when they redistrict. but by the end of that decade, those districts in the state look a lot different than the beginning of the decade. that is why we need to focus on having a program address that. so, one thing that we have going for us this time that we did not have going last time is the fact in 2020, it will be a presidential year. so we have opportunity in both ' 11 and '20 to have higher turnouts than 2010. we can take advantage to win more seats. >> there is a political strategy and movement-building strategy and we need to push the party to be open-minded around, i do mean the democratic party, you know around what it means to do work around the census. every person needs to be counted if we want these lines to be drawn fairly and every person get as vote that counts. in washington state we had pretty abysmal census turnout

especially communities of color, with high latino populations. folks didn't want to be counted. took large invests in folks not concerned what the census could do for them, movement building, door-to-door contact, education to get people to fill that out so it could do two things. one it could build a case voting rights happening in different parts of the state, specifically in yakima valley and everett, north of seattle. it also brought more people face-to-face with folks already invested in the political outcomes of their communities. they could meet people who could intro for them, that meant better sidewalks and street lights, right? bringing macro down to the micro so people could see this affects everyday life. this affects my commute, my children's school and wages and census is first part of that as politicos, we look at census thing that doesn't impact us as much but is very important. we need to get out of the mind

set to make sure our communities are counted. second thing many of our states have redistricting commissions. in washington those are appointed by our legislature. we had a really, huge missed opportunity last time where our democratic speaker of the house din listen to communities of color, did not listen to advocates says we want somebody on the commission who will make sure redistricting represents our interests and our values. instead chose somebody that actually did not represent that and in fact really hurt us in a number of ways. we need to make sure he knows that. for those of you who have appointed redistricting commissions make sure to reach out to speakers of house and senate majority leaders to tell them exactly how want on those commissions. often those decisions are made in back room somewhere and not public. we mead to make sure they are public and publicly vetted and make sure they're people we should be putting into place. last thing, i'm a bit of a broken record, special purpose districts, water districts,

school boards, you can not cede the small ground because we will lose the war if we don't fill those positions with experts and qualified people, especially those barriers making it on to the ballot in the first place. >> amen to what michael and ej had to say. there is african proverb one should never build their shield on the battlefield. well there is shield building time. we have to have cycle by cycle plan. blue wave is coming. how do we wave from 2015, to 2017, to 2018, to 2020. in ohio, with chairman david pepper we came up with initiative, one is the 16-18 plan. part of our 16-18 plan, we understand ohio, people women come here, how much we love you, we love you, ohio, when it comes to midterm election some folks don't even know we exist time for midterm elections.

they're like ohio who? we'll not let it happen for ohio as we bring it to the nation twice in 2008 and 2012. we done it historically by recent history. we make sure we get love into 2018. so we're building that blue wave is coming. we have a 16-18 plan. we're focused local election. who is running for mayor. who is running for school board member. who sunning are for township trustee, 2015 as we ready ourself for 2016, do the same thing for 2017, for local elections. then in 2018 when all of the statewide offices are up again, that we have the strong foundation to take back the constitutional offices. we have to build our shield. part of the 16-18 plan is another initiative called the main street initiative. for the first time in the ohio democratic party's history chairman pepper and myself have created an initiative where we raise money for that main street initiative and those dollars go to candidates that are running on the local levels of

government. we show the local candidates the love that they deserve. number one, as democrats and progressives, we still control a lot of local offices. that is number one. number two that is how we build a strong bench for people who can run for state legislature, who can run for statewide office. who can run for congress. we have to build it that way. we have to take it cycle by cycle. progressives if we have to eat a elephant at all, the best way to eat it is one bite at a time. [applause] >> i love it. i'm going to start with sort of what i would like to see happen in my home state of arizona. i'll tell you that i was gone for six years from arizona. when i left, same people in power that were in power when i ran in 2004 that didn't help me. came, left in 2007. went to nevada. went to washington, d.c. someone once told me, your home state

will appreciate you more when you come back. not so true. let me tell you. i've come back. i have lived in nevada. i've seen great leaders being built up in nevada. i feel like nevada was what phoenix and arizona was 10 years ago when we opened our doors, when we really encouraged new leadership. came back in 2014, 2015, same people running stuff in arizona. it is a boy's club. i'm tired of it. i'm so tired of it. i want people like rosy lopez to always be involved. believe me everyone can learn from someone like rosie and people that came before me. tell you in the state legislature, represented by three guys. i don't like that. i love that they're all hispanics. i hate one of them is anti-choice and he is a democrat. this is what we've got to be doing, folks. it is not easy. it is not pretty but we've got to be calling those folks out.

part of our party platform is inclusion. equal rights for everyone. our gay and lesbian friends are. women's reproductive right, i don't consider you a democrat if you're representing me and you're anti-choice. [applause] we've got to hold folks accountable. we've got to make sure labor is talking to environmental. that dsa is talking to labor. that we're working together. the great tables and circles we're building in the state we have to make sure everyone is represented. i even had a conversation with someone about i have to join this table in arizona. i'm dfa i'm local. i work national state races. i'm local. let me put that out there. i want to elect good

progressives in my home state but if i can't do it there i'm sure as hell doing it all over the country. make sure in our state all of you are advocating new lip. rosie blazed path for people like me. we all need a rosie lopez. stand up, if rosie doesn't mind. rosie lopez, ladies and gentlemen. if you're from arizona you know who i am talking about. her granddaughter is my best friend. side note. every state we have the activists want to see the state. they want to retire. right, rosie wants to garden. she wants people to take on the fight. but us, as some of the younger generation we've got to fight to be at that table. i got to tell you, i will fight to be on the table here in arizona. we have to keep doing that we have to keep the people elected right now in office. and if they're not fighting for us, we've got to get them out. [applause]

>> because the panel is being live stripped we'll take audience questions in a moment. want to do one more round through. if you're asking questions, in the mic in the middle of the aisle. we'll get to audience questions. the question i want to want to ask the panel, related to something discussed you brought this up, i heard it mentioned today as well, monica, sb 1070. talked about voter i.d. laws and redistricting how republicans control the process. what we as democrats and progressive can do to fix the problem. we also have to keep in mind that republicans are actually trying to push back on us to make it a lot harder for us to do our jobs is specially through voter suppression. what are some things we need to do, how do we untangle that chicken and egg problem of we

need control of state legislatures to stop these nasty attacks on voting rights. in order to get control of state legislatures you have to win elections made more difficult for us through restrictions on voting rights? how do we untangle that knot? start with monica. >> i'm firm believer that starts for candidate. i come from the world where i was a candidate. it starts with candidates but starts with all of us. arizona got a lot of attention with sb 1070. we've been dealing with that for 15 years. it just wasn't as horrific as sb 1070. we haven't done a good job in states like arizona, talking about voter suppression. we talk about it really well here in our own state but we don't have sort of, we're not pushing the national leaders to talk about. so we've got great people in congress. we've got to make sure that they're sharing our state stories out in the national media, making sure that folks

know this is really happening. there are a lot of crappy things happening in our states but we've got to make sure that is coming out. then we've got to make sure we find those folks who are part of that movement, let's ask them to run, right? if there is a great attorney who has been defending voter rights for entire career, they make a great state legislator, i think. we have to get those folks who are at the top of their game in that issue, to run for office. i think that is, you know, the egg, chicken before the egg is making sure that we get good people in office. making sure they're protecting it all the way down. we've got to build coalitions around voting rights. i'm sorry. we're building great coalitions in arizona around immigration reform and dreamer movement is so active and so amazing here. that also includes voter rights, right? it also includes that. so just because you're a dream activist doesn't mean you can't be advocating for your brothers and sisters who can vote. we're voting for them.

my vote counts five times for four dreamers that can't vote. we have to make sure we build coalitions and everyone is making a difference and talking about that i do think it starts at candidate level. [applause] >> you know, really repetition. i wish, there is no magic to this. we have to continue to tell the story every single year and even if we're nauseous saying it over and over again. people need to understand all paths lead to the ballot box. that is great equalizer. that is no hype. that is real. my good friend, christine pelosi says in some of her trainings, if you don't respect me, don't expect me. if you don't respect me, don't expect me. for communities of color, they don't feel like folks who were elected to office really care

about them for their issues that is the bottom line. people opted out. in order to get people back into the process, we have to energize and to remind them it is important. if you care about education fundings you need to vote. not arizona, if you got to vote. if you want women to have a right to control, they own, dad blasted bodies, we got to vote. all of those things, whatever issues are that matter to people we have to make sure we remind them to vote. vra, the congress needs to take care of that, it is high time. past time. that is the foundation of this country. so to me, really an emotional thing. how do we get people to be emotionally invested in their future. since most folks won't run for office, that has to be done through the people who do run

and serve. i don't know which one, i don't know if it was sister perez or brother michael or ej that said, once people we get caught up with folks running with d behind their name, once they get there we need to scorecard for the folks. not enough to say you're democrat. what do you do once you get there to make lives of people better. keeping people energized. being authentic. can i just say, no, i used to work for a mayor in the city of cleveland. came into the cabinet one day. something terrible happened in city of cleveland. you would have thought it just started raining outside. if your hair is on fire, act like your hair is on fire. our hair should be on fire every single election cycle. we need to make sure that we act as though our hair is on fire. all of these issues are important but we can't tackle those issues unless people feel a part of this representative democracy of ours. they have to get out there and

