sometimes been the relevance of

the mosque to young muslims when sometimes it can seem less relevant to their lives and that is why we need to address the whole issue of making sure the moms have good english when they are dealing with potentially alienating radicalized young british people. >> mr. speaker today the prime minister said he would put a -- on e.u. membership and i'm sure the british people and myself should our shoulder-to-shoulder with him on that. why is it that the british media says he can do this when i know he won't accept anything less than fundamental reform? >> and i think the honorable gentleman for his supported say that i want to continue this closer? this ever closer union between us for as long as possible. >> jonathan ashworth. >> we all hope and pray for the safe return of ray and angela fisher and i'm grateful for the commitments the prime minister

has made for the embassies of the foreign office staff. as the prime minister agree that dais whether kurd-arab sunni-shia and can they tell us what he's doing to build an effective united front against da'ish. >> let me join him and wishing his constituents well. there is now an enormous international coalition that includes many arab and gulf countries and we need to keep that coalition together because all of us bring different things and some of those country -- countries as sunni-arab states will bring that ability to talk to sunni muslims to bring them away from da'ish and believed then and integrated iraqi government. >> if colleagues are willing to imitate the admiral example of their honorable friend from north essex i shall endeavor the honorable gentleman sitting there aiming for there will

shall do my best to accommodate him. mr. henry smith. ..

>> >> to make sure our offer is on board didn't important that it is directly will agree that terror is a fight we cannot win if it shows similar results to fight the hope of which you have spoken. >> you are absolutely right. it will take resolve and patience and determination with the government and the people. >> we need to do what we can't do disrupt on social

media up. is time to reassure the mainstream review editorial policies to stop publishing from videos or with the faces of the smirking terrorists in instead of those who stood up to protect innocent people. >> you make an important point dvd after exercise our own view of social responsibility of what they sugar should not publish a really hope the bbc can look of the issue to call islamic state is not islamic or a state it is a terrorist organization but --. >> thank you, mr. chairman speaker. i see the islamic values going hand-in-hand for each and every one of us has the

duty to challenged nonviolent extremism. >> to speak with great knowledge on this issue the shortie answer is yes and all members of the parliament can play a role to shift the debate on this issue. >> with the brave showing of airforce in the skies over iraq but yet on the ground forces are taking on a the isil canal is time for a the persian reverses to be properly armed. >> i will look into the issue with funding from baghdad with trading and support we are supporting them. >> but other countries are providing. >> if you look across what

we do a cross ted years have made people we have given asylum to we are consistently in the top five european countries and on that basis we play our part. >> would the prime minister agree that it is fundamental to reach a complete sovereignty over over british borders if we prevent the ideology creeping further on to our shores? tonight we do any strong border control but what it demonstrates is the importance in a age of tunnels and the rest that for the security that we need. >> was steps are taken to ensure intelligence is shared by national security organizations? >> we are sharing intelligence for obviously we have different relations

with different countries but the more we can build up trust the more we can do this. >> would you agree that were security services if they are here illegally that as a matter of authority should call them? >> absolutely. that is one of the reasons of the human-rights act to get in the way of the arrangements. >> during that particular region with terrorism with the prime minister considers to help combat terrorism? >> search of them will look into the point my honorable friend makes because if there are issues then

gibraltar we will look. >> my constituent of this taking place but agreed to waive the cancellation fee. for what the government can do in relation. >>'' we have done is encourage the operators that said they have offered people a cancellation without penalties with their money back that the front office team should take that up and he lost his life on friday and his daughter is a constituent mr. wilkinson has his dark contrast with those that have committed the crime. can you ensure this will go

on for many months because it could take many years to say actually we do need to change recall these terrorist they are not an islamic state. >> i will join my a tribute to bruce in the way his family have handled this terrible tragedy. the point that he makes about the islamic states is on the issue to make sure with help that part of that is highly carried. we're just coming up to the anniversary and that is a reminder how important of things because relatives will more and into the future. >> please return to the

ministry and from the leaky votes. what about the european union? >> a successful way to tackle large scale were organized and human trafficking. >> we look to let us finish did with regret to one year they received 36,000 migrants. but they broke the business model to find a way to return people to the african states. that i think is the ball and it is more complicated in this case.

