[applause] [music] >> tonight on c-span2, today's meeting of the national governors association including remarks by senator charles grassley. later, an oversight hearing on federal grants for local counter terrorism programs. governors from across the country are meeting in des moines, iowa. gary herbert and vice chair terry mcauliffe held a news conference at the start of the conference joined by iowa's governor terry branstad.

>> we will go ahead and get started. i am scott madison, the executive director of the national governors association. feel free to take your seats. welcome. this is the 108th summer meeting of the national governors associati association and taking place with the backdrop of a lot of serious issues across the nation and world and of course two major party conventions taking place in the next couple weeks. i am happy to introduce the chairman of the national governors association from utah, governor branstad and we have the vice chairman, governor mcauliffe from virginia and the host, the longest serving

governor in the mystery of the united states terry branstad. we are happy to have him. [applause] >> and now, it is funny, people say the meeting is going great so far and i say it is good laws of governor branstad. i am turn it over to david yepsen and many of you probably know david. heavy has been with the des moines register and on public television in different capacities and now he is head of the paul simon public policy institute at the southern illinois university and hails from jefferson, iowa. i will turn it over to david. thank you very much. >> thank you, scott. [applause] >> before we get started, i would like to turn it over to the host government for opening comment or two. >> david, thank you.

i want to welcome all of you to iowa. scott said this was the 108th meeting of the governor and i have only been to 21 of them. i want to thank the committee that put this together. jay buyers with the greater des moines partnership, paula field who is the mayor of johnsonton and the person who runs the iowa office in d.c. they deserve the credit for puts this great plan for the governor's conference together. we are delighted to have you. his used to be the old bets auditorium. i watched many basketball tournaments and wrestling meets here. i cannot believe how it has been transformed. it is a beautiful facility. we had our inauguration, last inauguration here, and we have a lot of wonderful events and conventions. you may notice there is a

convention hotel being built next door. a lot of activity, a lot of construction going on in des moines. it is a wonderful time to be able to host you. i would like to say the weather is always like this in july in iowa but you may find that not to be exactly accurate. we are excited and proud to host. this is the second time des moines has had the national governors association here. the last time was in 2005 but things have happened since. we have the sculpture garden and this facility and the wells fargo arena next door. tremendous construction going on in east village. so we hope you enjoy your time here. we think it is going to be a wonderful opportunity for the governors it share ideas and learn from each other and focus on issues that are important to

our country and people. thank you. >> thanks, governor. welcome to our guests. governor mcauliffe is no stranger to iowa. >> been here a lot. >> i might have a question about that. what i would like to do is you all are talking about special initiatives in your states. so i would like to spend time off the bat talking about each one of those initiatives and asking you questions about that. this is, being an election year, this is iowa so i have political questions and then we will throw it open to the media questions. sound all right? >> yeah. >> governor herbert, starting with you. you have an initiative fighting poverty in your state. how is that effort different from things that have been done in your state and other states to fight poverty?

>> thank you, david. let me thank governor branstad for the hosting of our national governors association conference here and giving us the opportunity to come to iowa when you are not running for president. we have a chance to enjoy your hospitality and your wonderful facility and larry hogan from maryland is here as well. nice to have you with us. i think one of the opportunities we have with the national governors association is to highlight the successes of the states because the respective states are doing really wonderful, good things. they are getting things done, solving people's problems and improving people's lives and that is what this whole initiative we have is about. on poverty, which is a big issue for all of us, in utah we have a successful economic growth taking place. maybe the best in the nation. >> one of the best. >> and we are grateful for that

but we know there are people still struggling. there are people that are left out and generational poverty, intergenerational poverty is a big issue. we decided it is not a one-size-fits-all approach when you talk about poverty. there is situational poverty where somebody has maybe a medical condition or event that happens in their life that causes them to become impoverished. intergenerational poverty is generation after generation and habitual and bad processes and over the grandparents, parents and now the children are trapped in poverty. we are trying to break that cycle. we are addressing it by understanding one that it is unique and we need to address the underlying causes. we are collecting data and can

identify -- we have 29 counties and 10 countries are more prone to poverty. we have families and analyze their standing, economic wellbeing and education. with the children, are they prepared to go to kindergarten? getting a good education? education is the key to breaking the cycle. we collect that data and put programs in place with mentoring and coaching that help those unique families so they can break that intergenerational poverty. we then collaborate in ways that has never been done before with the governor's office, our legislature, our different agencies whether it is workforce services, the juvenile courts, local government. and that coordinated effort is helping families lift themselves and break that intergenerational cycle of poverty and the results

are impressive. utah's poverty rate is one third below the national average and youth poverty rate is 50% lower than the national average. we are on to something that is good and would like to share with the rest of the nation. >> do you think -- right now in america, big problem with income inequality. i don't know anybody that is happy with the fight against poverty on either the left or the right. there are a lot of criticisms made in the way we are trying to combat this in society. do you think you found a sweet spot that might work for other states? or is this just only going to work in utah? >> i think most of us as governors in the respective states recognize that the concept of a one-size-fits-all doesn't work. all states are different. we have different cultures, regions and politics. you need something that works