exercise their right to vote. so repetition, over and over and over again. >> i see the lights. i will be really quick. when we're acting like our hair is on fire, we need to tell those democrats, voting rights is your hair on fire. because the states can pass it. where the congress is not acting. that needs to be expedited. we need that to be priority of our party. no reason why any state has majorities in either house should not be advancing legislation that increases access to the ballot. in washington state this is real issue where we have weak democrats not pushing hard enough. we have relegated the voting rights issue to person color issue. that is why democracy is not working for everybody right now. >> go ahead. [applause] we tell people of color and liberation of democracy is theirs to learn we already lost the game. we need allies fighting for us,

not behind us. not sometimes on sunday but every freakin' day of the session they need to be fighting and offering prime legislation that opens the ballot up. >> that's great. one of the things i want to echo, particularly something that nina talked about was authenticity. i really think a lot of our power and a lot of ability for our candidates to actually not feel like, you know, for not to come across about problems, not actually talking about solutions, not connecting with people. we have to be authentic to talk about things in way that connects with people. that is easy to say but so often when we're in these campaigns we find ourselves in the position where you know we want to make sure we're just not making a mistake. we want to make sure that the campaign is as risk-free as possible, which look, i'm running a national party committee. we want to do everything we can

to run the best program possible and we don't want to make mistakes. often times see this with certain republicans on paper we see opposite research book. they're just horrific record, you know. generally even unpleasant to be around, and yet, everybody knows where they stand and they're authentic. they actually own who they are. and even people who don't agree with them, will vote for them because they actually think you know what? i know who this person is. they have the courage to actually say what they believe, even though we look at it, how can they keep on electing this person? so that is you know, i think like pam roach or somebody like that. >> her name says it all. >> you look at these folks. you could have tv movie about some of these folks but in the end they win because at some level, i mean they're running in right districts, sure, but they come across as authentic. and i think that is what people are hungry for because they have real problems. they want somebody who actually,

they know that they can actually count on who they talk to. they will come about this in human place. >> that's right. >> i think when you're talking about voter perception of politicians, right, voters distrust politicians. when they see a politician is authentic that conveys a sense of trust. yeah. thank you, guys, for being patient in the line. i will start with you. >> thank you. >> hello? >> talk loud. >> my name is bethany. i want to thank you you all. this has been a fantastic panel. i'm actually from minnesota, up until recently hadtry tech at that. i'm a fieldorg sizer. organized campaigns statewide and local elections. one thing not only in minnesota, even some states would be considered more traditional red states very vast difference between the rural areas and the messaging that is effect i have

there about what people are talking about there, versus happening in metropolitan areas are more economic drivers of city or economic drivers of states. there is real urban divide. there is a lot of states that have it. and unfortunately the structures that i have had opportunity to work in have often times failed to find a way to get that rural voice at the table in the war rooms and when coming up with communications, and so i'm just wondering if you would agree or disagree with that statement? if you agree, what is being done in your organizations to bridge that gap? >> go ahead. >> please. >> no, i do agree with that, with that statement but we have more in common than not. you're absolutely right. we often through a urban lens. the rural poverty is gut-wrenching. for me starting at that place, based on what we have in common,

whether it is urban or suburban, rural, that you want a to live in safe community and work and not have a decent life. people don't get up for decent. people get up for good and great. decent don't do it for me. i want good and great, baby. that is what it is. one of the things we're doing at ohio democratic party, is recognizing ohio is 88 counties, urban, rural, suburban and speaking that. starting with the issues that we have in common. for guns and urban areas you know that is a whole different discussion, in cleveland, ohio, than it is some of my rural brothers and sisters that live in cuyahoga or dark county. we have that commenting about economic fairness and economic justice and children have future bringing people in.

because of ohio, that firsts us. we can't separate the two. at ohio democratic party we're trying very hard to bring that together a little more and weave that into the narrative more about what we have in common than not and build that strong coalition, even with our party chairs across the 88 counties. we have that rule leadership who will begin to take that message back. we have that urban leadership and bring in those two forces together because we are the same in the struggle for good and for great. >> i just wanted to add as someone who's from rural arizona originally and ran in a rural area, could have come up to phoenix and probably won if i found a nice urban democratic district where i could walk in grid but the district i ran in had five counties including mayor cope past it was massive. the it was second largest district in the state. my issues are different. i come from rural perspective even though i live in phoenix. i don't identify what subpoena

nag phoenix. i'm concerned for health care access for my parents back home. i'm concerned about water issues like ej was talking about. with arizona i think for us, democracy for america, i know my personal mission is not just ethnic diversity in our candidates but geographical. i think we have to push that we need to hear from all of you. you need to push us at the organization to say, i've got this great candidate in the rural part. there is not even an airport. there is not even a target, you know, anything but they will change our state. we need that. we need that. i feel like in the legislature you know, there needs to be a rural caucus if you don't already have one in your state legislatures. so they're talking about rural issues and talking to urban folks. that they're just not siloed out. please push us as folks running these organizations and working to elect new people and progressive, that we need to support those rural candidates. really an inexpensive to help radio ads and things like that.

my radio ads were 65 cents. you don't get that here. so push us at the organizational level. >> thank you. next question? >> howdy, i'm just another person from washington here. i learned about the democratic party when my dad brought home the machinist union newspaper from his shipyard job and heard the first party slogan, a new news, vote democrat i can, the party for you, not just the few. yet as i look how americans are the verying now, people like my dad, a marine machinist with a ninth grade education, have been the people who have left the democratic party, regardless or as george bush would say irregard guess? what the republicans are doing to them, what the republicans are doing to them economically, doing to their rights to organize, you know the right to, rights to form a union. you folks have done a wonderful

job in terms of pumping up this organization. in a way preaching to the choir. i would like to get your thoughts on how to win back those who have left the church. >> i think that is a great question and i think a critical part of it is, something that we preach in our campaigns, and when we build our problems is, we have to build, campaign strategy that actually fits the district of the candidates running it. we need to make sure that our candidates are talking about issues that matter in issues they're running in. if it is not not number one article written in the state capitol newspaper, that's okay. we need to talk about issues really resonating in those communities. talks a lot about before between

authenticity and also, being in a position where we're meeting people where they are as well. we're not just telling them, well, why don't you get it? you should understand why this is important to you, right? we actually had to help them make connection that you know, our policies working together will actually lift everybody up, and you know, success is not zero-sum game where only some people can be successful an everybody else can't. i think we have to stress that again. instead of the right being able to talk about this vulture economy where you really want to be one of five people that can actually win lottery. everybody else gets left behind. if you're not happy with your life, you obviously didn't work hard enough. i think at love our folks, people we used to count on, the vote democratic some ascribe to little bit of that. we need to reverse that, have messages inclusive that brings

everybody. >> i agree completely. other thing that comes to mind, people don't leave the church, the church leaves us. many parts of this country that live in blue states that don't act very blue. there are people very much turned off by this idea of lip service and not a lot of action. and when i say action, talking about revenue. talking about tuition. talking about the real things that people are affecting their ability to break out of working class jobs or poverty wages. you know, i don't think anybody in this room can really challenge that. our party hasn't been as bold as they were in generations past to think big and dream big and really get that legislation through. so for, i would say for every person that feels like they were left behind by the party, maybe there is also person with other experience. >> this will have to be our last question. >> thank you. i'm state representative marcia

moody from new hampshire and i'm in my sixth term and i first have to agree with senator turner and monica that i owe my success to howard dean and jim dean and dfa. [applause] into running in the first place and been supporting me ever since. i'm on theelo appreciate the struggles we're having with voter suppression. and i want to go back to a question that you asked earlier. what do you think causes the voter apathy, and peopleyiying home and not voting? well, john nichols in his new book, dollarcarcy one of the most subtle ways of voter suppression is negative advertising. what it does, it doesn't convince you to vote for the other guy.

it makes you so disgusted with not only the opponent but they depict your candidate as being so bad too, that you say, well a pox on both your houses, and so you stay home and don't vote. so my question is, isn't it really a responsibility of all of us to tell our neighbors, you just can't stay home and not vote because, of what you hear on the airwaves or what you read in the newspapers and all this negative advertising? you have to get out there and vote for your candidate, would you agree? >> yeah, we agree, absolutely. >> thank you for running. thanks for being there. >> i want to thank the excellent four panelists how we fix this. thank you so much. [applause] thank you all for joining.

next panel is coming. keep the conversations outside. thanks for being here. we appreciate it. should be available on the station site. >> with the senate in rye ses this office booktv in prime time each week night. tonight we focus on the white house. at 8:00 p.m. eastern, nbc political director chuck todd on his book, the stranger, barack obama in the white house. at 9:00 p.m., american urban radio correspondent april ryan, author of the presidency in black and white. my up close view of three presidents and race in america. then at 10:00, former presidential candidate ralph nader on his book about the

unanswered letters he wrote to presidents george w. bush and barack obama. booktv in prime time starts tonight at 8:00 eastern here on c-span2. >> with the senate in its august break, we'll feature booktv programing weeknights in prime time on c-span2. starting at 8:00 p.m. eastern. for the weekends here are a few booktv special programs. saturday, august 20 second we're live from jackson, mississippi, for the inaugural mississippi book festival beginning 11:30 11:30 a.m. eastern. with discussions on harper lee, civil rights and civil war. saturday, september fifth, we're live from the nation's capitol for the 15th annual national book festival. followed on sunday with live "in depth" program with former second lady, senior fellow at american enterprise institute, lynne cheney. booktv on c-span2, television for serious readers.

