president's unconstitutional executive amnesty or sanctuary cities or anything else that might secure our borders. i believe that republican majorities in both houses of congress can do nothing meaningful on spending or the debt or tax reform or regulatory reform, that we can do nothing to rein in the e.p.a. or the cfpb, no matter how many millions of jobs they kill. i believe that congress must acquiesce to the obama administration's declaring the internet to be a regulated public utility. and the administration's attempt to give away control of the internet to an international cartel of stakeholders, including russia and china. i believe that congress can do nothing, absolutely nothing, to stop this catastrophic iranian nuclear deal. yes, it will send over $100

billion to the ayatollah khamenei, who chants "death to america" in front of mobs burning american and israeli flags. and even though it threatens the security of israel and potentially the lives of millions of americans, i believe that congress has the constitutional power of the purse but i believe congress can still do nothing whatsoever to protect the american citizens.i believe that congress can do nothing to protect religious liberty or free speech, that congress must quietly accept an i.r.s. that targets citizens for exercising their constitutional rights and a president who ignores federal law. and federal judges who disregard the text of the constitution. i believed republican leadership when they promised the american people that if only we had

congressional majorities, we would fight obamacare and amnesty and lawlessness. and today i believe republican leadership when they say, of course we cannot and will not do any of that. and it was unreasonable for anyone to have believed those promises in the first place. i believe that any time president obama threatens a shutdown, republican leadership is exactly right to surrender and fund all of obama's big-government priorities, to fund obamacare and amnesty. and planned parenthood and the iranian nuclear deal. otherwise obama might shut down the government and it would be our fault. so we must do whatever he demands no matter what. i believe that it is unreasonable, radical even, to expect congress to do any of the things we promised the voters on the campaign trail.

i believe that when a republican speaker joins with nancy pelosi and the democrats to fund all of obama's priorities that it is the republican freedom caucus who are the crazy ones saying we should stand for something. i believe that when the republican senate majority leader publicly promises there is no secret deal to reauthorize the export-import bank and then one month later contorts procedural rules to force through the deal that he had claimed didn't exist, that it is not his public lie that matters but rather it is the junior senator who has violated decorum by pointing it out, out loud. i believe that the only thing we can expect republican majorities to do is expand government, reauthorize corporate welfare, and grow the debt. that's called governing.

always said one oka octiva lowen washington. governing is measured by how many bills you pass. and one cannot govern without agreeing with democrats across the board f. we pas board. if we pass a lot of bills, even if they do nothing to address the debt or bring back jobs and economic growth, and even if they actually expand washington power and make the problems worse, then i believe we should celebrate. i believe that democrats can never be forced to compromise on anything, that it is always unreasonable to ever try to win a political battle with them. and so it must always be the republicans who agree to the democrats' big-government priorities. and i believe the only way republicans can win is to continue making these same mistakes over and over and over

again. of course i do sometimes wonder why it matters if we have republican majorities in congress. after all, leadership has told me they cannot accomplish anything different from the democrats, that it is an unreasonable demand to expect them to fight obama on anything. since it is only the crazy kamikaze caucus who thinks we can fight obama on issue, anything whatsoever, i believe that leadership is right to fight on nothing. to pass the very same bills filled with pork and corporate welfare, the export border security bank, obamacare funding and amnesty, and confirm the very same attorney general that the democrats would have done. i do wonder sometimes, as

hillary clinton would have put it, what difference does it make? but then i put aside such foolish thoughts. instead i believe. i yield the floor.

mr. cruz: mr. president? the presiding officer: the senator from texas. mr. cruz: i ask that the senate proceed to a period of morning business with senators permitted to speak for up to 10 minutes each. the presiding officer: without objection. mr. cruz: i ask that the senate stand adjourned under the previous order. the presiding officer: under the previous order, the senate stands adjourned until 12:01 stands adjourned until 12:01

>> sunday at noon, the live three-hour conversation with walter williams as he shares his life and career in response to your calls and tweets. on american history tv on c-span3. saturday evening at 6:00 p.m., don doyle looks at the worldview of the american civil war and the perspectives of foreign-born soldier that join the cause. and then sunday morning at 10:00 p.m. come and interview with clarence thomas on his upbringing in the segregated south.

get the complete weekend schedule at c-span.org. >> the director of the national institute of mental health told the sentinel and transcendent about mental health. lamar alexander chairs the senate health education labor and pensions committee. >> the senate committee on health education and labor will come to order. it is suggested that we go ahead, the senator is going to be here very shortly. she and i will have an opening statement and then we will introduce the panel of witnesses. after the witness testimony the

senators will have five minutes of questions. today we are discussing the importance of the issue of mental health and substance health disorders. it affects a great many americans. according to a 2013 report from the national survey of drug use and health, one in five adult over the age of 26 years old reported suffering from mental illness. in the same timeframe one in 10 americans between the ages of 12 and 17 years old reported having at least one major depressive episode. in tennessee, about one in five adults reported having a mental illness in 2013. that is more than a million tennesseans according to the tennessee department of mental health and substance abuse services. about 5% had a severe mental health illness, that's about quarter of a million tennesseans. and many of them had a major depressive episode. already there is an enormous response to help the state level

and is a former governor i know firsthand that states have traditionally been on the forefront with the department of mental health, treatment facilities and community-based services. the states have had the primary responsibility for behavior and health and provide programs that often include counseling, social work, case management, providing screening diagnosis and treatment for children. and in the private sector many private hospitals and mental health professionals and others worked to help those in need. efforts in the private sector totaled about $67 billion in 2009 or 39% of total dollars spent for behavior help, which includes mental health and substance abuse services. government spending totaled about 105 billion in 2009 with 65% of total dollars spent and that includes medicare and medicaid and other efforts on

the global and state and federal levels. one role that the federal government places through the agencies. the substance abuse and mental health services administration is an agent within the u.s. department of health and human services. the role in supporting mental health programs is relatively small. compared to the responsibility that states have and the role of medicaid, it is also critically important. they support states, behavior health care providers and others by providing and improving the availability and quality of prevention and treatment services, collecting behavioral health data and sharing best practices through evidence-based initiatives. it should be looked at as a leader in the field, receiving $3.5 billion each year through the discretionary appropriations process. but the biggest government role is the amount of money and the amount of money is spent through medicaid which is a federal and state partnership. in 2009 medicaid spending on behavioral health totaled about