were for your respective state but the principles are similar. education is key, making sure everybody has an opportunity. focusing on the children. sometimes it is too late for the grandparents to change and be retooled or better education skills to get a better job. but for the young people it is not. i think the focus of all elected officials ought to be in growing a healthy economy, the best thing we can do for those who are impoverished is give them a job. not just a government handout. let's give them assistance but find a way for them to help themselves. i think the human spirit is the desire to pay your own way and support yourself. we are trying to give skills to the rising generation and i think all states can share that. respective regional differences

and what works in utah may not work in virginia or in this great state of iowa. i think there needs to be flexibility. >> thank you. governor mcauliffe, cybersecurity. strikes me as an odd thing for state government to attack. what can states do that the federal government and private industry are not already doing? >> very important question. let me first always thank governor branstad and the first lady for a spectacular reception at your beautiful capitol. it is great to be here and i have seen you many times. david, i was here in january and took a picture in front of the bank sign, minus 25 below 0. so i appreciate the beautiful weather we are enjoying. on a serious note, our thoughts go out to all of the folks in france who lost their lives and the people injured. i see john bell edwards from louisiana who went through difficult issues down there.

big issue, like a lot of it, comes back to security and national security and what we need to do. the states are more important or as important as the federal government because most of the data on an individual is kept at the state level. our health care records and state tax records. the states are very important. my initiative i will announce tomorrow is all about cybersecurity. it doesn't matter if you are democrat or republican, as a governor, your responsibility is to keep your citizens safe. we need to make sure we are protecting their data, we have to protect our businesses, and personal information. in virginia, we have had sense january 1st, 53 million cyber attacks. that is four cyber attacks -- 300,000 a day. 131 turned out to be very cease area.

we botched 4,000 malware attempts on citizens. we need to be out front. in virginia and maryland we have important assets in our state and are constantly under attack. our initiative, and we were the first to put up framework and i want all states to learn what we did to put together the framework to make sure you are doing everything you can to stop these cyber attacks. it can destroy business -- look at anthem. one of the largest breaches in the country. saw what happened at opm. and talk to target about the damage it did to their business. the states i would argue are at the forefront. we had the governor meetings

with the governors who are appointed to meet with dhs and we have an agreement about information sharing with the federal government, with the states, to our guard to make sure we are protecting our citizens. >> with the exception of change encouraging me to change my password what can a governor do that is different than what the federal government is doing. give us specific examples. you mentioned things changed. give us specific examples >> you will hear from one of the chesterfield county folks who are here on the technology front and he and our state guard went into the localities to do a deep dive on their own protections. >> the national guard? >> our state guard with the department of homeland are going into localities and doing a deep dive on their cyber aspects.

it is frightening what we found at the local level. the data is not protected. you can bring in the most sophisticat sophisticated technology. we are the first state with every vendor has it setup where no one can commit fraud. every card was the first one out with the chip technology. you cannot do business with virginia without the chip technology. there is a lot of things you can do. and obviously most importantly is working with the federal government to make sure you are bringing in everything you need to protect it. but it is also the job creation. 209,000 jobs are open in cybersecurity. i tell every parent starting pay is $88,000. i am forfitting the pay role.

code writing and such are the jobs of the future. i have 656 cyber companies. got home from israel and announced a major deal that will bring an israeli cyber defense company to bring their center to virginia. >> any progress in the whole issue of ransom wear? businesses are being attacked by this and paying ransoms in bitcoin to get their data back. any progress on that? >> that is the federal and the fbi talked about at the winter meeting what we need to do in that regard. 53 million attacks in virginia. every governor can have the same data. we are not unique. we need to make sure we are -- and what i will do and hand out tomorrow -- is all of the steps we have done to protect companies and citizens. we have the most data at the

state level. our health care system. >> governor branstad, you talk about veterans and project home base trying to find jobs for veterans. tell us a little bit about that effort. >> i am very proud to say in 2014, the iowa legislature passed our home base iowa initiative. it passed with strong bipartisan support. i appointed leonard boswell and maybe -- bob myer who lead the effort. they are both retired colonels from the military and have done a great job. we have placeded over 2,350 veterans in good jobs, elum have a credit for veterans who purchase homes in our state.