>> the hoist of representatives and the u.s. understand are out of session for their summer recess. both bodies are back on tuesday september 8th. both are expected to take up the nuclear agreement with iran and senate votes on judicial nominee on it is first day back in session. when the senate returns, live coverage here on c-span2. the national business group on health advises large employers on health policy issues. the group surveys its members every year what they expect their health care costs to be for the upcoming year. this year's survey results were released yesterday at the national press club in washington. >> good morning, everyone. i have responsibility for the national business group on health. with me today is karen marlo, vice president of benchmarking

and analysis. karen and her team are responsible for putting the survey together. we're talking about 2016 large employer health plan design survey results. this is the survey we do in the may-june time frame in particular because that's when large companies finalize their decisions for the upcoming year. the significance of that, this is survey about what employers will do in 2016, not what they're considering to do in 2016. one of the reasons we dot survey in time frame we do it. karen and i will tag-team the presentation this morning. i will walk you through some of the major findings and walk you through some of those. karen will talk about key tactics employers will be implementing in 2016 to manage health care costs. i will spend a few minutes about implications for employees during annual enrollment. then we'll go to q&a. a brief bit about the business group.

national business group on health is the nation's only non-profit organization that works with employers and is devoted to working employers on national health care policy issues and working with them to optimize business performance through health improvement and health care management. we have roughly 425 members. these are primarily large companies. they, 71 of the fortune 100 and they provide health coverage for over 50 million employees, dependents and retirees. so a bit about the survey. the survey is a survey mostly of large employers. we have 140 respondents in the survey. it cuts across all industry sectors and it's predominantly large employers. more than 70% of the participants in the survey have 10,000 employees or more. nearly 50% of the survey participants have 25,000

employees or more. so these are big companies. these are companies typically self-insured. meaning that they pay claims out of their general assets and they contract with health insurers and other third parties to ajudicate claims, to administer the plans, to leverage their networks, their provider networks and to provide medical management services but claims are paid out of general assets of these companies. so key takeaways of survey. i think the first take way is that health care costs are expected to increase in 2016 at a rate of 5% after companies implement certain changes that they're making to their health plans. that is consistent with what we've seen over the last several years. while 5% is modest increase still from employer perspective unacceptable rate of increase. it is still two times the rate of general inflation. what you think about what a 5%

increase means to a company that spends half a billion dollars on health care that is $25 million of additional health care costs for next year. and $25 million translates into possibly 100 million and 300 million additional revenue a company has to generate to offset increase in health care, depending if in high margin business or low margin business. when you factor a business within a growth cycle or low-growth cycle, they may have to take other steps. they may have to increase price. they may have to effect jobs. they may have to impact the amount of wage increase they provide for employees. even at 5% increase in health care costs is a significant is an employer as they look to go into the upcoming year. some of the key drivers of health care costs consistently every year we see high cost

claims, being one of the drivers of higher costs. number two driver of medical trend for them as they look into 2016. that's a, and what is significant about that specialty pharmacy typically affects about 3% of the population. so in a situation we have specialty pharmacy trend running in double-digit and by 2018, specialty pharmacy will exceed traditional pharmacy in terms how much it cost as company year in and year out. one of the things we did this year in survey we asked employees about the excise tax. the excise tax is scheduled to go into effect in 2018 and we asked employers when they would hit the excise tax if they weren't making any additional changes and the interesting feedback we to the from that question is that nearly half of the employers in the survey, at

least one of the other plans will trigger the excise tax from 2012 when it goes into effect. in 2020, over 70% of the companies would trigger the excise tax, have at least one plan that woulding interester the excise -- would trigger the excise tax. one of the interesting things about the data, 2028 which is 10 years of the excise tax in effect, nearly all plans would trigger the excise tax by 2028. the excise tax way it is structured is tax on all plans, as opposed to cadillac tax on rich plans. as we think about what companies are doing to minimize the impact of the excise tax, one of the main tactics that has been deployed over last number of years is a move to consumer directed health plans. we've seen in fact, in the last year's survey, we saw 50% increase in number of companies that went to a full replacement,

high deductible plan or consumer directed health plan in 2015. by full replacement, i mean only option the t ey may have other consumer directed options in place but consumer directed plans are the only option that they're making available to employees. so we expected to see a similar type of jump in this year's survey. we didn't see that what was surprising we only saw another, additional percent of companies moving to full replacement or only option consumer directed health plan for 2016. and when we step back and try to understand what is going on with that, from my perspective, i think what we see here is a number of companies would prefer not to go to consumer directed plans as only onion. they're taking wait and see approach. i think what we're seeing is calm before the storm. companies are looking to see what is going on in washington. they see energy around possibly

repealing the excise tax and taking a wait and see approach. if the excise tax isn't repealed, data shows 20% of the companies will simply mint consumer directed plans as only option in 2017. this year will be a quieter year from a plan change perspective as we go into 2016. as companies look to whether or not the excise tax will be repealed. if it isn't repealed we'll see another rush to full replace placement of high deductible plans in 2017. zoom of the tactics employers are deploying to mitigate impact of cadillac tax or minimize or delay the impact of cadillac tax, continued investment in consumerism. continued investment in decision support, transparency tools, navigation tools, to help employees make decisions. continued investment in wellness and well-being initiatives and

incentives around engagement in those initiatives. we're seeing activity around spousal surcharges where, if a spouse has coverage through their own employer, looking to move them to get coverage under their own employer which would also reduce the company's cost as it relates to the excise tax. we're beginning to see as you look out into the future, an interest in delivery system reform. accountable care organizations, narrow networks and centers of excellence as a way to control costs down the road. as we think about the, as we think about the impact on employees and i will stop there and turn it over to karen, as we look to annual enrollments, in annual enrollment we expect it will be fewer plan disruptions. modest increases around 5%, similar to what large companies are experiencing.

we'll talk a little bit at the end about what employees can do during annual enrollment to maximize their benefits. so, karen? >> thank you, brian. as sort of brian already stated employers expect an increase of 5% in health care costs for next year. as we surveyed large employers this year we wanted to see what tactics they are using to control costs but also to help employees live healthier lives as well as navigate the health care system and what we found is that the tactics fell into three groups. those things that are on the rise, including a aggressive management of specialty pharmacy costs. implementation of telehealth. onshun for employees with acute illnesses to connect with physicians via phone or video. a more focus on employee advocacy tools, help with claims services as well as optimizing the delivery system as brian

mentioned around accountable care organizations. we also saw some tactics decline or interest in certain tactics decline around disease management programs, condition management programs. although we know that one of the drivers of health care costs are chronic conditions, the programs where employees connect with a nurse telephonically do not seem to have the impact that employers had hoped for. in addition, interest in private exchanges seems to be on the decline as well. then there is a bucket of tactics that we call holding steady which means that they're continuing to be a tactic that employers are using but they're not growing. so brian already talked a little bit about consumer-directed health plans. that is unwith tactics that seems to be holding steady. we have 83% of the employers indicating they offered at least an option. one of the interesting things that although we're not seeing a lot of employers, more employers going to consumer directed health plans.

those that do offer them are investing in terms of helping employees with their health savings accounts. health savings account is vehicle by which employees save money to pay for costs when they have not met their deductible. last year we saw employee could earn maximum of $600 for their employee health savings account. that number jumped to 750 this year. in addition we have seen other tactics around cost sharing. so traditionally over the last several years employers struggled with increasing health care costs and looked to increase not only if you have a 5% increase in health care costs everyone's premium goes up because costs are more expensive but employers shifted additional costs by increasing percentage that employees pay for those health care costs. this year we did not see a lot of employers saying we'll shift cost to employee. one in three employers indicate they would make small increases

into the amount the employees would pay for their health care. we had even fewer employers, about 25%, that they would increase the deductible that employees would face. from employee perspective there is not significant changes. i know brian will speak to that more later. while employ earliers are not increasing plan offerings or increased cost sharing, they're managing specialty pharmacy costs. brian spoke to it's a major driver of costs. they have seen that especially last 18 months as new medications for hepatitis-c came out, they have seen costs skyrocket. all they have numerous tactics, one traditionally used on all medication, step therapy, you can use one medication before you go to the more expensive one we've seen them look to other tactics targeted to specialty pharmaceuticals.