44 billion. 26% of total dollars spent. these medicaid dollars can be used to provide care from community behavioral health professionals inpatient or residential services and helping those with severe mental health illnesses get the prescription drugs that they need. in tennessee, state spending was used for programs and services and totaled about $555 million. about half of that was spent on the state shared medicaid related to mental health, 325 million spent by the state department of mental health. the federal government's medicare standpoint also plays a role in financing 7% of total expenditures to treat mental illness at about $21 billion per year. these medicaid dollars can help seniors get prescription drugs that they need or can be used for doctors appointments, outpatient therapy and a small

portion of inpatient treatment for mental health. this federal support is already a significant amount of money. one question is should we be spending these dollars currently. or should we be spending more dollars and if so, in what way. there are calls for the federal government to act differently to help those in need or to do more. twice the senate health committee has passed different versions of the mental health awareness and improvement act. the senator and i have cosponsored. and this bipartisan legislation support suicide prevention, intervention program summit helps to train teachers and school personnel to recognize and understand of mental illness, it works to reduce the stigma against those struggling with mental illness and helps children recover from somatic event. i hope that the mental health awareness and improvement act will be passed by the senate and become law in this congress. other senators are also attacking the issue of how to improve mental health treatment.

editor cassidy and senator murphy has a bill through introduced in august and senator franken has also introduced a legislation. senator cornyn has a bill that is working and he is working on the judiciary committee. i expect to see additional legislation that better support states in addressing substance use disorder in their communities and then we will see what other committees are doing and what the judiciary committee might be doing, what the finance committee might be doing on medicaid and medicare and also see if putting all this together we have a better and coordinated response to mental health. today's hearing is really to better understand the federal government's role in mental health treatment and how how to help states like tennessee deliver such critical care. i am looking forward to hearing from today's witnesses and are we putting up roadblocks, how are the programs working, i am

interested in your thoughts on mental health research. one of the most important things the federal government does is to enable research because that enables individuals to move forward in this big complex society of ours. sometimes we are not good managers or good regulators but government research that we have funded and encouraged has enabled enormous breakthroughs in our country. so i would like your thoughts on that as well. senator murray. >> sir, thank you. thank you to all of our colleagues and i especially want to thank the witnesses who are taking time to join us today. and i especially want to welcome you, doctor, as we move on and we thank you for your tremendous amount of work and we appreciate what you have been able to do and will continue to do, i am sure. over the last two years we have made real progress towards building a health care system that works for families and communities and puts their needs first. but as is said there is a lot

more that we can and must do and this is especially true when it comes to addressing mental health and substance abuse. today nearly one in five people in our country experienced mental health illness in a given year and far too many do not receive treatment when they need it. in fact there is on average nearly a decade between someone showing signs of mental illness and getting treatment. suicide is the second highest cause of death for those ages 15334 and nearly a quarter of the state prison population has struggled with mental illness. these statistics are deeply disturbing but the stories behind them are even more tragic. astigmatic keeps too many of them from seeking help even though it could make all the difference, of treatable illnesses dealt with by a judge rather than a clinician. of millions of lives and especially young lives are cut short. these stories demand action.

members of the committee on both sides of the aisle have made clear that improving our mental health system is most definitely a priority and in particular i appreciate the bipartisan work that senators murphy and cassidy are doing to push for progress. i am looking forward to hearing from my colleagues as well as our witnesses about the ideas that they have to strengthen the mental health system and prevent more of the parents and friends and neighbors and students and children from falling through the cracks. there are a few challenges i'm focused on in particular. the mental health workforce should serve as a foundation on which a strong and supportive system is built. but today far too many communities have inadequate access to mental health professionals and in fact half of all u.s. counties today do not have a single psychiatrist or social worker and that means that far too many patients and families, it's unclear where they should turn for help. so we need to make sure that communities have access to trained professionals who can

intervene and support those struggling with mental illness. this is critical to ensuring that mental health is seen as just as much of a priority as physical health. and so is integrating primary care with mental health care, too often patients mental and physical health is considered separately and that silo means that on one hand patients experienced mental illness and those may not get it when they need it and on the other hand that any signs of mental illness may go undetected. that presents a true threat to patients with mental illness and especially with those who have chronic mental health problems or substance abuse disorders that can make mental illness worse. i am very interested in a collaborative model being practiced in my home state of washington where mental health professionals provide telephone consulting to primary care physicians in communities that lack access to mental health

care. that helps patients receive treatment that is mindful of both their mental and physical health. as we work to improve detection and treatment of mental illness, we need to prioritize crisis response. i have heard too many stories in my state and across the country of patients with mental illness held for days and weeks in emergency rooms or even solitary confinement, waiting for treatment. that is unacceptable. communities need the resources to respond quickly and appropriately when someone is clearly in or approaching a crisis. because without those resources intervention often comes too late or not at all. suicide prevention must be a priority in each ear suicide takes tens of thousands of lives and our country and shatters countless others. like many today i have been deeply concerned about the high rate of suicide among veterans and we also need to take a look is what is driving this tragic

decisions among other populations. i was very concerned to learn, for example, recent studies show young adults from tribal communities are at especially high risk. i know the administration is very focused on suicide prevention and our committee recently passed the mental health awareness and improvement act which authorized the critical suicide prevention act and i look forward to continue to work together to putting an end to the crisis in every one of our communities. it is critical also took knowledge that in order to confront the challenges we have talked about and many others within our mental health system, we have to break down the barriers that the stigma creates for those suffering from mental illness. that means prioritizing research helps to enhance the understanding of and ability to effectively treat mental illness. and it also means raising awareness for those struggling so they don't feel that they have to struggle alone. i saw the stigma earlier on when i interned in a va psychiatric

ward when i was a college student. they were veterans with severe psychological trauma and they were told that they were simply shellshocked. over the course of my career i have heard time and again from veterans and all walks of life that stigma and the stereotypes are a crushing burden to bear on top of illness and those struggling with mental illness should be treated with compassion as well as respect and dignity and they should have the resources that they need to live and work in their community and that is something that i will continue to be focused on. esther terman, i am pleased to have this discussion and i look forward to working with you to strengthen our mental health system and give more patients and families the opportunity to lead healthy and the filling lives. i am confident that everyone in this room has a story about a friend or a loved one or classmate or coworker that face is mental illness.