up next agrippa policy analyst talk about the federal health care law and the prospects for future legal and political challenges. the forum is hosted by "politico". it is 45 minutes. [applause] >> good afternoon. i am the health care editor of "politico" i'd like to thank you all enjoy a - - for joining us today and those of you on though live stream. we are irked excited to continue our even in its and today we have a time a discussion about the recent supreme court ruling of king addresses burwell to talk about the policy in the future before i introduce the panel thank you to do a

cvs health and also at all series a and also is the exception deaf vice president for strategy. mary? >> good afternoon. i am happy we have this turned out and i thought maybe you'd be at the beach. well come on behalf of cbs health and now with their ruling on king had all of us on the edge of our seats. but now the court has spoken on obamacare we have asked ourselves what is next? where do we go from here? and has been five years since the affordable care

act passed and signed into law and three years since the marketplace was up and running. in that time we witnessed a law of changes a law of positive disruption and the players adjusting and working together to approve the system but there are significant challenges ahead as expected. there will be complicated by political or her laurels but also other factors that we face together by the aging population, a chronic disease, and that will demand the entire system and all those working within the system will come together to focus on health care activists with cost and quality and will push for word. at cvs we are extending

their front lines to deliver better outcomes right there in the community. with the king case behind us with the supreme court decision as it is the health care system has the opportunity to look to the future and i am pleased to be partnering with palmetto to host this discussion to have that constructive dialogue for what the future holds for both thanks for being here per gram the foreword to the discussion. [applause] >> thanks for your partnership. so for those in the room don't forget to join the conversation #pro h. c. i have i can take tablets it -- i have attached a questions of a twitter.

president and ceo of kaiser very foundation and a managing director of the health division and the ads don't lecturer and at the kennedy school on and i first met her years ago working flatland dash four senator in dave fellow at the american enterprise institute. irate expect them to talk to each other and not just to me and the lively but we want to part of the talk about how to move ahead of first you e-mail me something but first is this the last lawsuit? to read the last big one. [laughter] i had a couple of days before i will lead mitt babette the existential threat to go to the court if

though law is meddling in business journeys to be reconsidered. that part is over there may be others but the big lawsuits are over. >> so we get june back next year? iraq --. >> is this the turning point? is a pivot point? >> i think that hca dodge its own particular nightmare but look at "politico" or other morning reports it feels strangely familiar because of the politics they will feel familiar the implementation challenges will the you have known and loved and the focusing in

the election depending on what happens and something that refocused on a law of scarcer in don't expect public opinion to change. that is a quick summary. >> implementing the building blocks. what is different about this moment now? >> they never thought that partisanship would continue to get deeper and more entrenched each year. now we have a profit of - - potential that the interesting question whether

it will be a major issue between the parties or not but i could see is stepping into the background but the administration preference would be that they could focus to employment the law and tell the election there is some of relative quiet bed there are many things that could go wrong. i generally have the feeling both parties will find in their interest to back away to not keep it on the front burner although will be talked about. >> you have watched the republicans.

is it a point for them? >> it is a period of time of reflection and you can see in the court a series of conversations about things that could be done by either of king or burwell i don't think any stretch of the conversation is over for our think there is a set of issues between the states in the federal government yet to be sorted out as a guess how to proceed and we are at a point where we still have to go through reconciliation and the things that might be done is the baseline no desire have to be adjusted. so there will still be conversations whether it is

votes to repeal is not clear but there is a great deal yet to be done and to be learned. >> if somebody just decided they did not love a law because. >> host: did not go the way they wanted? is that a historic we will look back and see? >> the turning points with each it is in dover. we could go on but to be based on rhetoric and those passions behind us with of legislative front the opportunities are pretty narrow they encourage more symbolic moves and to make them feel good while you do it. the world is safe for lobbyists again in washington and.