these medications are complicated to administer. they usually require special delivery. they have significant side-effects. they require monitoring by clinicians of the so employers looked to move specialty pharmaceuticals through a specialty pharmacy. either freestanding entity or one connected with their pharmacy benefit management company so the medications are being monitored. so you insure the right medication gets to the right patient and that not only is that happening but there is high touch care management meaning you're spending the time to make sure the employee understands what the medication is for. the fact that they have a particular disease that this medication is to help them with. how to take the medication and then also how to report back if they have a problem, not just to simply stop the medication. beyond those sort of planned design efforts there are a numerous programs that employers are offering employees to help

them. specifically we talked, i already mentioned that they have traditionally offered disease management, care management programses to employees as a way to help people with diabetes or heart disease better manage their condition. they have struggled a bit with that in terms of getting employees to engage with nurses telephonically. we've seen decline in terms of employers deciding that is the way to help these employees with their care. instead they're focusing more on things like medical decision support services so that second opinion service, if a physician says that you need back surgery, offering services where another physician reviews that. we all know that when a doctor tells us we should go to have surgery we should get second opinion but for most consumers who are busy, taking the time to find another physician and go to the office to have that second opinion isn't something that always happens. so these second opinion services all can be done electronically

or on the phone. so provides employees with additional data so they can make better decisions. in addition we've seen some interest in about a third of our people surveyed indicated they implemented what is known as high touch concierge services. so as an employee you might need a new insurance card. you would call an say i need a new insurance card. the person on the phone would be more than happy to help you but in addition they would ask, why do you need insurance card. well i need to see a physician. can i help you find that physician? what condition do you have? extra steps helping them 1/2 fate -- navigate the health care system. one growth on the rise is around telehealth. we saw a few years ago employers really look for additional ways to help employees with acute illnesses who can't get to a physician's office during regular office hours. these are people who may end up in the emergency room or urgent care facility both which can be

somewhat expensive. telehealth is opportunity for employees to call or videoconference with a physician, to get help with an acute situation. and so last year we had about 48% of large employers offer telehealth. this year we saw significant increase to 74%. so, they either directly contract with an entity that is able to provide physicians on call, or, they're doing it through their health plan. another area there is a lot of interest in but we haven't seen huge movement is around accountable care organizations. this is about improving the supply side of health care. so the idea that we need to insure that employees get right care when they need it. but idea they would get care in integrated delivery system such as accountable care organization.

employers have a lot of interest understanding how these things are working. providers are connecting together to create these accountable care organizations. but this year, new for us this year, we asked in 2016, are you going to be actively pursuing some kind of strategy around accountable care organizations? what we found is about 20% are saying yes, we're going to either directly contract with accountable care organizations or we'll be working very closely with our health plans to insure our employees get access to them. 60% said, well our health plan probably has accountable care organizations but it is not something we're looking into at this point and i think that really get as the issue of, will these accountable care organizations really be able to deliver change in the health care system? will they really then to impact appropriate care, reduce unnecessary care and improve, and control health care costs. what we aren't seeing

significant growth in for 2016 is around private exchanges. so private exchanges came out a few years ago, and we had a lot of our members interested in understanding whether they should move their active employee population to a private exchange and we see about 3% this year will have their employees in a private exchange. that hasn't really changed significantly from year to year. what we did see drop was last year we had about 35% of employees saying yeah, we're evaluating them for the next few years. maybe we'll move there in a few years and this year we saw that actually drop to 24%. so i think a lot of employers feel, large employers feel that they, the private exchange is not the right vehicle for them at this time. where we, for their active employees i should say because for their retirees we are seeing significant movement. so employers who still have, who provide health coverage for their retirees we've seen a

jump. in 2013, 10% had moved their retirees into these private exchanges. and that number has has increased to 24% for 2016. lastly before i turn it back to brian, we surveyed employers as you look to 2016 and beyond where are you focusing in terms of behaviors of employees? with so many ways you impact their health, how they receive health care, where are you really focusing efforts for next year? we saw top behaviors are similar to last year. the top one being, consumer engagement in health care decision making. having employees make smart decisions about their health care. then in addition to that, that the second and third top behaviors they're focusing on are things that greatly impact the prevalence of chronic disease an hence health care cost. that is increasing physical activity and weight management. at this point i will turn it back to brian.

the. >> thanks, karen. the question is, what disit mean for employees during annual enrollment? when you think about changes there aren't a lot of changes. you will not see the same type of plan disruption for next year. you're not going to sigh the same type of plan design change as you had in the past. increases seem to be small and modest for the most part from a contribution perspective. the opportunities for employees are tools and using to help them maximize benefits and help them make decisions. telehealth, for example, or decision support tools or transparency, or, in the case of wellness programs the opportunity to engage to get incentives. a lot of companies are putting money into health savings accounts. as karen talked about increasings on average or median being $750 per employee into a health savings account. employees have the opportunity

to put their own money into health savings accounts to maximize their benefits. i think opportunities for employees during this year's unlike last year's there was significant amount of change. it is not so much the changing of our plans but opportunity to maximize benefits and leverage tools and resources a company is providing you to engage and to make best decisions for your sell. so with that, we're opening up to questions. yes? >> do you anticipate your members will pay the cadillac tax in 2018? >> that will be a mixed bag. you will have some companies -- each company is different based on culture, demographics, value proposition and their financial position at time. i think you will see a mixed bag. some companies will pay it and a lot of companies won't pay it or share the cost with their employees. >> the irs has affirmed that

both employer and employee contributions will fall under excise tax threshold. you see any movement you talked about increases in hsas and contributions but won't that be a mitigating factor as we approach '18? >> it will be. interesting thing in the meantime we continue to see money flow into health savings accounts. employers continue to contribute and increase contributions to savings accounts. you're right, it will be a factor into determining whether or not you hit the threshold or don't hit the threshold. it could come into play in terms of employers reducing those contributions down the road. other questions? yes? >> you said you're not seeing a lost disruption and -- a lot of

disruption and changes in big plans. you're seeing companies, expressing a lot of them think they will hit the excise tax by 2018 or at least by 2020. seems like there is a disconnect there they're not trying to avoid that. do you know what that might be? >> companies there has been a lot of movement to consumer directed health plans and the like and we saw significant movement last year for full replacement or only option. i think there are a number of companies that would prefer not to go that route. so they still have a window to do it before 2018. you will see a rush in 2017. that is what i expect. that is what the survey data tells us. they're waiting to see what will happen. there are couple bills in the congress, one in the house that has bipartisan support. they're waiting to see if something happens. and it does get repealed. they probably won't in that correction -- that direction.

if it does go into effect i think you will see a lot of move and activity next year. yes? >> can you be a little bit more precise about what do you think will be the successful strategies employed by companies that wish to avoid the excise tax? and, can you give us an idea how long they can hold it off? >> sure. the interesting thing when you look at the companies that do the best job at managing their trends, it is not any one thing, it's everything and obviously moving to consumer directed health plan is one of the big, one of the bigger opportunities, or defer the impact of cadillac tax. it is combination of everything employers are doing from investing into wellness and

well-being and decision support and consumerism, to specialty pharmacy management and condition management. companies consistently run between 0 and 2% every year in terms of trend have done just about everything they can do to affect both improvement and health care management. we asked in the survey to what extent do they believe their initiatives could delay impact of cadillac tax. for their plans with most enrollment, they feel the best they can do is delay it by two years. other questions? yes. >> survey, just haven't got into it but what proportion, you differentiate in the survey

between at least one plan and the largest plan, right? >> yes. so what proportion of companies in your survey are going to hit the excise tax? about half of them, is it? >> about half believe they will hit it when it goes into effect in 2018 for one of their plans. i think by 20 to -- 2020 believe they will hit it for their largest plan. so you can see one plan comes earlier and then it haven't affects all of their plans as we continue to move down down, down the road here. >> okay. >> you will see in the materials that were sent out there is a, there are a couple of different graphs that illustrate when companies will hit and what the timing of that will be. >> could you talk a little bit about the price of drugs which is going to increase even more with high close cholesterol drugs coming on to market?

talk about disease managements programs what other ways are companies looking to avoid, to mitigate the impact of these high-cost drugs? >> i think it getting to the focus on specialty pharmacy management. really being a core focus. in other words, there are a number of, there are a number of elements to that. for example, if you do prior authorization to insure only people who really need that medication get that medication. that is the first step. while you have that employee, then you're looking at, where is most appropriate sight of care for that person to receive that medication. when you get a sense of transparency on specialty pharmacy medication, there is significant variation in price within incitative care or physician visits or outpatient visits, you can see 4-x difference in terms where to go

to get the medication. you see significant difference between outpatient facility and physician's office. it is trying to identify what is the most appropriate site of care. physician's office even at home or outpatient facility. then within that site of care, what is that most efficient, what is the most efficient price. . . >> beyond getting that specialty dd reaching back out into the rest

of that individual's community of providers to make sure that everything's being coordinated. >> sorry, just one pick qol-up. -- quick follow-up. do you think a lot of employers are going to stop providing these kinds of specialty drugs if the costs continue on their current trajectory? >> i don't believe employers will stop providing them. many of these specialty drugs are good. some of them are cures. some of them are -- actually, many of them are good. it's really trying to manage to insure that the right people get them, that they're compliant with them, you can build programs around them, insure they get the right dosage so there's no waste and really manage them effectively. now, some of them are challenging from a cost perspective, and i think there are efforts to, for lack of a better term, kick around different, different reimbursement mod to els. is there other -- models. is there other ways to reimburse