the harsh reality is that these challenges impact each of us and i hope that the efforts here today are a step in the way to overcoming it. i think you for everyone participating. thank you for holding this hearing and i look forward to this conversation. >> thank you, senator murray. this is a subject that has brought interest among members of the committee as is indicated by the number of senators here today. i would say to members that this is another what we call bipartisan hearing which means that senator murray and i have agreed on the subject and the witnesses and we have agreed that that is the best way to get total results. so we have had very few partisan hearings during this year and i think that that has been good for our committee. i am pleased to welcome three witnesses to the hearing today. thanks to each of you for taking time to be here and we have busy

jobs overseeing important agencies. that means she oversees for centuries. the second witness is jim mcrae who is acting administrator of the health resources and services administration and he joined in 1992 and has since held several positions and has received several awards for his service as well as the leadership as an administrator. next we are going to hear from tom who is director of the

national institute of mental health, which is part of the national institutes of health and he leads research related to mental health. he is focused on genetics and biology. before that he was professor of psychiatry at emory university and he will be leaving his position soon to pursue research but we appreciate his service and we especially appreciate his willingness to come here before his departure to tell us in plain english what we ought to be doing. so it is safe to do it now. [laughter] >> i think it will be safe to do it in a couple of days. >> so we will begin. >> chairman, ranking member, members of the committee. thank you for holding this hearing on a topic that is

critical. the physical and economic health of the nation. thank you for inviting me to testify today. it's a great honor to talk to you about the state of america's mental health system, a topic that is near and dear to my heart and i would like to discuss some of the initiatives that impact american people everyday. the doctor will also tell you that no psychiatric disorders are the leading cause of disability burden in the united states. one in for social security recipients are enrolled due to mental illness and individuals with serious mental illness makeup over 40% of the people that are duly eligible for medicare and medicaid. yet 147 billion per year in 2009, mental health accounted for only 6% of health care spending and only 1% for substance abuse. but the burden of undertreated behavioral health conditions on

labor market, criminal justice is done, families, schools and communities and others, is tremendous. the mental health budget is approximately 1 billion and in 2015 it is an important influencer of the nation's mental health system. to accomplish the mission, we cannot work alone. therefore another one of the key roles is to lead by coordinating mental health services across hhs and other federal departments. one main example is the behavioral health court any council which was established in 2010. achieve goal is to provide a platform for knowledge exchange and then ensure that behavioral health issues are handled collaboratively without reduction of effort across the department. across federal government, we worked with the department of defense, education, justice, veterans affairs and the social security administration. we work on a wide range of

issues spanning convention in treatment and recovery for people with or at risk of mental illness. we administer a combination of formula grant programs and i will share a few examples. first, the block grant is a flexible state spending soars, it is limited but significant funded with about half a billion dollars to support administration evaluation, educational activities and direct service delivery for adults and those with serious emotional disturbance. congress asks them to set aside 5% to address the needs of individuals with mental illness including psychotic disorders. these programs have similar research and initial evaluation tells us that this funding is helping to increase access to early intervention programs and reduce the duration of untreated psychosis and other conditions.

this news is so exciting that the ability to preempt long-term disability for hundreds of thousands of young americans is at our fingertips. we also recognize that financing is a central piece of the puzzle and we work closer to our colleagues and across for the payment systems to encourage high-quality care for adults and children and those with mental illnesses and substance abuse disorders. just last week thanks to the passage of legislation, they awarded the planning grants to 24 states to certify community behavioral health clinics and establish a prospective payment system in a two-year medicaid demonstration program. the ability to transform the way that community services are reimbursed could help us turn the corner on key provider capacity issues. this is also a critical area of focus for suicide prevention. this includes grant programs demonstrating the counties with

this activity saw lower rates of suicide and suicide attempt. unfortunately too many communities and to many people are unaware of the major health crisis that we are facing around suicide. and while we are making progress older adult suicide continues to climb and some limit their focus to adolescence. yet the data shows nine out of 10 people who die are over age 24. move the needle we must expand the scope of the prevention efforts. as jim mcrae well knows, no conversation about any aspect of health care can be complete without talking about workforce needs. together the affordable care act are expected to expand behavioral health services to over 60 americans. that is the current infrastructure and workforce that need additional capacity to help the people that need treatment that will now be begin

to seek it. this includes describing and on prescribing professionals including counselors, anarchists, and peers. we are grateful for the collaboration in the area and grateful for the outstanding work and thankful to the committee for allowing additional highlight. if i would like to take liberty for a couple more seconds i would like to express appreciation to tom. you are a powerful leader and you have been steadfast in your vision that mental health research, whether at the level of the genome or the globe should be of no less rigor polity than any other field of research. your commitment to bringing the best science on any policy program question has been invaluable. thank you for your service. we stand ready to help you achieve a tenfold impact of your

next renovation. >> thank you, ma'am. >> thank you, mr. chairman. breaking memory, all members of the committee, i am pleased to join my colleagues to share with you what we are doing at the health resources and service administration to address the mental health need of the donation. this is the primary federal agency with the department of health and human services charged with improving access to health care services for people that are medically underserved, including those that are low income, live in rural communities. we carry out the work in partnership with community-based organizations, state and local government and academic institutions among others. this program is over 3000 grantees providing affordable health care to tens of millions of americans across the country and we trained thousands of health care professionals. one key area of the work has been on expanding behavioral health as the chairman and ranking member have mentioned.

recognizing that primary care can often serve as a critical access point for those suffering from mental health issues and some individuals often feel less stigma and feel more comfortable discussing and sharing mental concerns of their primary care provider. in a community health center program depression and anxiety are ranked third and fifth as the most important reasons why people come to this primary care setting. they also share that by having a provider on staff and colocated in this setting that there are other care providers actually feel more comfortable and are better able to address the needs of their patients and to coordinate care. to support this type of integration that we have heard that they need, they have invested more than 160 million in the past year to expand the capacity of health centers nationwide. we have done this either through establishing new mental health

services or existing services. through those investments we hope to provide care to an additional 1 million people suffering from mental illness and in addition jointly reporting integrated health care solutions and this is a national resource that helps health centers on the mechanics of integrating primary care and mental health and substance abuse services and how best to do it. one of the other keys to addressing this access is of course building a strong mental health workforce so that individuals can see about it when they need it and see care. this includes providing scholarships and loans to those that are practicing in underserved communities either in primary care or dental or behavioral health. in return they agree to provide service for two to four years in designated areas of the country that need the most. the national health service has a number of providers including psychiatrists at facilities and

since 2008 the number of mental health providers in the national health service has increased to well over 3300 from 800 before. in addition the agency supports a number of workforce training programs that help to increase providers nationwide. since 2014 in collaboration, they have administered workforce education and grant program as part of the administration's now is the time initiative. the grants have enabled more than 1100 masters level therapists as well as more than 950 mental health care professionals to receive clinical training through 2014 in 2015. we also recognize that mental health is particularly a need in the world communities. and despite the need, there are fewer providers in rural communities. through the use of telemedicine

and technology, they have expanded support for providers in isolated areas to improve patient care. we also recognize that substance abuse is common in those living with hiv and aids and are critical barriers to both retention and care and treatment and we support training for providers to screen and identify and treat those with substance abuse or mental health needs. we also share the goal of ensuring a strong health system that supports substance abuse services by integrating behavioral health and primary care, training more providers and utilizing new methods and technologies to reach underserved populations and we look forward to continuing with the committee to address the nation's substance abuse needs. >> thank you, sir. doctor? >> first, thank you for holding this hearing.