and green counties was the first home base county in the state of iowa and now we have 40 home base communities that are counties and cities in some cases. we are 19 of our universities and colleges that have become champions and certified as college and universities that are really doing all they can to help veterans. we offer in-state tuition whether from iowa or not for veterans, spouses and dependents to go to our state universities or community colleges. we are excited about the way it is taking off. i signed the bill at camp dodge in the gold star museum on memorial day of 2014 in my uniform. i am proud of that. i got out of the service in '71 and proud to be able to still get into it. but i am excited about the tremendous bipartisan support this program has received and

the difference it made. at the planning session we will hear from one of those iowa veterans who through home base iowa. >> wouldn't they have gotten jobs anyway? >> some might have. but by having coordination and a direct effort made using the opportunity through the internet to communicate to people coming out of the military about the jobs available in iowa and having these job fairs and all of that i think we dramatically increased in terms of the employers. every member of the iowa business council is a home based business and so we have home base businesses all over the state, thousands of them, and so the collaboration and coordination and the community involvement, all of that is making a real difference. making veterans feel welcome and obvio obviously iowa is a relatively low-cost to live and we have

employers saying we need people with these skills and we can't find them. but people are coming out of the military and i know the reduction going on in the federal military and we want to get as many of those talented people as we can to locate in iowa. so far it is off to a great start. >> a lot of veterans come out of service with problems. do you find they have difficulty finding jobs because employers are weary of hiring veterans? >> unfortunately the unemployment rate among veterans is relatively high in this country. i am proud to say in iowa it is much lower. general tim moore put together a program for all veterans to assist veterans that have problems and issues. one of the things i think that really makes a difference is if a veteran feels welcod and supported by business workers and communities that makes a difference in dealing with the issues they have from the experience they have from

serving. we have challenges but i feel really good about the way it is being addressed in the state. >> just an open question to all of you. it strikes me on each problem a governor does something just by using the bully pulpit and putting the focus on it. focusing on cybersecurity or veterans or intergenerational poverty. is that right? are there other ways governors can use the bully pulpit to push public policy along? >> the bully pulpit is one thing to generate public support. we do represent the public and the issues out there. but it is also more than just a bully pulpit. it is about working with different agencies. bringing people together with different points of view and saying can we come together and compromise and worth together.

that is the strength the governors have, bringing the legislature together, public private partnerships. i know on the veteran's issue we took it on as a need and worked with schools and said when the veterans come back from military service they have skills and should be getting credit for those skills. i was trained as a surveyor and today if you come back to utah you can go to flight technology college and get a certificate and be a licensed surveyor because of the training i got in the army and not have to go through additional schooling. that is the schools, working with the government, veterans, private sector, and utah has ruls of an unemployment rate for veterans below 3%. -- results. >> governor mcauliffe, other examples in virginia where you can use the bully pulpit and

focus attention on specific problems? >> at the end of the day, people expect you to keep the economy safe and grow the economy. i have a very republican legislature. lots of tea party members in the virginia legislature and my general assembly and house of delegates i have 66-100 republican. we just had the biggest surplus in history. i got 90% of what i wanted in the budget. you have to work together in a bipartisan way to get it done. there are times, david, sometimes unfortunately partisan politics gets in the way and you have to take your action. as governor, you have to move forward. i am aggressive on executive orders. virginia governor is a powerful governor. you only get one term but a powerful governor. i have done 71 vetoes and haven't been overridden yet. i have been out front on the veteran's issues.

very important. we transitioned s15,000 a year and have 27 military bases. every employer says get me a veteran. i can hire every veteran i get. with the young workforce they think not showing up for work on friday is how life it. you have a four-day workweek. that is not how it was for any of us. you work five days a week and you get paid for five days a week. we moved ahead and are the first state to end veteran homelessness and are proud of that. i just restored 206,000 felons and 40 states did it already. we have a bad history in virginia since 1902 of racial disinfranchisement. you would have thought i burned

the capitol down. i did what 40 states did already and it was the right thing to do. at the end of the day the governors have to produce. we don't have filibusters and can't kick the can to the next day. we have to act every day. >> i am reminded of something former governor pete du pont said and that is a governor can do anything he wants but can't do everything we wants. today you might say he or she. >> he is absolutely right. pete du pont was governor when i came in and that was the piece of advice he gave me and many others. we tried to do that. you mead to focus. -- need. you cannot try to do 40 things. focus on maybe two or three key priorities each year.

2014, it was home base iowa. 2013, we focused on education reform and property tax relief. this year, we were able to get action on our bio chemical tax credit. we are the first state in the country to have it and think it could be the next generation of products made from corn replacing petroleum chemical products which are better for the environment, create jobs and increase income for iowa farmers. that is what is key. you just can't try to do everything or you are likely to not get much done. if you focus on those and spend your time and the bully pull-foot and your effort and you go out to motivate grass root support that can improve your chance of getting to the legislature. especially if you are like governor mcauliffe or me, most of the time i have been governor, the other party

controlled either both houses or one house in the legislature so you don't get anything done if you don't get bipartisan support. >> let me mention, i think terry said something correctly and as a governor you cannot kick the can down the road. other than governor branstad we are here for a limited period of time. you have to concentrate and focus on whatever the issues that are here today. you campaign and say if i am elected i will do this and this so there is pressure to get it in in four, eight maybe 12 years. that is unique with governments. the fact in our 50 states and five territoryies governors are getting things done. they bring people together and