that wouldn't be such a burden in a particular year for a particular drug? so i think there's some efforts to look at reimbursing for these or paying for these. but at the end of the day, if you have a drug that is a cure, that's a good thing. you want to make sure the right people get it, and you want to make sure that it's affordable and employers will continue to work with health plans and prescription benefit managers and the pharmaceutical industry to see how we can best leverage that. but there is some concern about how they're trending and will be trending over the next several years. any other questions? >> is the survey providing special insight into the hepatitis c drugs? because that's a fast-changing market. last year we had city sovaldi, everybody was talking about it, and now it's yesterday's news. any insights from the survey on

that? >> we didn't focus specifically on any drug. we really focused more on the category of specialty pharmacy and how to get a sense of how it's trending and how employers are going to manage and focus on managing the overall category can, not specific drugs. so i couldn't tell you on that a particular question. great. no more questions, i'd like to thank you all for your attendance and participation, and if you have questions to follow up from the materials that we provided, please don't hesitate to contact us. thank you. >> booktv is every weekend here on c-span2, and with the senate in recess this august, booktv is in rhyme time each week -- prime five each weeknight. tonight we focus on the white house. political director chuck todd on his book, "the stranger: barack obama in the white house." at 9 p.m., american urban radio correspondent april ryan, author of "the presidency in black and

white: my up-close view of three presidents and race in america." and then at 10, former presidential candidate ralph nader on his book about the unanswered letters he wrote to presidents george w. bush and barack obama. booktv in prime time starts tonight at eight eastern here on c-span2. >> first lady helen taft called nelly made several notable changes to the white house. the most obvious was replacing the white male ushers with african-american staff. also while in washington, she led an effort to raise funds to create a memorial for victims of the titanic, but her greatest legacy was bringing thousands of japanese cherry blossom trees to the nation's capital. on c-span's original series, "first ladies," examining the public and private lives of the women who filled the role of first lady from martha washington to michelle obama

sundays at 8 p.m. eastern on american history tv on c-span3. >> last month the house passed legislation on genetically-modified food and replaced them with voluntary standards from the federal government. before the bill was approved by the full house, the commerce subcommittee on health held a hearing on the legislation and the issue of food labeling. this is two hours. >> i ask all of our guests today, please, take their seats. the subis committee will come to order. the chair will recognize himself for an opening statement. genetically-modified organisms, or gmos, is a term that refers to ingredients sourced from crops that have been genetically engineered to express certain traits or characteristics. there are real sensitivities around these issues and all

issues regarding the food we eat and feed our children and grandchildren. it is our job as policymakers, particularly as it relates to the public health, to establish a factually and scientifically sound foundation prior to taking any action that would impact consumers and our economy. in this hearing provides a great opportunity to put rhetoric aside and do just that. genetic engineering in agriculture has occurred for centuries. ingredients from genetically-engineered plants have been a part of the u.s. food supply for decades. in fact, as much as 90% of our corn, sugar beet and soybean crops are now genetically engineered, and more than 70% of processed foods contain ingredients derived from such crops. the food and drug administration oversees the safety of all food products from plant sources including those from

genetically-engineered crops. these products must meet the same safety requirements as foods from traditionally-bred crops. the fda currently has consultation process in place which developers of the underlying technologies address any outstanding safety or other regulatory issues with the agency prior to marketing their products. fda has completed approximately 100 of such consultations. no products have gone to market until fda's safety-related questions have been resolved. fda officials have repeatedly stated that the agency has no basis for concluding that bioengineered foods are different from other foods in any meaningful way, and the world health organization has confirmed that, quote: no effects on human health have been shown as a result of consumption of such foods, end quote. in fact, they can grow faster, resist diseases and drought,

cost less and prove more nutritious. nonetheless, there have recently been a number of state initiatives calling for the mandatory labeling of food products that contain gmos. we will hear today from a number of witnesses who can speak to such actions and the impact they would have. i'm concerned that a patchwork of state labeling schemes would be impractical and unworkable. such a system would create confusion among consumers and result in higher prices and fewer options. finally, i want to commend representative mike pompei owe and representative butterfield for their leadership on these issues and look forward to learning more about their continued efforts to work in a bipartisan manner on h.r. 1599, the safe and accurate food labeling act of 2015. while these efforts will continue as the legislative process moves forward, i'm encouraged that the revised language circulated in advance

of this hearing has been informed by conversations between the sponsors, the committees of jurisdiction, the implementing agencies and the impacted stakeholders. i would like to welcome all of our witnesses for being here today. i look forward to your testimony, and i yield the balance of my time to the distinguished vice chairman of the full committee, representative blackburn, of tennessee. >> thank you, mr. chairman. welcome to all. and the chairman mentioned the food that we eat and that we feed our children and grandchildren. i want to add one category to that; what we feed our pets. and we are concerned about that aspect also. i do appreciate mr. pompeo and the assistance they have given us as we look at pet food labeling, and the chairman also mentioned that we have had these products in the marketplace for decades. i would say we're talking about over a hundred years. go back and look at what farmers did, and they would breed cattle

to get the best traits. look at the work that george washington carver did in his 40 years of teaching and research at tuskegee looking for ways to improve the soil, looking at different varietals of peanuts and sweet potatoes and improving the health of individuals in the south. genetically-modified foods are components that are, indeed, with us. and it is because of them that we have greater yields per acre, we have more varieties and that our farmers' markets that i visit every single weekend are full of beautiful products that encourage people to access these fresh foods and brung them into their home -- bring them into their homes and kitchens. with that, i thank all for their work and yield back. >> now recognize the chairman of the subcommittee, mr. green, for five minutes. >> i was glad the vice chair

worried about our pets. i had a dog that ate curtains, pillows and everything else. [laughter] mr. chairman, i have a statement i'd like to put in the record, but i'd like to yield my time to congressman butterfield who's sponsor of the -- >> without objection, so ordered. >> thank you so much, mr. green and mr. pitts. before beginning, i just want to publicly extend my condolences to the families of the people of south carolina, so thank you, mr. chairman, for allowing me to digress to offer my sympathies to those families. mr. chairman, i support h.r. 1599. i am the bill's lead democratic can cosponsor. this bill is bipartisan, it proposes a national labeling standard for foods produced with genetically-modified ingredients. the alternative, the alternative is a complex and unworkable patchwork of differing state laws that can only cause confusion and do little to

provide greater transparency. several states have moved forward with proposals that would require foods containing ingredients to be labeled. this is in response to unsubstantiated claims that foods containing genetically-modified ingredients are in some way dangerous in human consumption. i take exception to these unfair and downright dishonest claims. foods containing genetically-modified ingredients are safe. the fda, usda, national academy of sciences, aaas, the who, every major scientific and governmental organization agrees with that statement. even opponents of genetically-modified foods admit genetically-modified foods have failed to produce any untoward health effects. but the demonization continues despite objective science proving to the contrary. those opposed to genetically-modified food simply reject science, and that is tremendously disappointing. and though i stand with science in my belief that these foods

are safe, i understand the concerns expressed by the opponents and want to be responsive. that's why i've worked with my friend, mr. pompeo to, in advocating for a a framework tht puts the fda and the usda, putting them in the driver's seat. 1599 is a balanced approach that reduces confusion by providing consumers with labeling uniformity across state lines. it addresses the concerns of those who are opposed to genetically-modified foods while not neglecting the fact that our nation's farmers and manufacturers grow and produce foods that are sold far and wide and not just within a state's borders. without a federal standard, mr. chairman, those farmers and manufacturers will be forced to comply with up even, costly and -- uneven, costly and potentially misleading and onerous state by state mandates. a new costly supply chain infrastructure that will disrupt the nation's food supply, cause

confusion and uncertainty. 1599 is reasonable, and most importantly, it is workable. i want to thank the more than 60 bipartisan cosponsors for joining me and mr. mom pushes -- pompeo, in agreeing our bill is the best way forward. i yield the balance of my time to the gentleman from vermont. >> i thank the gentleman. the issue is not so much whether gmos are safe, the issue is whether individual purchasers, consumers who purchase food, have a right to know that gmos are part of the food they're buying. it's a consumer right-to-know issue. i agree with my colleagues that a national standard would be good, but there is no national standard in this bill. it's a voluntary labeling which means there will be no labeling whatsoever. many states are reflecting the desires of their consumers to basically know what's in the product they're buying. and a consumer has a right to do that. they just do. and this legislation is ironic

in this sense: if gmos are so safe, and i'm not here to challenge that assertion, but if they're so safe, why not label so that folks who are getting what the manufacturers assert is so safe know that their product will be labeled and consumers can then make their own decision? i mean, my question really is if they're so safe, why would anyone be afraid of so labeling those products so the consumers would have a right to know? now, in vermont we have our assistant attorney general here who's going to talk about what we've done in vermont. three states have passed labeling laws. several others are considering them. there have been referendums that almost passed in california, and it's reflecting this groundswell of desire that consumers have to know what's in the products that they're buying. now, i'm going to play a little unfair here, mr. chairman, because i am here today to give mr. pompeo and mr. butterfield a

gmo-free-labeled pint of the most nutritious product on planet earth, and that's ben and jerry's ice cream. and this is labeled, and it sells. people love this. i yield back. >> gentleman's time's expired. the chair recognizes the chair of the full committee, mr. upton, for five minutes for an opening statement. >> this morning we continue our examination of the role biotechnology plays in our nation's farms and in our food supply. our food, as we know, is literally our lifeline. it is important for the public to be engaged. it is the job of this subcommittee to establish a record based on the facts and the science so we, ultimately, pass legislation that is in the best interests of our constituents and our economy. at the hearing that we held in december last year and in other venues since then, the fda has been clear that the premarket consultation process currently this place to review food