it is important for me to see a priority that both of you have put on this issue and have several members of the community have expressed their passion and some of this i know comes from everyone of us having a personal experience and this is something that we care about. mr. chairman, i think the eu laid out that this is very much a partnership between federal and state and private sector and how we do that going forward is that we have to be better. you have my testimony. i want to simply add to comments from my colleagues here that there's a lot going on that is worth talking about. senator murray as she clicks through your list of the issues around the workforce, the opportunity for collaborative care, what we are doing for crisis response and suicide in stigma, already has a partnership here across the

agency we are very engaged on the issues and it's incredibly important because we must always remember that the brain as part of the body and that mental health issues need to be thought of as health issues. so many people with serious illness also have issues around diabetes and metabolic syndrome and a tremendous number of problems with about two thirds of them being smokers. one of the reasons as you mentioned is not because of suicide so much as all of the chronic and often very expensive medical complications that they develop for a variety of reasons. these are huge health issues that need our attention and we need to think about how to address them in the most impactful way. as you have all mentioned and understand that we are the research part of this that does the science and the science is changing as well partly because

of our understanding that we can now address mental disorders as brain disorders and we have the tools to be able to change the way that we do diagnosis and develop new treatments and most of all that we have an understanding here that is very much coming out of our experience with heart disease and cancer that if we are going to ban the curve, we need to fight this appropriately. so much of our focus has been those with chronic disability and it's obviously important for us to do. but the future has to be much better detection and much earlier intervention and then also developing these comprehensive treatments for early psychosis to ensure that someone who does develop psychosis if we fail to preempt it gets the best chance for recovery and the focus on

reducing suicide, as you mentioned, this is an area when homicide has come down 50% and we are looking at about the same rate that we had in 1990. we have to understand how to address that in a better way. my final comment is many noted is that this is my swan song and in many ways i'm wistful about leaving the position and a lot of people that i care about and certainly i want to continue to focus on issues from the private sector. and i did want to share what i mentioned in my testimony. in leaving and sort of these abiding truths that i want to carry with me that there are two factors that come back over and over and one is that i think that we can do much better than we are currently doing with the diagnostics and treatments that we have.

in this field more than in any areas of medicine, there is a gap between what we know and what we do not. we are all aware of that from her own personal experience. this is a huge gap that we have to figure out how to bridge and at the same time i want to stress that as with heart disease and cancer and more so in this area, we do not know enough. we just do not know enough to ensure that everyone is going to recover to have a cure for every one of the problems that people with schizophrenia, depression, bipolar disorder and autism develop. these are very difficult and complicated problems and we must invest not only in better services but also in more science because it's going to be a central that we understand these disorders in a deep for

level if we come up with the treatments that will be most effective. in my career i have seen this happen from childhood cancer, heart disease where the mortality has come down 63%. i've seen it happen recently for aids, mortality coming down 50%. we have not seen those numbers budge in this area and that is something that we must tackle in any way with fresh ideas and better science and closing the gap, taking the things that we know and making sure that it's what we are actually doing in practice. thank you and i look forward to your questions. >> we now have a round of five minutes. doctor, did you say that two thirds of those with mental health or smokers? >> two thirds of those with schizophrenia, the numbers even climb higher than that. >> is that a lot higher than people with diseases other than mental health?

>> yes, absolutely. males have a high rate of lung cancer for smokers as well, but as a group i don't think that there is any medical demographic group that has a high rate of smoking that you see like in people with serious mental honest and i wouldn't just add that they are smokers but the way that people smoke is actually different to the way that others smoke. they are much more likely to develop chronic respiratory diseases. it is a huge medical public health problems that we have launched since we have worked on these efforts and the new programs to get people with schizophrenia who are ill to stop smoking -- it is doable but it's hard for them to stop and it's always questionable about whether nicotine in some ways is a way of self-medicating.

and the science is not quite there. >> the doctor says that smoking is still the number one killer in the united states. let's talk about research a little bit. the last time you were here you talked about whining from your recovery after an initial schizophrenia episode. what have you found out and what have we done to translate those findings in the practice? >> her recovery was a program in 36 sites across 22 states to try to understand whether we can do better with what we know today. taking a range of interventions from education, providing resilience training. looking at supported housing and employment.

putting all these things together in a package and then delivering them together. the results for the primary outcomes were just published about two weeks ago and they are very positive. it is the difficult part, the most difficult part is that many of them have a duration of untreated psychosis for 70 weeks, which is just stunning and it's hard to believe. what we are doing now working very closely as this kind of mentioned with the coordinated specialty care into the state system that is part of the mental health block grant and on. there are 32 states that have programs based upon this. and we are looking to expand it through something called the early psychosis intervention network that will create a learning system that will allow

us to have a single electronic health system and coordinated care effort that can incrementally improve as we go. it's a high priority for the institute and the great story of teamwork across agencies as well. >> you refer to the brain initiative. what are the most significant findings and is this part of the overall initiative that doctor collins has talked to us about that he hopes to be able to do? >> yes, it is. doctor collins has become a born-again neuroscientist and he has discovered how spectacular neurosciences today and this is a place where we have so much attraction. and it has moved forward that we

have fun at our second year, about $84 million a we have in this for over a hundred projects across the country. images within your agency? >> there are 10 institutes engaged in this and so it's a partnership with the fda and nsf as well, there are many different federal agencies involved and lots of private partners. the important thing to talk about is this. i think that in the house and senate there's an ambition to weigh in on this as well. and this is not about specific

diseases or brain disorders but developing the technologies to be able to understand how the brain works and we are already being fantastic tools being developed across the country without wanting to say too much about it at this time. but there is a group in seattle that has opened up this field for all of us in a way that gives us the excitement over the next two years we are going to transform the way that we study the brain. >> senator murray? >> bible does follow that up. we have the outlook. can you tell us what you can about that and some of the other projects, we have the research network there as well that are making amazing strides and we have great hopes for them. >> i could spend all morning