get it done. the states are in fact producing great results in this country today at a time when washington, d.c. seems to be dysfunctional and that is because of the work of the government and legislatures and whether that is opposite parties or divided inside their own party. we have a unique circumstances but governors and states are getting it done today as well as any time in our country's history. >> i just came from a bipartisan press conference to support ttp. democrats and republicans, unfortunately this has been a horrible partisan issue in the presidential election. unfortunately, a lot of rhetoric has been out there. but for the three of us up there it is about jobs. if we don't get the ttp done china will write the rules and agriculture is a huge part of business and we have to keep the markets open. we all came together, keep the presidential politics out of

this, and we have to do what is in our best interest. 39 billion in exports last year and will you close the window to the 11 nations around the globe? it makes no sense. >> in both political parties there is a lot of animosity toward the ttp. what do you say to republicans who are concerned about tpp? >> it is very important to iowa. 50% of echo's business is export and they do business all over the world. a lot of them with the countries that will be part of tpp. we are a major agricultural producing state. it is important to all of our agricultural producers. so it is not perfect. we need to continue and i except some constructive criticism that maybe we can do better. but let's continue to build on breaking down these barriers and

opening up markets and we do that we benefit, we create jobs, and we grow farm income and that is a positive thing and why i am a strong supporter of free trade and the tpp. >> governor herbert, what do you say to republicans who are concerned? >> it is frustrating to us whether it is democrat or republican. there are concerns in a bipartisan way. i don't understand why we can't sit down and come together with a compromise to move forward. our state is into international trade. in utah we speak 130 languages and our international trade is growing exponentially.

93% of customers for america are outside of america. it is a global marketplace and we need to find ways to interact with each other and the world. as we do, we will foster better relationships and bring about more world peace and understanding and harmony that comes with economic trade. it is important on many levels. we would call upon those fighting this, on both sides of the aisle, to come together and let's find a compromise and move ahead. we don't need the can kicked down the road for the next number of months or years. the president has been on board, many republicans are on board, let bring everybody together on this. >> governor mcauliffe, very touch issue in your party. >> very tough issue. >> what do you say? >> at the end of the day, the governors are responsible in

your state, are the chief job creators. we are responsible. if unemployment goes up or down you either get the credit or the blame. nobody in congress. it falls upon us. i look as this as a job creating activity. what i said to the democrats, and the rhetoric in this presidential campaign has just been so over the top. everyone for their own personal believe trade is why they don't have a job. it is a big complex issue. you cannot blame china, korea and others for taking our jobs. i tell everybody. you get a trade deal and negotiate out the environmental pieces and make sure labor is protected which they have done with the tpp, you give us a fair agreement. i tell you i will go against china and japan and korea and we will beat them. this agreement is working toward

that but putting our heads in the sand saying we will not compete we are doing a disservice to the citizens who elected us to create jobs. let the metrics speak to themselves. our trade is growing. but the biggest factor is if we don't do this, and encapsulated, china will write the rules for the 11 nations and we will be left out. >> the national conventions are starting next we're, this is iowa, i have two battleground states governors here, virginia and iowa and some reports are say utah could be at play. i would like to ask you to put your political hats on and what is the handicapped in virginia governor mcauliffe? >> most polls have hillary up about 68 points. i feel confidant we will win the state. president obama was the first

democrat to win virginia since 1964 and won it twice. the message of job creation, economic development, and i think she is in a very strong position. she will be a little stronger if she would take my advice and take our junior senator to be her vice presidential candidate. takes a lot of pressure off me. >> you know, i got to know you in 2008, you spent a lot of time campaigning for hillary clinton in iowa. she lost. this cycle you were not able to spend as much time in iowa and he -- she won. >> i went to every county if you remember. i visited every county. i got to four this time and that is why i think she won. >> governor herbert, is utah in play? >> i don't think it is in terms

of electing a democrat. it is a pretty big red state. we have a large unaffiliated group that is persuadable. the latest polls show mr. trump up 6-9 points in utah. once we get through the cycle, i think it is hard to conceive utah wouldn't go republican particularly if mr. trump picks a governor as part of the ticket as vice president. we will have to wait and see and i know they referred to the announcement that will happen today. i am hopeful it a governor he picked for the vp. i think it will help him. >> governor branstad, what is your take in iowa?

>> i am sure we will see more activity between now and election day. the polls show it going either way in iowa. i is seen polls showing hillary up by one or two points and polls showing trump up by one or two. we are benefiting with senator grassley as you know. grassley has not missed a vote in 20 years he goes to every county every year and works extraordinarily hard. he has $5 million in the bank. i think he will be a strong help to the republican ticket. is we have a great chance to win the senate. we have great candidates working hard and going door to door and raising money. iowa is competitive and i will

do my part to help trump carry the state. my son eric was in cleveland with the rules committee and that went well. so, i agree with governor herbert, having a republican governor on the ticket would be helpful. i think governors are problem-solvers. >> i could talk politics with the three of you all day long but i am out of time and have to turn it over to you governor herbert. they have asked me to have all of the governors here to now step up to the podium, the three of you, and field questions from the audience. governor herbert, you will call on the questions.