produced from genetically-engineered crops is rigorous, and the agency has no basis for questioning its safety. the who and every other legitimate health and scientific body that has examined this ed has echoed the fda's findings. nonetheless, there are a number of state-specific labeling requirements in various stages of consideration that are inconsistent, potentially confusing to consumers, would increase food costs if cast out over the safety of biotechnology. mr. pompeo and butterfield have been working tirelessly on a bipartisan basis in putting together a clear, understandable national framework that maintains fda's current review process, codifies federal labeling standards and related requirements, establishes a certification process at the department of ag consistent with current organic program for the labeling of products as being produced or developed without the use of genetic engineering. the draft amendment to h.r. 1599

circulated before this hearing is another step in the right direction, and i commend the ag committee for working with us to get the bill through the house to insure consumers will have a clear, concise and consistent system to assist in their food choices. i yield the balance of my time to mr. pompeo. >> thank you. thank you, mr. chairman, for yielding. i want to thank chairman pitts and ranking member green for holding this hearing. i appreciate it. i very much want to thank mr. butterfield too. we've been working on this for quite some time, and i think we're making fantastic progress. i also thank mr. welch for the ice cream, hope it was chunky monkey, i couldn't see. [laughter] and i want to thank the witnesses for for being here soe can get the facts about both the technology and the legislation. scientific con seven sups on the safety of these products is overwhelming. precisely zero pieces of credible evidence have been presented to show the food produced with biotechnology

poses any risk to the health and safety of consumers. the fact that government should step in and mandate that they be labeled borders on the absurd. enshrining preferences into a costly legal requirement is bad policy. what policymakers need to realize is that this bad policy has real effects on families we represent in our districts, those who support mandatory genetically-modified product labeling must admit they're willing to increase the costs to families in places like wichita and grand rapids and new york in order to satisfy the demands of anti-biotechnology activists. our goal here must be to insure that families in america have access to safe, nutritious, affordable food for their kids and families. having hundreds of different governments, state and local, regulating food labeling increases costs to families across america and for no benefit. we should also consider the effects of biotechnology on the ability to feed the world. providing affordable food the planet is something that americans and kansans are going

to need to be an important part of, and allowing biotechnology to flourish will be an important part of getting this policy right. the potential amendment we're considering on h.r. 59 and the one we're reviewing today is the result of much conversation between the energy and commerce committee and the ag committee, and i appreciate their work alongside us. like the current language, this amendment insures that every new genetically-engineered plant destined to enter our nation's food supply goes through an fda safety review. additionally, this amendment improves our bill by aligning responsibilities to insure a thorough and complete review of >> without objection, so ordered. >> thank you. these products is done. the reality is that i have a letter from over two biotechnology time and time again has been proven safe. this is simply not a debatable point. our policy ought to reflect that, and we shouldn't raise the price for consumers based on the desires of a particular set of activists. thank you again, mr. pitts, and i look forward to the hearing. >> chair thanks the gentleman, now recognizes the ranking member of the full committee five minutes for an opening statement. >> thank you, mr. chairman. today we'll hear a range of

views on why there should or should not be mandatory labeling of foods from genetically-engineered or ge plant ands why states should or should not be allowed to propose such requirements. i've long been a proopponent, i was an original co-sponsor of the nutrition labeling act of 1990, was a strong advocate for the aca requirement of labeling on menus and sponsored legislation last year which i will be reintroducing to update and strengthen current fda nutrition labeling requirementings. and i have strongly opposed any attempts the weaken existing labeling requirements such as the common sense nutrition labeling bill which i believe would impede consumer access to nutritional information on menus and restaurants, pizza parlors, grocery stores and convenience stores. so i'm inclined to be skeptical of legislation aimed at limiting rather than enhancing legislation on a food label. at the same time, i recognize that the differences between nutrition labeling and ge

labeling may warrant different regulatory approaches. nutrition labeling provides information that enables consumers to make health-related choices on how they eat. there's no question in my mind that the federal government should require food companies to put that information on food labels. ge labeling is about the breeding techniques used to making a churl crops -- agricultural crops which do not share nutritional or health-related properties. a ge consumption of the food -- i'm sorry, on composition of the food, on whether it is good or bad for you, on whether it tastes good or bad or on whether it is safe or unsafe. there is no scientific evidence that ge foods pose safety issues any different from non-ge foods. i feel the same way i dohe arens when asked if they believe in evolution. so from a science or health perspecte, to be a compelling government interest in forcing a food co genetic engineering.

that bei the state of vermont wants to require food companies to put such information on their food labels, is there a compelling federal government interest in prohibiting them from doing so? perhaps not. but i do think there is a compelling federal interest in preventing any labeling that is false or misleading consistent with current law. if mandatory ge labeling were inherently misleading, for example, because it implied that ge food was somehow inferior to normal food, that would seem to be a compelling reason to prohibit it. i'm so far not convinced that the requirement imposed by vermont would be inherently misleading. i'll be interested in hearing from our panelists today on that question. now, there may be a federal compelling interest in preventing companies from having to face 50 different food labeling regimes. in fact, it was a fear of such unworkable state of state food labeling requirements that led food companies and restaurants ultimately to support federal requirements for nutrition labeling. to avoid a 50-state problem, there are two obvious solutions. we can ban right-to-know

labeling requirements outright, or we can replace them with a uniform federal mandatory ge labeling requirement. but i personally think a voluntary labeling approach is more appropriate for ge labeling. i also don't believe in preempting state law without good reason. so i think this is important hearing, mr. chairman. i really -- there are a number of competing issues to weigh before moving forward on legislation, and i hope we'll wl take our time in considering them. i yield back. >> chair thanks the gentleman. that concludes the opening statement from the members. as usual, all written opening statements of the members will be made a part of the record. we have one panel today, i'll introduce them in the order of their presentations. first, mr. rick -- [inaudible] president and chief executive office of the council or supply chain management professionals. secondly, mr. todd dalas, assistant attorney general, office of vermont attorney general. thirdly, mr. john reifsteck,

president of growmark inc.. then greg jaffe, biotechnology project director, center for science in the public interest. and finally, mr. val getting, senior fellow technology and innovation foundation. thank you all for coming. your written testimony will be made part of the record. you'll each be recognized for five minutes to summarize your testimony. you have a series of lights on the table, green, yell elope will go on -- yellow will go on with one minute left. red, we ask if you please wrap up, and if you want to take less than five minutes, that's okay. so, you're reek niced for -- recognized for five minutes. >> thank you so much. good morning, my name is rick, i'm president and chief executive office of the council of supply chain management professionals representing well over 8500 members globally. prior to joining, i was senior

vice president for integrated logistics with conagra foods and in similar positions at kraft foods as well as nabisco. i've been president since 2005, and in this capacity i serve as the primary issue expert relating to logistics and supply chain management. i want to thank you very much for inviting me to explain the importance of national labeling frameworks. i will focus my remarks on the costs associated with vermont's labeling mandate, a law that goes into effect on july 1, 2016, and imposes incalculable burdens on our nation's largest manufacturing sector. grocery manufacturing is a high margin, low volume business. the primary cost centers in the supply chain are the cost of source materials, capital, operations, labor, storage, distribution centers, transportation, maintenance and, of course, fuel. n the supply chain for a processed food begins with the raw commodity.

the supplier sells the raw food to a manufacturer, and the manufacturer stores the food at the plant until it is processed into its ingredient form. that ingredient may be the final product such as in cooking oiling or it may be in products contained in multiple ingredients. finished goods are sent to a manufacturer's distribution center where they are stored until transport. the customer may be a national or regional chain or a regional distributer that sells to other retail outlets. the customer stores the finished goods at its center and distributes them to its retail outlets where they are sold, finally, to consumers. a manufacturer typically plans each stage of this supply chain to insure it is handled as efficiently as possible. the core unit in a grocery manufacturer supply chain is the stock-keeping unit or sku. this is simply a unique identifying number that applies to each distinctly-packaged and marketed product. a single national sku facilitates efficient storage, distribution and inventory

tracking. vermont's legal time clock is ticking, and manufacturers will have to determine which products contain ingredients likely derived from ge crops. companies will navigate vermont's exemptions such as foods bearing usda-approved labels. restaurant food is also exempted, and this could impact segregation and transportation costs. each exemption provides more complexity to the supply chain, less clarity for consumers and more red tape for manufacturers. manufacturers will have to make new labels with state-approved text and design. labeling materials are one of the largest expenses affecting a manufacturer's bottom line. any inventory left over when a manufacturer implements a labeling change must be discarded which is a waste not only of materials, but the money the manufacturer may have spent in anticipation of using that stock. waste and recycling charges will also apply. at the processing facility, let's assume it takes five minutes to stop and start to accommodate the new package. this reduces production time as

companies pay for the lost time in labor, energy and capital costs of depreciation. now assume a single plant with ten lines running simultaneously, each with one vermont run per day, over 3300 days in the year -- 300 days in the year. that makes about three weeks of idle time. these assumptionings are meant for illustration with respect to only one single plant. large manufacturers may have dozens of plants, and each plant may have dozens of production lines. the vermont products would then need to be segregated from the other products and be placed on their own palettes. pallets take up space wherever they go, on warehouses, trucks and at customer distribution centers. these vermont pallets must have sufficient space to reduce the risk of products being shipped to the wrong state; namely, product not intended for vermont ending up on shelves there. manufacturers would have to renovate or purchase new storage space of real estate. additional pallets means

additional trucks. the trucks are capital investments with ongoing maintenance needs and associated labor costs. .. horror are already on are already in the show also be subject to fines. mr. chairman from a supply-chain perspective this was a nightmare.