bragging about my colleagues in seattle. quickly telling you what these projects, it was funded through the recovery act and so that was a great opportunity with some additional running to build something that did not exist. and it was a way of saying, can we create a map for the human brain of where and when this is expressed. when we find a gene that is associated with autism or is his attorney, the first question you ask this is that even found in the brain and if so when. and the most significant piece of information that has come out of this work is that there are enormous differences in both space and time for how the genome gets read out in the human brain and that the developing brain looks almost like a different origin than the adult brain. so to our amazement even though we think about schizophrenia and bipolar disorder as

neurodevelopmental disorders, it is the genes that we are finding which may not be that significant that are remarkably important in the development. often they do not get expressed together at the same time in development and that is fantastic and we would never know that without this reference. so it has been transformative. the mental health research network, 10 million patients, and it's actually across now 12 different states with 11 different systems to create a single beta framework with all of these people getting mental health care they're using that are using the same electronic health records giving us a platform to move very quickly to ask questions about what is the best all up after a suicide

attempt. if someone shows up in the emergency room we know that 2% of the people after an attempt would be dead within a year from suicide and that represents about one in five suicides or people that have been in an e.r. within 12 months. can we figure out who those people are and with greg's help we can begin to look at how to deploy services for those people that we bring down the suicide rating and not population. so it has turned out to be for us and our i don't platform to ask practical questions about how to provide better care. instead of the classic how to we move the research, they are saying how we take practice and move it into research and make sure that every patient becomes a partner. >> that is an interesting and exciting thing and i think people really open up to that. thank you for that. going back to you in the short time that we have left. we talked about the public health crisis.

when i was chair of the veterans affairs committee it is not just veterans that are at risk here but we know that suicide is the second leading cause of death and those that are between the ages of 10 and 34, the cdc reports that it's more than twice as likely to die by suicide as peers. so going back based upon some of the experience we are seeing with veterans, what lessons have we learned about reducing stigma or encouraging individuals to seek out care. >> they have developed a systematic process for suicide screening assessment and risk assessment and i do think that we have learned that it's quite

important to specifically screen from that work and we have also learned the importance of connecting as tom has mentioned, as well as the need to connect people who do express further desire for services with suicide specific services so it's not just enough to connect them with the general mental health services but services that are going to address this in itself. we have seen great progress with these models and we have also seen them deployed outside of the system into other community systems and tribal communities and it is something that they are building their initiative around. >> is it fair to say that in the past we have thought not to talk about it because it could make it happen to let's be open so we can prevent it enact.

>> absolutely. i believe that that is a very insightful comment. >> enqueue, we have 11 senators here in addition to senator murray. and when asked the senator senator and the witnesses if we can keep each q&a to about five minutes so that we can have everybody the chance to join in. i will call each of you in seniority and so the next senators will be senator collins, senator franken, senator murphy, then now we call senator collins. >> thank you, mr. chairman. one of the things with our current mental health system is that it's often hard to difficult for parents to get help for adult children who are suffering from serious mental illness. over the past few months i have gotten to know joe who has told

me of what happened to his family. i would like to share his story with you and with my colleagues from the committee in the hopes that we can work together to come up with some kind of solution as we look to revise the mental health load. it was 24 years old at the time of this tragedy. joe had schizophrenia and yet he was discharged from a psychiatric hospital without the benefits of any medication. he had a history of serious and persistent mental illness. but he had been advised by federally funded advocates that his parents had no right to

participate in his treatment or have access to his medical records. but according to his father in an extensive wall street journal piece, eventually his medical records were released and it showed that the doctors were all opposed at his being discharged it that the advocates had coached him in a way that he was able to secure this and that he could refuse medication and not involve his parents in his care. well, this ended in a terrible tragedy because wells butchered and killed his mother. he was in a deep psychotic state and ultimately he was found innocent by reason of insanity or not responsible for his

action and he was recommitted to the same mental hospital from which he had been prematurely discharged. he is now doing well because he's getting the treatment that he needs but his father put it this way to me. ironically and horribly, he was only able to get the treatment that he needed by killing his mother. now, i would like to make two important points. first of all i understand that only a tiny number of americans with serious mental illness engage in unspeakable acts of violence either towards themselves or towards others. and second i understand that these federally funded advocates can do some enormously valuable work in preventing the abuse of patients who are institutionalize. but i cannot help but wonder how

many tragedies we have witnessed in recent years might have been prevented if those suffering from mental illness had access to treatment had had more roles in their treatment. so how do we address what admittedly is a very difficult challenge. >> thank you for that question, senator. i agree that the circumstances are extremely tragic and the loss of anyone is too much. the thoughts go out to the family. in the case of the community program we believe that it is important to have a program that protects the rights of people

and at the same time we have worked with the office of civil rights that has provided guidance and understanding that physicians are able to listen to parents and that they are able to share information with family members. and so i think that there is more to be understood about this in particular. but i could not agree with you more that the country needs to better understand how to get people with the greatest need connected with the care that would most likely benefit them and keep them safe and their families save and ensure the greatest chance of recovery as we have seen in this particular situation. >> thank you, senator collins. >> i think the senator from maine for raising that question. that is an important area and i

know that in this bill we are addressing that. i thank you, mr. chairman, for this important hearing. ..

>> >> supports this training for adults and i am proud number of these recipients are in minnesota can you talk about the collaboration

between schools and other community-based organizations to help students and families and how it helps young people? for the services that they need? >> absolutely. figure for the question. what you have proposed an but we have implemented under project aware connects schools in communities and families with shared information what they can do about them but it is meant to raise awareness with negative attitudes that is barriers for those accessing service. to help them understand these are brain diseases to

offer solutions and it is more accessible to get people connected to care more quickly. >> early diagnosis that we are all witnesses and it is so important. i want to ask about your background with health and trauma. we know it reduces the ability of the child to succeed in school what can we do to build resilience in kids who have experienced with these adverse experiences? that they can overcome them to change the brain chemistry to go through this

type of trauma with chemical abuse or illness or child abuse all of that extreme poverty. >> there are many evidence based interventions and through our never give the initiative there are many resources available on-line for technical assistance for schools to be learned about the programs in the classroom or in partnership with communities with the experience is that they have of social development skills so to understand to have a

place were all children can learn well. >> senator cassidy. >>. >> those who are supporting the bill that we have put up the last few questions i only have five minutes please keep your answers brief if i interrupted is not meant to be reared. >> the gao has replaced jute reports how it has managed mental health issues so my first question will center upon that. hhs is charged with leading the federal government substance-abuse is

specifically told to promote coordination through the federal government. with those across the federal government the gao report to have not met since 2009. hhs officials have stated that behavior coordinating council perform some functions the yet that is limited to hhs not interagency. this is important but that doesn't take the place of leadership the gao has found key with successful coordination. the cassidy has the assistant secretary for mental health specifically charged to do the job of interagency coordination that has not been done since