veba be back in a in business. there are incremental changes then the law but this will add to the presidential election. we always had a generalist stance ucb will change this but i will spend the rest of retiree branding administrative law. >> you have some numbers how the country felt about what happened. >> i've read that absolutely with the forecastles from congress almost certainly would not pass but that is mostly of history and

research and they it is not all in one place just with same-sex marriage years of version how the course failed to save you from obamacare but for me and i will. that would distinguish some candidates rather said with the general election it is about to motivate the turnout. so we will see that health reform is not the decisive issue but it could be so rhetorically we will see a focus we are releasing another tracking poll later today. >> attention did inject as he got to a decision. it doesn't sound like a law

but the interesting ways 62% supported what the court did so well reef and the current the one-third of the republicans supporting the courts decision in the deaths - - scene in our tracking poll said it is locked since the beginning cry would not expect things to move very much the at least in the short term as of today, it is 42% favor 40 do not oppose it so it is in favorable territory but no big switch. >> it is the thought that it

should be across are they don't understand that christ american was not illegal but [laughter] if you read the opinion there is a law of policy. >> but it does discuss the public we don't know why some people love some states get it and others would not. don't talk to me about anything else. >> but the thought of public opinion. >> i am still counting on the 25%. [laughter] >> it has not moved a law but at this point i swear if the hca to solve the climate change program we would get a perfect split between republicans and democrats.

>> congress cannot repeal obamacare. there are not. >> there are all kinds of things to get in the next couple of years but it was still be at that level of generality with a proposal coming out of a presidential candidate. >> of the pressure on congress but in the house

you are more likely to get something but feet are inherent in this film the president to veto that would be more thoughtful to be mandated in isolation with reconciliation to visit the transfer full ownership of what that means to the white house. they are expecting the reconciliation bill to be vetoed. so it tends to europe cater but that is the main shelter >> you point out in the interesting question looms

so the question of the affix but the decree you would settle but to have issues around the mandates in the the cadillac tax not likely to be resolved but read the context of a tax reform we certainly do have - - reason to see what they say. is unlikely but an opportunity for people to position themselves. >> we have seen that they could develop. >> sure. but with the political

theater is with the individual mandate that is the most likely scenario and favored but they do have a question is if some of those show a law of work to her credit input now he had a photo coverage it will he be charged price directive is the template will dash medical device tax. but the question is do they see that as an attempt to piecemeal and take it apart. there are opportunities but the closer to 17 and the tougher to identify those

incidents whether it is the cadillac tax. each of those has a different impact that have to be taken into consideration so those are opportunities that the likelihood i suspect of many of those. >> it does not rise to the level to get people excited those going out of business for the next year but they give the impulse and the emotion of the field. >> the actual impact is big with the symbolic importance as it sits there as a potential target which use the democratic presidential candidate who hast to have a

plan to improve the california to pick up the quagmire of politics so hillary clinton talks about high deductibles and reach an petraeus but there will be a law of live'' attention f well as the medicaid expansion. . .affordable that the american butter doesn't understand per capita price trends. they are just seeing more money coming out of their pockets. republicans are saying it's not affordable. and it's obamacare's fault here

and how can hillary talk about affordability without sounding like she is a republican? sheila: two drew's point currently her focus is on drugs. i think she thinks of it as a pocketbook issue separately. i think she has resonance, even among some republicans and certainly the introduction of new drugs and the out out of pocket costs. so, she's able to do that i think without getting caught up in the obamacare conversation by highlighting a particular issue that does have resonance. >> i think it's an explit is to g able to do that without getting caught in the obamaout a care conversation clicks frankly, i think it is an explicit attempt to get beyond obama care. onepe of the most striking findings is we just asked the american people in a a way what the top healthties wer priorities were command it ju