consumers benefit from the safest most efficient rules in the world. i urge congress to protect our national food system from unnecessary patchwork of state labeling that will hurt american employers and protect consumers. i thank you for your time. tonight the chair thanks the gentleman and recognizes -- for five minutes. >> ranking member grain congressman wells and members of the subcommittee thank you very opportunity to testify today. as you are well aware of the state of vermont has been deeply involved in the labeling of food produced with genetic engineering. passing a law requiring such labeling which will take effect a little over a year from now. from attorney general this bill passed with the enforcement of this line adopted british implementing the law. my name is tom davis and i'm assistant attorney general testifying on behalf of attorney general sir ralph about the draft legislation in the discussion draft of h.r. 1599 great and to discuss and answer questions about vermont's

experience in labeling foods produced with genetic engineering. in my oral test mail it to highlight to me point as we began. the first is the role of states in our democracy and importance of the states and the federal government and sharing responsibility for protecting consumers. what is most troubling about the proposed legislation both the draft in front of you and the discussion draft is that it would cut short and prematurely and state efforts to label foods before vermont's law takes effect. it also offers no substandard replacement for the regulations are maude has in place. vermont does not oppose all of the federal regulation in this area nor all elements of the bill. what is important to vermonters is the ability to have accurate, factual information in front of them in order to make informed decisions about their food or kisses.

and this is ahistorical design of our democracy. states and the famous words of justice brandeis have long been the laboratories of democracy, experimenting with social and economic policies in manners that allow them to determine the best course and there is a robust history of states leading the way towards ultimate federal regulation. two simple examples that come to mind. the first is they are -- fair credit reporting. vermont and other states were among the first to require credit reporting to consumers and as we all know congress ultimately move forward with that making it national law. another example that was referenced by mr. blasgen is menu labeling which new york began requiring the labeling of certain nutrition facts at chain

restaurants are you vermont and other states followed and recently the fda has implement the same information labeling requirement nationwide. vermont acts 120 is no different than this. it is a state taking a lead role in requiring a factual disclosure, a simple forward factual disclosure on the back of the package stating merely produced with genetic engineering. it's not a warning, it's a notification and it's a notification that is there to provide consumers with accurate information so as the vermont legislature found they can make intelligent choices about their consumption. and that's the second i want to talk about. trusting people to make their own decisions is a fundamental american principle. and what act acts 120 does is trust consumers to make their own decisions. if trust consumers to be intelligent at and make

intelligent choices. there was a tremendously strong demand in vermont for this labeling bill. there is in fact strong demand across the country for such labeling. the legislature found that giving consumers this information enables them to make a choice similarly to calorie counts and the cartoon figures on the front of the package to flavor. this is another piece of information that consumers want in order to make a decision about how, whether on how they will purchase their food. and it's important that there is no state oversight of what information is disclosed. it is merely the presence of materials that have been produced with genetic engineering. this is not the state determining what is right for consumers to know. this is the state simply providing information for consumers to make decisions on.

lastly i want to briefly touch upon the fact that vermont also has flexibility in it. as a mandate exactly where the disclosure has to be placed. it doesn't mandate the size of the font. it provides a ceiling, excuse me a floor for where this is and where the disclosure should go in that kind of flexibility you think is important as manufacturers and retailers begin to comply with vermont's laws so i want to thank the committee and chairman pits and represented pallone for inviting me here today and i'm happy to answer questions. >> thank you. mr. reifsteek you are recognized for five minutes for your summary. >> chairman pitts ranking member grain and members of the committee bankrolling today's hearing. i am john reifsteek a grain farmer from central california california -- illinois and chairman of the board of the cold war parted based in bloomington illinois. our co-op is owned by member cooperatives and provides input

such as seed fuel plant nutrients crop protection products and grain marketing services. i appreciate the opportunity to testify before you today on behalf of romar to the national council of farmer cooperatives and the coalition for safe affordable food to buy live in a farmhouse my grandfather built 101 years ago through the farms sustained three generations of my family. my father and grandfather were good farmers but the tools and the practices they use in our farm back then would not be good enough to meet the needs of our country and our world today. instead each generation of my family has used new technology to build on successes of the past. global positioning systems automatic steering and biotechnologies are examples of new tools available today that future generations will use to build a better agriculture tomorrow. i know first-hand the value

biotech crops provide to my operation. my farming experiences illustrate this. in the past i have abandoned -- riddled with insect damage or overcome by weeds. harvesting those fields are not just an economic loss but present a real risk of physical harm to my farm employees and myself. these are memories i won't forget. they represent past challenges to biotechnology has helped me overcome. i am very proud to see growmark has been at key to the solution of these problems. affiliated companies and former owners have been directly involved in the use of biotechnology crops for a number of years. growmark was at the forefront of providing technology to producers when i was introduced in the 1990s. i is successfully used by itec feeds at my farms as it became available. the rapid adoption of these products reflects a value that the world world that affects

them farmers also relies crops they grow today benefit from biotechnology are safe and healthy as a crops grown by their parents and grandparents. this is important to farmers. it's providing her customers with safe quality products which is the number one party. biotechnology provides substantial benefits to producers, to the environment and to consumers. to reverse course now would wreak havoc among america's agriculture industry. make no mistake that's what a patchwork of biotech labeling laws would represent an unworkable step backwards. a growing concern among farmers and co-op managers that this would not stop at the state level but perhaps extend to individual cities counties and townships. food and agriculture companies including cooperatives like sub i would have no choice but to comply with hundreds or perhaps thousands of burying if not direct the conflicting labeling laws and near impossible task

for us us. a safe and acrid food labeling act introduced by representatives butterfield would ensure that the labeling of biotech food products is based on consistent standards using sound science. it would allow those who wish to label their products as gmo free to do so by utilizing a verified process offered to the usda very similar to that at the certified organic to graham. i encourage members of this committee and congress to support safe and accurate food labeling act. this bill would ensure that consumers are provided with accurate consistent information about the food they purchase offer choices available to grocery shoppers and their nation's farmers. in conclusion i strongly urge the subcommittee to support a voluntary uniform and national standard for labeling food products derived from biotech ingredients. the impact of not taking action

would have a devastating effect on food and agriculture companies across the country as well as farmers whose livelihoods depend on the freedom to conduct their business using the best business available to them. thank you again for the opportunity to testify before this committee. >> the. >> the chair thanks the gentleman and now recognizes mr. mr. jaffe for five minutes. >> chairman pits a member grain or want to thank the house could imaging commerce and that the subcommittee of hello for having today's hearing and inviting me on behalf of the center for science in the public interest. the issues surrounding the proper role of the federal government and the oversight of genetically engineered crops in the labeling of foods made with or without ingredients from those crops are issues of obvious public concern that congress needs to address. it is critical of federal government ensure that all ge crops are safe and whatever information is provided to consumers about ingredients made from those crops be truthful neutral and not misleading. i'm here today as the director

of the biotechnology project. cspi is a nonprofit organization established 44 years ago. cspi works primarily in food safety and nutrition and publishes nutrition health newsletter to educate consumers on the issues surrounding diet and health. cspi receives no funding from industry or federal government. cspi has advised consumers journalists and policymakers that foods and ingredients made from currently grown ge crops are safe to be back. the current crops have provided tremendous benefits to farmers and the environment in both the united states and around the world. cspi's advocate for improvements in current federal oversight to ensure safety to humans and animals the environment and agriculture or to limit my testimony to the federal government oversight of food and food stuck issues are directly related to this hearing. if the insurers safety of foods and the food drug and cosmetic act.