>> i don't know if you need this here. >> so again, we are honored to be here as we begin our national governors association conference. again, our initiative we have had this year for the governors is in fact states solving problems and improving people's life. each state we highlight will have publications to put out and web pages showing the great successes the states are in fact having. again, it gives me hope, frankly, and i think for a lot of people in their respective states seethi -- see things improving because of the work of the governors. we are trying to get washington to do more issues and solve problems than they are capable when it should be left to the e respected states.

if there are any questions you have for any of us we are more than happy to field the questions. >> talking about tpp, could you express briefly the opinions you shared there? >> sure. well, in louisiana we have the largest port complex in the country and one of the largest in the world. so in addition to the manufacturers and farm products we produce in louisiana we are looking to export we are also facilitating the export of products from across the country including agricultural products here from iowa. it is a big deal for louisiana especially in light of the panama canal being expanded so we will have larger vessels. we have an opportunity to capture more of the market. but this partnership needs to be ratified so we can take advantage of it. those were the sentiments i

expressed this morning. it is about economic and job creation in louisiana and a way that shows the interdependence of the state and also of the world. i am mindful that 95% of the people we want to sell services and goods to don't live in the united states. we have to have that access. thank you for the question. >> we have been joined by the governor of puerto rico. buenes dias. any other questions? [inaudible question] >> we see terrorism has taken place and we will have a little report on that in the governors-only meeting and see what we can learn. one thing i think we all understand is the public safety is really not a partisan issue.

the important and appropriate and proper role of government is to keep us safe. and i know our governors are taking that seriously. would any of you like to speak about your issues? >> i mentioned that governor dayton was intending to be here and because of the problems he had in minnesota he canceled at the last minute. governors take this responsibility seriously. governor sand ball was here yesterday. he went back to nevada because a bombing occurred -- not terrorist related activity but it was a bombing that killed one person, the perpetrator died, but several homes were damaged in a small town in northern nevada. my advice to a governor is whenever you have an incident, be it a natural disaster, or something that happens, it is important for the governor to be

there to reassure the people and support the local authorities as well as the others in law enforcement that are protecting the safety. in iowa, we are blessed to have a great public safety department and many wonderful local law enforcement people are providing services to us for this nga meeting we are hosting. i want to say how much i personally appreciate and respect all of those people that risk their lives to protect our safety and wellbeing. i am honored and blessed to live in one of the safest states in the country. next question? >> i would like to make a

comment about medicare and the fraud abuse and issues you are working on. >> medicaid fraud, waste and abuse comments? >> in louisiana on january 12th, we expanded the medicaid program. we used the existing framework to expand the program where we have manage care organizations that are ministering. we don't do the traditional fee for service. by doing that, we have transferred the risk of loss associated with fraud, waste and abuse away from the state and to the manage care organizations in that business. so we have that member per month we are paying for coverage and we transferred that risk to a very large degree and i believe it is working in louisiana. it is one of the ways that we were able to gain so much support in the legislature and the state as a whole to demonstrate we are not doing the traditional fee per service.

it is being minimized and where it does exist it isn't coming at the taxpayer's expense. >> in utah we created an inspector general's office with the primary focus of reviewing medicaid to see if there is fraud, waste and abuse. the fact we have someone's primarily responsibility to review this added to the efficiencies so there is not waste. we don't see a lot of fraud in utah but there is a watch dog taking a hard look and that probably helps prohibit and prevent fraud and certainly making us be more careful with the dollar so there is less waste. any other questions? >> anyone feel compelled? we have a great program lined up today and tomorrow. we have governors -- did i lose

the microphone? i know how it is in iowa now. we are honored to be here in iowa and again the national governors association which is a bipartisan group bringing people together, solving problems in a bipartisan way. i think you will find this association is a good example of how it ought to be. we hope that others particularly in washington, d.c. will look at us as maybe a good example of how we can work together. again, we don't all see things the same way but have mutual respect and learn from each other. we are the laboratories of democracy. we are a little pilot programs going on and trying to experiment and learning from each other. we steal from the best. we modify and adjust but it is a wonderful system the founding

fathers createded with this united states of america. -- created. i am honored to be chairing with these wonderful men and women who are leading in a profound way during this difficult time. we look forward to starting our first session in about ten minutes. thank you. [applause] >> in this part of the nag sum national governors association summer meeting, they discuss information technology, finance and employment.

john hawk berry moderates the are 45 minute discussion. >> please be seated. >> let me, as chairman, welcome you all to the open session for the 2016 national governors association summer meetings. we are honored to be here in des moines, iowa and appreciate the opportunity to gather together and talk about important issues facing our states and the nation.