was surprising, absolutely at the cost -- at the top of the list with the high cost.nd it is not surprising to me. and the meat and potato issues the prices of medical care, price transparency,struck u and the aca issues which consume all of us are way down the list i clicks one ofp. the other part of the thingyes that struck us wasagre o republican, democrat command independent. i can remember there was a poll and all the years i'vewhat been watching where everyone agreed on the top issue.rely r >> in this case it matches the substance in the sense of the actuaries are worried, but about the trendlines.he so not really related to thethe ug underlying issue, but here insu it is. worried about health ea

pricing from a substance perspective, you are worried your worried about how you. managed the drug cost. fascinating to watch making sure that they go after each other with the differente is solutions. it can have a lot of play. >> the high deductible issue is the tip of the iceberg of the bigger issue about how insurance is changing, more cost-sharing. particularly democrat they would not defined as and obama care issue and affordability of policies and exchanges. as a broad issue about how insurance is changing the marketplace. whether to get away with that or not is absolutely true. >> you were -- there were trying to decide whether to have an exchange and how to set it up and all of that. the enrollment takes place at the state level going into 2016 medicaid

enrollment was higher than anticipated and exchange rate was lower. no one is put on the forecast for 2016. you have affordability issues, political people hat didn't happen. what from an implementation standpoint has to break through because if you don't get people covered, the law is not doing what it was intended to do. >> well, i think it's like a lot of parts of the aca, just on longer path than people thought. change is harder than we think. in terms of i.t., all the different dimensions. i think the secretary has it rigts to say let's step back from the estimates that were made six or seven years ago now and look at what we think we can , accomplish and make it about right this year to say get over ten million. >> it was way lower. >> right. way lower and cbo numbers will double that in the next two years.

probably won't get there would be my guess. and you'll see hhs come out with numbers that are based on real data looking at what's happened over the last couple of years and we will be slower. what political implications that have, i think are generally ok for the administration because as long as there's progress whether it's as fast as people thought it should be or not, i think it's still positive story. at some point, someone may try to make an issue, gee, there's a lot more on the medicaid side in terms of how this is balancing out. that's true. you're accurate on that point, but i think if we continue to make coverage gaines and a big dynamic. that's happening is that the states are going to take back or take a back step on the i think -- the ip functionality. as things level, they will take

a step forward in terms of involvement in the insurance market. one thing that united the most conservatives and liberals was we all wanted to go over our state insurance markets and we've lost that in the last two years, but i think that will come back and you'll have a system where the states are the the locus of activity about granting through and all that. but i.t. is done either through the federal exchange or private vendor but not state-by-state. joanne: it will be more like what nevada and new mexico are doing now. where they're controlling certain amount of on the ground, but everything technically because that's the one that ended up working. at healthcare.gov. joel: we had federal data, so the states pick up after enrollment. things they are traditionally good at. i don't know how long it will take. tom: when there is protections

going up in 2017, premiums go through the roof so you've got , your group of people that can go there, so nothing's wrong working with the small businesses. you've got something and it's going to be stuck in place. which we can't get that hairball out of our throat. sheila: but you wonder -- reflecting on what joel has commented, in 17, the states have the opportunity to waive out. the states have the opportunity to essentially restructure what it is they want to do both in , the context of setting up in exchange and also down to the benefit issues. some of the issues joel raises about the state's, that opens up -- states rights historically, that opens up entirely in '17. now, one wonders in setting up infrastructure, the moment -- enrollment process, whether they will take full advantage of the waiver. notwithstanding the rules say they have to cover the same population, have similar kind of benefits, there are enormous

amounts of flexibility that in fact, the states could take back in '17 if they choose to do so under current law. so, again, i think the question of what the states are doing what they've learned in this process, raises a lot of issues about what the states may choose to take back. should they have the opportunity to do so. drew: a couple of things on this. the issue of people, not just a political problem. i think it is the biggest implementation challenge facing law. the need to sign up more people and reach more, which is a -- and reach more uninsured which is a different group and a , tougher group to reach. the coverage goal, more importantly as has been said, to stabilize the exchanges and the premiums on the premium increases are reasonable for people and also, tolerable politically. sheila was referring to there's a course of people i join interested in the so-called section 1332, which is state health reform. one point i would make about