2009. that being the case do you think hhs should raise the profile to get the interagency coordination that has not occurred since 2009 despite the mandate? >> but to increase collaboration is good. i am happy to agree to a positive opportunity for that collaboration so the committee hasn't met since committee hasn't met since 2009 but the original committee had 25 people meeting they do still meet on trauma, there are also groups related to employment

>> one to hear about mental health and that is what appears to be was lacking. the second report talks about problem of a lack of evaluation for this year's the mentally ill specifically targeting individuals 17 had no evaluation completed it and none planned. i could go through but it is a dismal statistic in the cassidy murphy bill based on evidence based practices purpose there is need for consistent review what is said to of the better culture of evaluation? >> i agree evaluation is the important issue with program oversight we are continually

working to improve. >> give me specifics. >> we have the evaluation committee severe overlooking all programs to identify. >> men were planned or evaluated then why did that ever occur? >> i think there is some challenges in how those are measured switch don't know that is exactly the same thing we are committed to evaluating those programs. >> [inaudible] q route before that i have been told the more reason money has been put towards mental health that the funds may not be there a better elsewhere.

that that is normally the means i have also seen a statistic that for every death and suicide and $420,000 for every death from hiv. but it may be too difficult is that for the issue of suicide can we expect to see some benefits from that? >> to have both scientific traction to make decisions about investments we have the attraction here where greater investment will give a greater return and we have seen that already with the recovery act dollars as additional money the result is spectacular with a lot of

projects that would not have happened if we point to recovery act dollars which is the with the best things they have done over the decades though no question they could have used more funding but the last issue to compare suicide to aid their want to stress the fact that investment in aids could be attributed to the fact we have reduced mortality 50 percents and maybe not spending too much on aids but maybe not enough >> we try to get all of you over. >>. >> thank you for taking this issue so seriously it thinks senator alexander comments are useful to understand why congress has taken on this issue because it does come

across so many agencies in so many different committees and i appreciate the focus to get to our product that can get to the floor. a few of us read a bipartisan briefing from the commonwealth fund talking about the need of the behavioral health systems didn't interesting fact was if he studied the incidence of diabetes alone as a cost driver they are not that extraordinary by themselves will have a physical and mental health diagnoses together all of a sudden you're now in a small percentage of patients driving cost.

>> is this issue not having enough providers or not to be as coordinated as they should be? our bill is focused on the question of coordination. where should our attack be? >> i think it is a combination of the to in terms of primary-care, we have seen incredible interest to increase capacity on site because a lot of them have share they feel with investments we have made over the last several years we have doubled the health providers that our health centers and by having them it has helped screening in terms of what we do to extend the capacity

to do more so we see that as building up of primary-care to be integrated with behavioral health so we see in incredible demand we are only able to fund half of the applications the community health center for 65% is in terms of what they're requesting pc support for coordination but also providers. >> with is this a question of providers not interpreting the existing statute correctly or do we need clarification of what allows a provider to share information with a family member? senator collins has identified that particularly acute problem that goes to

parents and caregivers with a young adult that could be psychotic the needs the help and assistance and a coordination between need to clarify the standards? >> we believe there are more flexibility is the and people understand to clarify the rules that we have to disclose information to family members is the best interest of the patient would be helpful to a lot of people and we're happy to work with people to do that. >> dr., the time your at the institute roughly corresponds that we have reduced inpatient beds about 4,000 across the country of 15 percent reduction i appreciate what you say to identify early but can we sustain this level of

continued reduction of inpatient beds over time? is this something that worries you as you leave to provide short-term acute care stage. >> absolutely it is a big issue there is no place to send patients that is why people are boarded in the emergency rooms we need to look at how you extend capacity is not the answer to all questions but a least i would note over the last 13 years there has been a reduction but the big came long before that it has been 90% reduction of public bin since the '70s so a huge change in that capacity to help people when they need full-time support. >> in the '60s who took them off of the institutions and

within the committee but we did not fund the support and we set up a system that was separate and apart from the rest of the health care system hopefully our discussion will be around those items to bring the two systems back together. >> that would be great. we do have a system called the criminal justice system that is the defacto mental health care system in is if you look at legislation you cannot ignore that in need to ask is this the way we want to train people with a brain disorder? >> thank you for the time you're spending on this issue. senator isakson? >> thank you for your testimony today. we are participating in a number of hearings on the

issue of suicide there approximately 22 per day for the veterans in the crisis we try to deal with memnon a position or technical person but it appears in the emergency room practice there is that golden hour from linda accident takes place to win the have treatment it seems in terms of suicide is that golden minutes with their rubber realizing they can make that call and if there isn't someone when we lose them with a lack of access to talk to to get them to an intervention in a writer romney? >> i would defer to my colleagues i would say absolutely. the other piece is that early intervention is important we have had much

success to do screening in the primary care setting where you can identify children and adolescents and veterans were if they just have that intervention early on and then we can talk about the golden minutes. >> there is the moment someone is reaching out for help that is rarely have the national lifeline party -- perduring with the department of veterans affairs so they can press one to access that military culturally informed type of support bin get connected with services in the local area available to the network of the phone number. >> have you have any interaction with the veterans administration with

peer review? >> we have worked in terms of work force through the day in the other underserved programs and in addition a round of veterans choice act center is a real working on model contract language so they can have greater access >> and realize it is important to improve because right now by calling the when the undercover it takes of longtime and it occurred to me where there are lot of veterans with not a lot of health care, ed does the

veterans administration rely on you? >> we do right now to the community health center to serve about 300,000 veterans and a significant number are in rural communities in the partner with the v.a. with telehealth to make sure they have access that is something we have been working in particular to do more but also through the partnership. >> with every mass shooting in the country the american people call for action and the u.s. congress does

nothing. the does add up with more than 30,000 people there is a lot that we could do but to with thorough background checks the problem of mass shootings as a mental health problem and should be dealt with that way but when it comes time to fund global health research beecher and their backs to study mental health problems but over the past five years the national institute of mental health budget has been capital% in the adjusted budget has been adjusted. in new to begin research on gang-related violence with

language that the is the cdc from any meaningful research to reduce gun violence the author wrote the op-ed three years ago calling for the bay and to be lifted year after year. after nearly taking of life of gaby gifford congress expanded the began to include an age research what might help us better understand the connection between mental health to help us reduce gun violence because of congress's billion -- bay and?