certainly want to thank simon estee who just gave us that wonderful rendition of the national anthem. please give simon a round of applause for the beautiful performed rendition. it is probably more poignant today as we sing the national anthem and gather together going there have been tragedy and one of our own governors had to go back to nevada to take care of issues there and tragedy that occurred. we know that is part of what happens sometimes on our watch. but as i see what happened in nice, france yesterday and 84 victims there and two americans we know of, the tragedies in baton rouge, louisiana, dallas, texas, and falcon heights,

minnesota and others i think it would be appropriate to pause and recognize our thoughts and prayers are with these people and their neighbors, friends, and family. we wish them well. let's just take a moment of silence if we can in their behalf. [moment of silence] >> thank you. let me, again, not only welcome but thank you for coming. i know your schedules are busy asgovernors. we apriepreciate you taking timo participate in our summer meetings. we know with not only going on in your states, but it is a presidential election year and things are going on, and we know you are busy and thank you for taking time out of your busy schedule to come and participate in the summer meetings. i want to recognize distinguished guests we have.

let me recognize a few of them. we have from japan, governor he rye, governor day co sake, and ambassador from vietnam and the ambassador from singapore, and senator moore from canada and it is his last time here with us. also recognize we have special guests from the white house in jerry abe and sims. let me recognize our corporate sponsors. we have partners that help us

put this on. for over 30 years the national governors association has partnered with the private sector recognizing that a lot of the work we do impacts the private sector and we appreciate their financial and intellectual contributions to help us understand policy, help us get policy correctly and make sure the marketplace is working as effectively as it can on behalf of our citizens. we appreciate the financial support and appreciate them being here with us today and thank them all. please give a round of applause for our guests and corporate sponsors for making this possible today. [applause] >> i want to recognize our executive director and his staff for the work they are doing to put this on. scott, we appreciate the good hard work you have done and

thank you for your work, too. before i turn time over to our host, governor branstad, i would like to go through -- we need to take some business action here. an adoption of the rules of procedure which is appropriate for us that we have in place for today's activities and so i entertain a motion to proceed and adopt the rules of procedure. is there a second? thank you. any discussion? all those in favor say aye? nay? motion carries and is approved. we have adopted policies for two years at the winter meetings and if anyone has questions please see anna davis at the nga staff and she can go over those with you if you have questions and need clarification. governor branstad, we are

honored to be here in your beautiful state and appreciate your hospitality. it gives us all as governors a chance to visit you in iowa and not have to be running for president is the joke. we are honored to be with you. why don't you come forward and make an official welcome, if you would, terry. >> governor herbert, thank you very much. governor herbert, governor mcauliffe, and fellow governors and guests, we are honored and pleased to welcome you to this 2016 national governors association summer meeting. on behalf of first lady chris branstad and the people of iowa, welcome to the city and hope you enjoy your time here.

we are proud to have this in this convention center which the old vets auditorium and has been renovated and made into a wonderful place to have meetings like this. you may have noticed there is a whole in the ground next door where they will have a convention hotel. a lot of other exciting things going on. i hope all of you enjoyed the reception at our beautiful state capitol building. we started renovating in 1983 and my first 16 years as governor the renovation went on. i am proud to say is done now although one of the rooms had a fire and we have work to do on that. but we certainly hope you enjoyed last night. this is the 21st national governors association summer meeting i have attended but the first i have had the honor of hosting.

i want to thank the nga for their work and the opportunity for governors to come together and we can share ideas with each other and solutions that work in our individual states. i have learned a lot from these meetings over the years and copied some of the great ideas from other great governors. we have a lot of great events ahead of you. we have a taste of des moines at terrace hill and the governors and spouses are invited to that. we hope you will enjoy the local food from the best chefs in the state. we will move to the world prize food in east village to hear the des moines metro opera. the other guests will be there. and tomorrow, in addition to meetings, in the evenings, we will have a special night at the iowa state fairgrounds to experience just a small samp of what iowans get to enjoy when we

have the iowa state fair which was named the best state fair in america. the fairgrounds as well have been totally renovated. there is going to be some of the activities open. not the whole fairgrounds but it should be a great time and enjoyable opportunity and an opportunity to taste a pork chop on a stick and many other iowa specialities we have at the state fair. we look forward to many productive discussions. i want to note things you may have noticed on the first level coming up. we encourage you to stop by and check out the iowa history and innovation pavilion. down there there is information about the caucus history and about iowa's innovative activities going on at our university and other places.

please visit those booths. i would encourage you to sign' and participate in the community service project which is packaging meals for the iowa food banks. this is -- we have a wonderful program where we package meals and help people throughout the world but also to help with people in need here in our own state. on sunday morning several of us are going to be participating in that. we would encourage you and others, the governors and also others that are here for the national governors association, to participate as a way to give back and help people in need here in this state and around the world. again, we are honored and proud to have you in des moines and hope you enjoy this summer meeting of the nga. thank you. [applause] >> thank you, terry.

i thank chris, too, for your hospitality and those involved making this a success for us today. as we start today's opening session, i want to recognize our great vice chair, governor mcauliffe from virginia who has been supportive of my initiative and a great addition to our team here. we appreciate, terry, all that you have done and looking forward to you taking over in a few days. our initiative i started, and hopefully everybody has the cards why passed out, taking about states finding solutions and improving lives as governor branstad talked about states are the innovators. those out there finding the needs of it public they serve and finding ways to solve the problems in usually unique, innovative ways as respective states should do.