that having been involved in getting federal waivers and giving them and also studying them, is that will also be a political process. there is a lot of flexibility so, democrats are in charge of the administration, there will be i think withering republican , oversight. however, if republicans are in charge of everything, we will not have henry waxman sitting over you know, on capitol hill. you will not have democratic oversight. so, if they decide, they could still place the use of reform labor in lots of ways. -- waivers in lots of ways. >> when people look at that, they can say they're going to see mandate, the individual mandate. get rid of your exchange in favor of insurers, you can change the benefit structure and posture and very huge opportunities and what will play there is a lot is is going to edge up, which the president will have in 2017.

tom: we are going to have a very loose definition of the three things. same coverage achievements. budget neutral. and seeing consumer protections. those are real boundaries. joel: you say they are minor. today people have individual insurance in a way they never had. in my 20 years of insurance regulation, you couldn't bet on the individual market. i came out of my role in pennsylvania, i had to have a job with insurance because i couldn't go to the individual market. today, people don't have to have a job to have insurance. you're not going to roll that back. sheila: but i don't think in the current context of the conversation on the republican side, i don't think there is a view towards rolling back some of the things we agree on the issue. guarantee issue, coverage. there's no question about that. but to drew's point, and you're

right. there are issues in the near-term. but recognize even in a democratic administration, there has been a fair amount of flexibility in some cases with the negotiation of the waivers because of the desire to increase coverage, so then, the context of both the medicaid discussions as well as these discussions about exchange structures, this administration setting aside whatever public -- republican administration might do, were frantic to essentially increase enrollment . and i think went farther than you might have imagined in previous administrations, so what would happen depending on whether it was a republican administration or a democratic. i think there's a great desire to maintain coverage, to maintain the population of coverage. there are options about whether it's the employer mandate or individual, but the fundamental insurance reforms stay largely in place with some tinkering. the question is, do you create an environment where there is a death spiral because only came in are essentially the people

who need the coverage. i think that has to be negotiated. but i think there will be less ability -- flexibility regardless of these waivers. on both the medicaid side as well as the employee side. tom: flexibility comes and goes with depending on how desperate you are. in an environment where there are a lot more tools in this law that the administration has. when they're about to go out of office, they're going to blast out a lot more stuff because they're not please, please, please, come in, establishing a template for maximum authority in the future. joanne: give an example of something you think thegoing to -- think is going to happen in january. tom: not in what we are talking about i think much more in terms , of converting what are the innovations, we say this is success. we can implement that. we don't want somebody in the administration playing around with it. some of the payment rules can be stretched. there's a lot more clout where if you're not trying to be the nice guy in order to get off the ground i think there's a wide , range of discretion for this administration to go further than it has. sheila: i expect, referring to

what is taking place in medicare and some of the payment reforms. it is not just on the private side, but the administration has enormous opportunity to ensure this puts it in place without going through the normal process. that was one of the gifts that the aca provided was the ability to do that. to put it into practice that would have required a demonstration project. the secretary can deem it as a challenge and put it in place. i think there is a lot of that. tom: a lot of that will be established by these states. joel: more flexibility to the states. i think that's probably going to continue all the way. if there's a huge federal play at the end of this administration, it's going to provoke a backlash among the states that they're cognizant of and i think the smarter play is to say this law here to stay.

for all the reasons sheila just said. coverage and guaranteed accessibility, all of that. it's going to be the ground that as much as possible in the states and give the states more flexibility. i think that's the realm in which the law doesn't continue to be a piñata at the federal level. tom: my wildcard why isn't estate in a year or two, save someone from running on medicineaid. we're going to put everybody on the exchange. scott walker move before, ipg we'll see more of. joel:>> if you don't expand medicaid, everyone is eligible. >> you can go down. >> on that point. this is a gut feeling. but there may be more there may be more flexibility now on the wagers but the thorny issue right now is the welfare

requirement. somebody who did push for welfare reform years ago i can see how that is could be pushed out. >> i want to start one -- with one of our reporters and -- twitter questions, we will get one in a second. >> sorry to pull a fast one on you guys but i want to ask a question about the exchange. a year from now, how many states do you think will be enrolling people through their own websites of the states that have state exchanges right now? we have 16 and the district. >> fewer. >> how many fewer? >> single digits. >> yeah. >> 38 today will be using the federal platform in 2016. states are not going to go the other way, so a number like