>> obviously a very topical and difficult issue the president has talked about this almost after the day after sandy hook announcing the initiative focusing on just the issue. i understand and appreciate your concern of the cdc language that has been talked a lot in the press as well. at nih our interpretation of that language puts a prohibition against advocating or perverting any sort of gun control it didn't prohibit us from doing research on firearms and violence in public health issue with a request

for application on the consequences of violence and particularly firearm violence put up by the national institute of the call abuse and addiction we have funded grants under means restrictions how to assess risk with a suicide attempt one grant is to understand their access and the best way to deal with that with projects of pathways looking at people who were concerned having access to weapons and if there is of great to put a scientific understanding on

who is most likely to get into trouble? and in a word is entirely a public health issue that is in the sweet spot to understand how science can save lives. >> so you're telling me see date -- cdc is caught by the ban but nih has found ways to work around it so you are still conducting some research? >> i will not speak for the cdc but certainly at nih we're doing the work trying to serve the public. >> game grateful for the direction that you're trying to go but congress would

watch people die by gun violence in refused to take action is irresponsible and a sellout to the bill and lobby but to follow that up with congressional inaction to underfur and mental health research in refusing to support research to help us reduce gun violence to improve the mental health system loses congress from irresponsible to culpable. it is tearing apart of families in communities. >> thanks to the panelists to discuss a very important issue i have been appreciation of the impact

of the mass violence around the country we're looking for ways to help reduce the impact they give for the, - - progress being made in the highly did earlier -- highlighted earlier the local and county jails frankly 20,000 are incarcerated in the least 3,000 have been diagnosed some studies suggest it could be to read three times higher so we're finding folks incarcerated not because they have the crime but the mental illness is the primary reason. that is something we must address in one of the most expensive ways to have people lose their freedom. dr., you probably know those

chronic mental illness cases that by age 14 half of pieces that three-quarters of those have been done with early intervention if they and instead what science to look for. can you comment how you remove that stigma? then we have had great success to deal with physical illnesses because we have the ability to put a major spotlight to reduce those challenges a appreciate your service to

nih as well. >> a wish this was easy to answer in the other areas who don't have the legacy that we do here in which it is considered a moral failing horribly and families or that explanation is that your mother or father did this to you so not surprising they have not been at the forefront to turn the tide. the future is around better education or better science people need to understand this is like any other disorder like most industry in a star in the young people and makes the more

touching that we don't do enough to grapple early to give them the support that they need to understand their real disorders with real treatments but they're not getting to the people that need them. >> thank you for your work to help so many veterans especially in the rural areas of our states to spend a lot of time to focus on the issue the military faces with the importance to have a sense of urgency and according to reports those areas that are underserved as that panacea had you seen

any other innovations that is challenging for some of the rural areas in states like south carolina? the think the challenge is that we face to appreciate any new opportunities for telemedicine. >>. >> that is what we are also looking beyond that with those providers in the community that needs assistance one of the projects is called project echo where we bring together academia to bring together different communities to

basically bring cases for word to talk to someone who has more expertise and they can use that information to provide more care. we're definitely looking at other types of technologies also into meet the needs into rural communities almost 40 percent so it is a combination of physical presence with those that might need that extra support with that project echo model. >> with the number of ptsd cases have you found fell level of awareness and

interest in mental health issues has risen substantially? >> absolutely working closely with the v.a. or the veterans choice act to increase the capacity of some of to treat people with ptsd we have worked with them on a curriculum. >>. >> it access to insurance coverage but also the affordable care act. with high-quality treatment

options but i want to lick eating disorders. i hear from countless people who share their stories relating to seeking treatment and in some cases after a couple of days of residential care with the general psychiatric hospital where the professionals treat the background about eating disorders.

with the number of colleagues to introduced the west in an act that avis to improve care for those with eating disorders that the mental health parity include coverage for residential treatment services. i wonder if you can speak to the consequences which insurance companies fail to treat with eating disorders with appropriate care settings by professionals in town you what your respective agencies are doing for a comprehensive treatment and access for those suffering from eating

disorders. and then also the state of the science. >> 84 the question because so many don't understand eating disorders have the highest mortality rates and start very early in life so that is resulting in average outcome to affect -- a tragic outcome affecting families from the department of labor to improve compliance as well as coverage for mental disorders including eating disorders where we develop

informational materials with the primary integration as well as insure they are carrying for the whole person. >> we have two programs focusing on work force training that increases the capacity to identify it provide additional treatment and support and we can share that with you if it is helpful but it is a concern. >> let me continue, the adolescent act that would award grants to train primary-care physicians on early identification and

intervention of eating disorders in how to properly refer a patient, is sadly as noted those individuals suffering are facing very high risk. the risk of a person with an eating disorder more likely to attempt suicide or engage in self injury in addition to the physical impact of struggling with the eating disorder. what more can we do to increase awareness of the mental illnesses among individuals?

and this certainly invite a conversation of the current state of science on this issue. >> yes people have higher rates of conditions as well as substance abuse and self injuries of their complicated to treat and manage in there is some specific guidance to improve skills and knowledge in this area unfortunately we don't currently have any funding dedicated to improving were raised the floor around eating disorders and is an area for potential growth. >> the good news there is the treatment called family focus there be that is the opposite of typically we have taken parents out of the scene but today between

the parents to make them the focus in the remission rates are 50% after two years ago adolescence this is a good story but the bad news very few people trained to provide that there be with the features that seem to be most effective so there is more we need to do to get the work force. >> thanks to the three witnesses for the testimony. do you have any concluding remarks? >> i appreciate this hearing in the think we're all learning as we go into a forward to make sure we're making the health care system working for everyone we have to include mental health care. >> i appreciate the

attendance of all committee members today we may try to have another hearing before the end of the year i will talk with members of the committee how to do that. the record will remain open 10 days to submit additional information for the record the next hearing exploring issues of mental pope will be open uaw's thursday november 19. thank you for being here today. we are richard adjourned. [inaudible conversations] ion.