it louis barletta a quick year with this being the initiative and it has been encouraging to me as we looked and saw the different things respected states, our 50 states and five territories have accomplished. the motivation behind the initiative is to make sure that the public is aware of the successes of our respective states. you as governors are accomplishing great things. many times in bipartisan ways with the divided states and democratic and republican governors are finding successes throughout the country and dealing with the problems they face in their respective states and sometimes we get lost in the shuffle with the dysfunctionality we see in washington, d.c. so the ability to highlight this makes it important for the public to know.

we have created a book you have at your table that really highlights to a limited extent because there are so many we could have put in here of different examples of what you are doing that really are quite remarkable. ... >> modifications to presenter different cultures, the different politics, but nevertheless this association is networking capabilities, i found my experience as a governor to be very valuable. we found that the policies on the solutions you have come up with have been innovative. they been relevant to the times, they have been good for public policy and good for the public as you, in fact recognizing that

in all we do has to do with people and helping improve people's lives. we have three examples and will have many more for the sake of time under governor branson's leadership have taken a. significantly they have helped transition into trance civilian life and find implement, jobs, and employment economically. it's called the home-based iva program. will learn more about that in a few minutes. virginia virginia mcauliffe has created cyber security team we

have a challenge uniquely so with cyber security. millions of attempts per day on our systems. but i'd also like to hack it in his together the secretary state agencies and with backgrounds to help with and combat that as we have ever more sophisticated cyber security attacks that face all all of us. we will learn more. my state of utah, proud of their efforts not only economically which is a challenge for us to grow the economy, but we also recognize that there's a need for a safety net for those who fall through the cracks for variety of reasons. we addressed, in a positive way and utah what we can do to stop those in poverty particularly intergenerational poverty. we have devised a plan going

forward that seems to be working well. as the results many of the poverty rates and utah are one third lower than the national average which is a significant reduction. our youth poverty is 50% below the national average. we have come up with plans that respect are 29 different counties and state. to address their unique needs we have data collection where we track families and find out what is taking place economically, educationally, healthwise, to healthwise, to see what we can do to intercept. and stop this intergenerational cycle of poverty. in doing so we been at for nader agencies how we have not been before weather is working with education, the the department of health, juvenile courts emma to make sure that particularly the rising generations, we give them the tools to break the intergenerational poverty cycle. we'll hear about that in a few

minutes. i'm proud of the work that we are all doing in our respective states and we could go on about this with the colleagues that we have in the room and highlight many different success stories. i will just conclude and then we'll have panel discussion. on the card we passed out a think it helps us all to remember, again, the states are laboratories of democracy is not by accident, is by design. our founding fathers talked about the united states of america and james madison trying to get the constitution ratified talked about the powers given to this new, stronger government and he said those powers are few and defined. we know them as the in numerator powers in the constitution. he said to the states was this federal government going to take ray our abilities under the articles of confederation and he said not to worry because although the powers designated

to the federal government are few and defined, those given to the states are numerous and indefinite. i think those lines have been blurred over time. i think it's time for us as states to reassert our unique position as states to help solve problems. we are in many ways in better positions, more and ample combo more close to the people, and people, and the ability to act and solve problems is being demonstrated as governors by the success stories you have provided and highlighted in our purple book. i think purple by design that show that this is bipartisan. with that, let me me say that we will have an opportunity to have a little bit more in depth discussion and highlight the successes that were having. to do that we have emmy and peabody award-winning radio host john hockenberry.

were honored to have him here and we have a state solution panel i will talk more about that. let me in and reduce john hockenberry to you here. john has reported from all over the globe, as a journalist throughout his career. he is spoken at design and idea conferences around the world including the ted talk conferences that we know so well. for the past eight years he has hosted the public radio program, the take away on wnyc, america's weekday conversation on news of the day. were fortunate to have him as the moderator of the panel here today to moderate the panel and join with me in welcoming john to the stage. thank you [applause]. also behind me we have the state solution panel it includes livvie shelton from utah, thank you [applause].

, the cio of chesterfield county, virginia. give barry a welcome. and also brian, the veteran home base of iowa here, so we are honored to have all of the special guests year and will turn the time over to mr. hockenberry. thank you. >> it's great to be here. i've been been covering conferences for decades. i go back a long way. not was some of you although many of you have been on my show. governor hutchinson, many of you i spared have on the program. the idea of the takeaways to take news, events that are compelling and have emotional and political significance, contain a certain amount of suspense is good stories do and to think them through so that we have a way of reacting to them that is not purely emotional and

purely brain stem. there is a lot of brainstem in politics these days. i'm sure you are aware that. i think our idea on the take away is to empower people to think a moment and then to talk and to understand conversations are better as a result. in many ways what you're doing here in the state is an example of that. i wanted to reminisce a little bit. i was at the des moines marriott, i remember the old days when governor conley would ride a horse at the meetings of all governors, governors outside of washington, you lose the blue suit and the red tie thing. not so much anymore. but you get people in their actual natural habitat. they actually have an antelope path that you might get him to wear it he shows up. again, things have gotten so