40, 41, maybe, but again, that's from the beginning. i think there will be a play against the federal government running i.t. if you say ten years from now who's going to deliver better, i.t. can create a consumer experience, i say it's somebody out of the private sector, not the federal government. there's a lot of turmoil in that market to improve it and i think we need to think about i.t. separate from running exchange. who's running the marketplace. >> some of the exchanges federal exchange states where the governor is hostile, florida being the key example, they've had phenomenally high 1.6

something like that, enrolled in a state where they're not a state exchange and they don't have support on the ground and some of the state changes that are blue states have not had fantastic despite efforts to do outreach. >> medicaid, you have a much bigger population for the exchange. that's some of the way those things go. >> who's going to pay for this stuff? the states don't want to pay for it. there's not budget money right now for the feds to run their marketplaces as aggressively as they'd like to. no one wants to pay and the question is how much can you add on to the premiums? i'd say the answer to the financial sustainability is a little unknown. >> biggest plus is the i.t. we've got ibm mainframes now. we're going to have something different five years from now, ten years from now. that's going to be a big part of the law to make it affordable, too. >> and the cost to be born by the states or feds. >> questions in the room.

i've got one from twitter. is there anyone who has their hand up over here? >> there's somebody somebody to your left. >> right. >> will the private vendors will wary because they'll liable for hacking where as it might be insulated from that? >> there are 50 private web brokers who signed up with the federal government gone through the security protocalls that the federal government has, so, so far, they've been willing to do this sort of thing. whoever can tell me what's going to happen with security generally in our society, i guess you could ramp up quite a bit because we've had real issues with breaches of security all over the place. >> including federal government. >> one question from twitter how does the king dynamic affect

labor age? not sure there's, i guess it means labor age. gl the appropriations process. >> right, if the republicans want to go after the aca and the report didn't do it, they are trying to defund. >> well, they're both the house and senate have included provisions that would stop funding or call from stopping funding for those who essentially implementing the fact for the risk corridors. obviously, they didn't go after the subsidies, but didn't go after some of the infrastructure issues and again, moving on both house and senate sides, the outcome of that and whether they actually complete an appropriations bill this year remains to be seen. or you're the cr. >> it's the infrastructure kinds of issues. >> the house approach, which did not become law. we passed state exchanges, but ended wup a federal exchange.

>> depends what the meaning of state is. >> stop it, tom. [laughter] >> it's a new world. got a new vocabulary. >> you know why i invited him. but there's no money. there was never money to implement the federal exchange. there was like this chunk of money that had to stretch. >> sofa cushion money. >> right. we wrote about the money. four years, there's got to be no more, by the time -- came in all the coins under the coaches were gone and i think labor age is trying to stop some of the flexibility they have to transfer money. >> yes. >> how on earth did you do it and how are they doing it now? >> in the end of the day, we're pretty much going down the road of what we should do with everything. people use it, pay for it. so user fees are used at the federal level, probably going to go up some. that's how it's going to be ultimately paid for, so it's not going to be a federal appropriation, competing with some other federal

appropriations. it's going to be through user fees. you look at the exchanges, outside of the technologies, there's not a lot of costs, but some have been in outreach. some in regulating the plans and all that sort of thing, but mostly, the cost is on the i.t. side and obviously, the subsidies. between the next two parties. >> you've been involved in the federal procurement for technology, you know how it works. last decade's technology is today's crisis. >> technology is a game changer and anybody who thinks that we're going to have the same technology running these exchanges ten years from now as we have today, i think is is not look inging at where technology is moving. on the i.t. side, no, i think that's why the question over here, again, what we should have

done from the beginning here the fight in congress was not about who runs the i.t. it's about who's regulating the insurers, that, those things that are the policy issues that people care about are in health reform, those are going to allow states do those things already. those responsibilities are going to stay in the states as the bulk of the states and the i.t. who runs that, probably we should have hired google to do all of it for us. >> a couple of 12-year-olds might have had --