under that law and ta has established a voluntary process whereby developers can provide safety data and their analysis of this data to show the crops are substantially equivalent to its conventional counterpart. when fda consultation is completed fda responds to the c. developer and a letter that fda has quote no further question about the determination that the ge crop is substantially equivalent to its counterpart. cspi believes fda should determine the safety of all ge food crops before foods from those crops enter our food supply. fda should review the safety data submitted by the developer conduct its own analysis of that data and provide the developer with this opinion and whether foods from ge crops are safe to eat by humans and all sprayed over the consistent with how most countries ensure the safety of ge crops are at h.r. 1 599 goes only a small step towards what we believe is the proper

role of fda to ensure the safety of ge crops and the foods made from them. h.r. 1 599 would codify the current fda voluntary consultation process. does not require however fda to provide its opinion on each particular ge crop safety. in addition it does not put the burden of roof on the notifier to satisfy the fda that the ge food crops or ingredients made from those crops are safe before marketing the ge crop. the recently announced amendments to h.r. 1 599 does not crack those major decisions. it does not grant fda and a new legal authority to ensure ge food crops are safe. instead it immensely protection act to state that the ge crop has been granted non-rated status under usda relations and be marketed by -- that no further questions whether it receives from the fda. fda was still money to make its own independent determination of

the ge food crops may safety standards in the amendment does not provide fda with the needed authority to prevent foods or ingredients of ge crops from entering the food supply until the notifier set-aside fda of their safety. h.r. 1 599 and the amendment provides usda's agricultural marketing service with new legal authority to establish the certification and labeling system for food manufacturers who wish to label foods that data container do not contain ingredients of ge crops. cspi supports the federal government oversight of ge and non-ge labels to show they are truthful and not misleading. there is no standard definition of what it means to be a non-gmo no standard way to describe time than usual manner and no way for the consumers to develop that claim is prepared to cspi believes there's no benefit to consumers avoiding foods that contain ingredients of ge crops

cspi understand some consumers want to buy such foods consistent with a usda if congress passed h.r. 1 five -- 1599 would go a long way towards uniform labels with non-misleading claims. their first cspi endorses that legislation. i think the committee for allowing me to testify and i'm happy to answer questions. >> the chair thanks the gentleman. right on time. the members are voting on the floor. we still have 12 minutes so we are going to continue the witness's testimony and some questions before we recess to go to the floor to vote in and we'll come back. >> thank you mr. chairman. thank you mr. chairman, mr. grain, very much appreciate the imitation to testify before you this morning on behalf of the information technology and innovation foundation, the safety and appropriate labeling for crops and foods in fruits or

biotechnology. we are a nonpartisan research and educational think tank whose mission is to formulate and promote public policies to to advance technological innovation and productivity. the focus on integration issues. we have long been involved in the conversations about agricultural biotechnology and how best to ensure its widely shared benefits to humans and the environment are not burdened by ill-considered policies especially those based on fear and misunderstanding. i very much appreciate the opportunity to comment on these issues today and think of particular mr. pompeo for proposing this legislation which i think is approaching perfection as a solution to some of the problems we have hasten this area of public policy. introduction of crops often called gmos has been one of the greatest boons to humanity in the last 10,000 years of our history. know whether innovation agriculture has been taken up more widely or more quickly and

none other has delivered greater benefits to humans are livestock and companion animals and the environment. these crops have been grown over the past two decades on over 4 billion acres worldwide. lassar london were grown on or hundred and 40 million acres by 18 million farmers in 28 countries legally including a lot more where they were grown by farmers with a government sanctioned by the farmers could get access to the seeds. a farm gate value that it has the environmental impact ofon agriculture been reduced on average by 18% rate this has entailed a 37% reduction in the use of pesticides to 22% increase in yields and a 60% increase in farmer income. the single most important element in the equation of credit for this avalanche of global benefits is a science-based predatory process adopted by the united states in 1986 for which you and your colleagues and your predecessors

bear an enormous amount of credit. the bipartisan endorsement supporting a science-based approach to regulation that has been in place in the united states for the past four decades has been absolutely essential and made it possible for this technology to be developed and adapted and disseminated. the intention of h.r. 1599 to extend his legacy of bipartisan support for science-based regulation is important and special interests seek to undermine its credibility and authority with false claims and no considered policy proposals that every level particularly at the state level. congress clearly has authority to address these issues and should formally preempt state-level actions as the constitution directs and article i section 8, clause three interstate comments clause. i'm less enthusiastic and indeed would have but buys into one provision before you in this legislation which would change the nature of the fda safety review process for bioengineered

foods by making it mandatory. it's widely acknowledge that the biotech derived foods on the market today are safe, they have all gone through this review process. the review process has worked and is working well, does not need any fixing. there are no safety issues outstanding which it failed to address. i know that there are those who favor making this process mandatory but if congress were to take that step that would for the first time step away from a science-based regulation that is served us so well for decades. i say this because the term gmo is an artificial construct and it does not represent a meaningful class of items deserving of special much less discriminatory regulatory status or scrutiny. that category further bears no meaning full relation to hazard a risk. jim is a process, it is not a product. provisions with the fda regulations on labeling already in place mandate consumer information about the contents

of the food that they buy and consume. i would enter a plea that is to consider these issues please think carefully about what will help accomplish your objectives and what will not, making it clear to the state the labeling is a federal responsibility. that is something that would be helpful. the actions of some will construe and represent to be an acknowledgment that there are safety issues or concerns where in fact there are none would not be helpful. thank you for the opportunity to speak to this morning and i'm happy to answer any questions. >> the chair thanks atonement. the chair and bites the members, there are still seven minutes left to vote but some branded 82 members have not yet voted. so why will begin questioning them recognize myself for five minutes for that purpose. the first question is for each of you. today's hearing is not the first hearing this subcommittee is help on this topic. previously the d.a. has stated that their current consultation

process has provided appropriate oversight of new foods derived from genetically engineered plants. fdi -- fda testified before the subcommittee last december that the consultation process is working well and provides for rigorous food safety evaluation of such food -- foods. i would like to ask each of our witnesses, do you agree with the agency's assessment, yes or no? mr. blasgen. >> yes. >> is just a borg? >> i don't believe i have a base port -- a basis for agreeing or disagreeing. >> mr. jaffe? mr. giddings? fda testified in december that there have not been any material differences identified between genetically engineered ingredients and those derived

from traditionally bred crops. again would be to be please answer yes or no, do you have any evidence to the contrary mr. blasgen? nestor dalos? mr. reifsteek. mr. jaffe. mr. giddings. >> bears samples where there are material differences as with cooking oils that have been modified to be heart-healthy but where does it occurred they have been reviewed by fda and pass the safety reviews and the differences are and get it on the labels. >> thank you. finally fda testified that there is scientific consensus about the validity of the research and science behind the safety of foods derived from genetically engineered plant varieties. do any of you disagree with that do you want disagree mr. blasgen? mr. dalos? >> no.

>> mr. reifsteek? mr. jaffe? >> the current crops that are being grown i would answer no but for future crimes we need to look at those on a case-by-case basis. >> i'm not aware of any aryan signs with a consensus on safety is stronger than in this field pay its. >> mr. giddings can you explain what additional testing testinge department of agriculture conducts a new plant varieties used in food before they are commercialized? >> the usda does not necessarily do testing for food safety. the usda does extensive analysis of a vast and brought amount of data relevant to the safety and impacts, potential impacts for u.s. agriculture and the environment. these are the data submitted by applicants comes in response. they are filling out form 2000 which lists a series of questions relative to the safety of these crops on which the usda

wants data. the amounts of data provided our voluminous. they go far beyond it that what regulators need to know to assess the safety of these crops. these crops have been examined in more depth, in more detail in advance for safety than any others in human history and their record of safety is unblemished. >> all right, mr. giddings or any of you i have heard from a number of constituents who insist despite this evidence to the contrary that gmos are dangerous to their health and are harming them by or mitt. why has this sentiment recently proliferated? who would like to speak to that? >> mr. chairman there are very few issues in our lives to which we are more emotionally attached in food and the idea of somebody messing around with our food

supply is inherently one of concern and the folks who have issues with food their concerns are heightened and there is a very well-funded campaign of special interests who have adopted raising unwarranted fears in this way as their marketing tactic for which they seek to expand their market share. this campaign has been funded massively and executed across the united states and around the world for years and they have succeeded dramatically in shaping the public view on these issues to create an appearance of safety issues where in fact they are absent. recent surveys have shown that the difference in opinion between the public and the scientific community on these issues is wider than any other major public policy issue befor us today and this is the result of an ongoing propaganda

campaign designed to raise fears and mislead consumers in this mandatory labeling pushes an integral part to do that. >> on time has expired. we still have a minute and a half. 288 members haven't voted yet so the chair recognizes mr. green for five minutes. >> thank you mr. chairman. i want to thank our witnesses testifying today on gmos. dr. giddings one of my concerns is are you aware of any incidents where gmo crop cozin imburse impact on human or animal health and frank awy we start with you and we can go down the list. >> their. announcer:. >> i'm not aware of any but when the crop what you are doing is adding dna that might produce proteins and some proteins can be allergen so i think you need to check those to make sure that does not occur. >> with the bill we are

discussing today correct that with the authority given? >> fda looks at data on a voluntary basis currently and h.r. 1 599 with make that mandatory but i think it's missing if fda giving his opinion on the safety that food. >> mr. reifsteek. >> gmos have increased the safety of my farming operation because they have a lot of to substitute dmo technology for other products that are more dangerous to for me to use my farm. >> i am unaware of any such studies. >> mr. reifsteek? >> no. >> mr. giddings are you aware of the -- consumption is caused adverse reaction against hope other witnesses. >> on the issue of allergenicity that is the particular concern to me because my son has a

life-threatening peanut allergy and i can tell you the only foods introduced to the market for allergy -- allergenicity the only reviewed our biotech derived. >> i'm not aware of any. >> i'm not aware but i'm aware that consumers have deep concerns on the issue. ..

a series of distribution networks. the product is shipped into the retail network and finally to the consumer's shelf. so the right to know the choice is very important. that's why a clear national standard is so critical to the manufacturing community. >> the same thing on the