mr. mcconnell: mr. president, i said the senate would take up the fiscal agreement after the house acted, a we are. house acted, a we are. >> mr. president taking the fiscal agreement it isn't ful perfect guy sure concerns but here is the bottom line is a fully offset agreementprov that rejects tax hikes to time secure long-term savings to entitlement reform in support for the military repu when we confront threats ingoti. multiple theaters in each of w these items head into the t negotiation each of these m can be achieved in the agreement before us i am billi encouraged that since 1983 moref

resulting in $168 million inged long-term savings i'mur ccouraged it is for what our troops desperately need with a challenging and a global threat. when isis is consolidating gains in iraq and syria in into seek the militia the choice that they make when it comes up for vote there are valid differences of opinion and that is okay. but also as to ask what that full offset agreement will mean to voluntarily put themselves in harm's way. commanders tell us the additional resources are required to ensure safety

and prepared this this fully offset agreement, along with social security reform over three decades in repealing another piece of obamacare from i hopes senators will join me. allow me to say a few words. there is a lot you can say about john boehner. he loves his breakfast every morning at pete's diner and a fan in one of the most genuine guys you'll ever meet. i know because we have fought many battles together in the trenches he never breaks his word, he never buckles and what is amazing

how we have had no friction relationship with you consider the their party is just the opposition but the senate is the enemy that may have been true of the past but not press. although you may not expect it by-election and henry clay he sings another some bio is considered an ally and friend. it is hard not to like him and in my ear when he has accomplished in his career. as a concerned about ohio he took on the scandal-plagued incumbent and one injured on

money laundering schemes and banking scandals and prevailed. as an engineer of a contract with america he to upon democrats and he triumphed. as the next number of leadership was considered dead he thought he had more to offer in convinced his colleagues that he did. inheriting the dispirited house minority he dared to believe conservatives could rise again to help grow the largest republican majority since flappers were dancing the charleston in the '20s. john peter has wandered the valley and is also been to the mountaintop. john boehner has slid back into the valley then

ascended to great heights once again. he does it hard work and honesty i have always admired. when he talks about struggling to make it is not a platitude he is choked up about america reaching for their dreams. he had to share a bathroom with the 11 brothers and sisters. his parents slept on a pullout sofa. he worked hard behind the bar and eventually found his way on top. maybe that is why he is so humble or why when he orders breakfast bagel call him mr. speaker they call him john john.

here is what i knew about speaker john boehner. he says the code he lives by is simple. do the right thing for the right reasons and the right things will happen. i have always found that to be true i find that in our battles to fight side by side from a position deep in the minority. we have had our share of moments for sure but he always would push for word. the date he announced his retirement, grace under pressure country and the institution before self is what come to mind when they think of him.

i wish him the very best in retirement and always working hard to do the right thing for his family, his district, his party, his country. farewell, my friend. we bid farewell to one speaker today we will say hello to anyone the house will vote later this morning on the nomination of congressman paul ryan. the think it is appropriate to wait for that vote to occur before we give full comment fed it goes without saying he is one of the most respected guy is a round here he is smart everyone knows he is serious in their look forward to work closely with him to share a conservative solutions for our country. mr. president and stand there is a bill at the desk to do a second reading.

>> declare'' read the title of the bill for the second time. >> beecher 597 neck to reauthorize the export import data of the united states and for other purposes. >> i object to further proceedings. >> the objection has not been heard. >>. >> last night the house passed a bipartisan agreement to keep the government funded and free from default would have to percent of the democrats voted for this 68 percent of republicans voted against it. let's pause to understand what i just said. 60% of the republicans voted to default on the full faith and credit of our country

and to close our government. the legislation now before the senate it isn't perfect as the leader said no legislation is but a this has two major priorities it promotes economic growth from sequestration for two years insurers invest equally in the middle class. the budget agreement is good for the middle-class those that work so hard to make this agreement what it is today speaker boehner and mitch mcconnell, i applied

-- applied and he was resolute and very smart. with the good work that he did to get as to where we are now. but to reach these negotiations we had discussions directly with each other and we also know that a lot of the work was done by our staff. my chief of staff was part of these negotiations the caucus is aware of whose expertise and hard work helped us. the democratic floor leader who was indispensable s.c. number of people on my a team who helped a great deal.

and all think anyone in the senate does not know if she is and she is the health care expert. bruce, helen, tyler, george, alex in the bill who all work literally night in day so we could be here today seeking support. mr. president iso grateful for the wonderful staff that i have the senator mcconnell said negotiator was hazel. a good person, resolute to carry for word what the leader wanted you never get exactly but you want and david stewart was speaker

breeders' negotiator on this we also admire the work he has done and i hope paul ryan will use him. leader policy negotiator i does want to say a word about speaker pelosi. i so admire this woman. she is a stalwart in the house of representatives will go down in history is one of the great leaders of that body. wiedmaier her and appreciate her friendship and extend to

anyone within the sound of my voice my appreciation for the work she did on this bill. with the white house i have already indicated to the president but also i cannot state -- say enough about these two people. the white house negotiators cady is a woman that we all know in the senate. she worked for the democratic policy committee for a number of years if she was so helpful for everything in this legislation. so mr. president it is time for the legislation to pass the united states senate. i just one to say a few

words about speaker boehner. i have to read it i was skeptical when he said he wanted to clean out the barn before he left but he found out a way. with a two-year budget agreement that will go a long way to return the appropriation process the way it should work. i will always consider him my friend and i will miss him and wish him the very best pearlescent to his final remarks on the house floor. they were very moving it wasn't only jim nash said the tear today. mr. president there is a lot of talk about the appropriations process. i have been the appropriators since i was a

brand new senator many decades ago to be on the appropriations committee. that work is not as as used to be. . . bills. we need to understand there's a time and place for doing that. there's authorization. do the bills, authorize stuff. but don't mess up the appropriations process. we will be happy to support next year individual appropriations bills coming to the floor. we don't need motions to proceed. we'll be happy to move the bill as long as we get rid of those vexatious riders that have nothing to do with the bill brought before us. we don't need on a defense appropriations bill something to do with women's health in the sense of directly attacking planned parenthood.

we don't need on commerce, state, justice something dealing with doing away the environmental protection agency. there are many examples that we could use. but let's just get to doing appropriations bills the way we used to. i want to do that. we don't need to have a motion to proceed as long as my republican colleagues get rid of republican colleagues get rid of get rid of the foolish ideological rumors that have nothing to do with the bill for us. >> in the senate is expected to gavel back and momentarily working on legislation dealing with the budget and debt ceiling, an agreement between republicans and democrats with the house passed yesterday. mitch mcconnell hopes for a final passage but later tonight, expected to take up procedural vote at 1:00 a.m. eastern time, two-year budget proposal that includes raising the debt ceiling through 2017.