>> there are enormous administrative complexities. but there's no question that this added to that burden in terms of the state insurance commissioners. many of whom have said they don't have the resources or the capacity to do the kinds of things that need to be done. network adequacy. have you ever gone beyond what was required in terms of review. i think the states have come into real issues in terms of being able to finance. the question is to how much can you shift to the premium and not simply put the premium out of reach and of course, you then tr have the feds looking at the premiums and saying no more than ten and looking at those and saying too high. i think the states are at risk of not being able to sustain them, but all the basic infrastructure in place.

mr. ario: an example. rate review is one of many more complex tasks. 45 states have gotten certified to run rate reviews. the florida insurance departments has one of the best reviews of the country. they were tied their hands for two years. the legislature said no, we want our rate review guys to actually operate and they do operate in the insurance regulars basely eating the cost to do that sort of thing through the way they get funded. so that's not a big charge. host: can we get a mic over here? i know who you are, but identify

yourself. >> phil with kaiser health news. the future of the success of the aca, how much does it depend on texas, florida, georgia? florida, republicans were willing to shut down the government instead of expanding medicaid. any sign that now that we're past king burwell -- ms. burke: expansion of medicaid? i think it's a state by state battle. tennessee's a good example. we know that governor haslem would like to expand, but reluctant to do so. depend on the -- make up of the legislature and you've got some states where legislature out out for a big chunk of time. so, again, i think it will depend on the politics of the state. you've got a lot of governors up for re-election who are worried about positioning themselves you can't assume single answers for all the red states. i think it will be a state by state battle. >> but the state legislatures in many of those cases, are more important than the governor.

mr. ario: look at the governors who tend to be drifrven, the governors in many of those states are in favor of moving forward. legislatures aren't. so, the real question is -- ideology, the answer to that president. one last question. anyone in the audience. paul. host: one last question? over there, paul. >> i'm wondering what your thoughts are on how the coming consolidation of the health insurers are going to affect some of the top imp menations as -- the top implemenations as we

discussed it. >> the fact that all the insurers are trying to buy each other right now. >> look, in you want to control people, it's better to have to control fewer of them. the real question is who's going to be captured and who's going to be the capturer. >> i think all of the deals will get through for antitrust reasons. we have doctors being bought up and the idea is if we get a big enough box you don't know what is going on underneath is. that is a serious problem because you cannot break through into the health place with something that is different and better. it is getting harder as this is being more politicized. >> any other thoughts on -- consolidation? >> what i am concerned about is what is happening to the people. >> what if you have two or three big insurers doesn't that

increase the availability of negotiating items? >> it does. >> the real question is i don't really care if i am in the bay area. i mostly care about two or three things that are capable of competing with each other and in my home state of pennsylvania there is competition between two and etna and united and everybody else sneaks into the market. you don't need huge numbers. but you don't want to get to where a single hospital or carrier dominate and we don't have that in the metropolitan areas. this is showing how tough they are in the rural places in america. >> to wrap up panelist if i were to bring you back july 1, what would be the big health care story?

>> it isn't working any better than it was yesterday. that is going to be the big story. >> sheila? >> i think drugs. i think drugs will continue to be an issue. i think a lot of the pressure on what to do with high cost drugs is with us. the issues that have arisen and in july of this year we will focus on november. it >> phil? >> people are going have trouble breaking through because people are going to go this is okay and we don't need everybody fighting about this. i think it is moving in that direction. and >> and drew? >> the nta will be a focus but the aca won't be. i think the big health story is cost are starting to rise sharply. >> time to wrap up. thank you for being here,

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