corporate, and every walk in life, certainly in journalism is just the same. i remember mario in the old days used to autograph the bill of rights and highlight places that he said he would've thought of if he was one of the framers. people believed in. and then bill clinton, he was too young to order beer, but branstad would always get it for him, because all of the democrats were scared of him and do not want to do anything for him. but branstad was around back then, and if you believe any of that, but seriously, i think we lose sight of the human elements, the face-to-face element of governance which is the best practice that governor herbert in this panel is about. i have a product of a state initiative, when i had my car accident that resulted in the spinal cord injury that was permanent in the 70s, the

federal options were that you get on social security or ssi and i was in college at the time. and the fed said, here, and that was it. then i would say would say well i would like to get a job in my federal case worker would say will don't do that, you lose the check. and i said i want to get a job and then they said will you lose the check. when that was sort of it. my vocational rehabilitation, state folk rehab counselor had a whole set of ideas. some were really stupid, i studied math in college and folk rehab thought it was may be a good idea to screw nuts onto bolts and count them, folk rehab was still developing at the time, but ultimately ultimately folk rehab paid for my further college education and i kind of

fooled you all because i was studying mathematics, i don't think any of you would've expected at the state level in michigan that i would go on to become a journalist will spend the rest of my career criticizing government and, sorry about that, that, you sorta created a monster. but it's a good kind of monster. as we think about terrorism and we think about the increasing tensions both racially and otherwise in our society, and how politicians are going to have to deal with those and how each of you have had to deal with those that will have to deal with those, it's clear to me that this election may be decided by the extent to which one candidate has thought through what you do when the truck comes to an american city, like it did yesterday and niece. or, the candidate, the candidate that just reacts with the brainstem reaction. because, in a time of crisis and you have seen it all at the state level, whether it is a crisis of burning buildings,

earthquake, hurricane, floods, or financial crisis, or just a finally losing its ability to function to sustain itself, in that crisis it's the helpers that are closest to home that matter most. you are the boss of them as my kids like to say. you you are the ones who directs the individuals who are closest to the crisis and empower them with the autonomy to make decisions to improve their lives. it work for me, and so much of the debate around federal policy comes down to states rights and that's argued before the supreme court. states right is an important historical issue throughout history. we cannot allow that to be a wedge to prevent governance from happening though.

state rights is important in states having the autonomy of the power to do what needs to get done is important, but we cannot allow state rights and arguments over states rights to prevent those faces of the first responders, of of the counselors, of the people who represent governments to americans who are crisis from doing their work. and we have have three of them here with us today. first of all, thank you for commenting, i think that was a sincere applause because you do do the work on the grounds that we say are the best practices that we shall think about when we think of governance. barry, what is it about the state that attracted you to make decisions that affected the rest of your life. >> what is it about the state government and the programs that were available in state government that your great surprise cause you to make some decisions that have changed your life. >> that was my introduction into public service. i spent two years in the

virginia technology agency before i went into local government and public service. it it is my introduction into helping people and getting close to citizens. i've seen resources available at the state how they can help at the local level, that's been very impactful in my career. >> how has the state and local partnership worked in your view? how have you been able to change people to be able to say to them yes, we can help you get from point a to point b. >> we have a saying in chesterfield that we are better together. partnerships partnerships between localities and with the state. so we put a number programs into place, cyber security assessments such as collaborating on other cyber events, collaborating on standards, procurements, procurements and we see the state as a full partner in our mission to make lives better. >> does that mean you actually do stuff or you set up

taskforces to study. >> sometime taskforces actually do stuff, that's true to. >> yes, we do have taskforces and collaborate like that. we actually get actually get things done. we use each other's procurements. we follow each other's recruiting guidance, we collaborate and pass standards on things like information security and information availability. >> the out-of-state policy and how are you to take citizens who are in crisis i move them to a different place. >> in utah i actually feel blessed to be in utah because there is a caring behind all of the policies that we have. we really do want help people. so in my particular program, i have some autonomy to set a schedule that works with the people that i'm working with.

most offices for the department of workforce services are open 8:00 a.m. to 5:00 p.m. i have the ability to go to my customer my participants outside of those hours if i need to and meet them. if you have somebody in your encouraging them to work and then you tell them that they have to work with you between the hours that are usually work hours, it's been easier for me to get to them for the time that suits them so that we can fine ahead for their future. we can can begin to work toward that employment. always the goal is self-sufficiency for people. but some people are starting at a much lower level of the policies have given me the opportunity to work with people at level. >> what a policy is enacted that says were going to create incentives that help you go from welfare to work or on a planet work. and then the numbers may be do not quite work out, the

conclusion at the federal level is often they did not want to work are they actually don't want the program. what you see in reality? >> the reality with most of the people i see is that they do not have the stability to work. they do not have the basic skills in place. they do not have a home. if you don't have a home a home it's really hard to keep a job. you are putting out all of these other fires so my job is to help them learn how to manage those fires so they are not buyers anymore. and and so they see them coming and can maintain employment. >> i can find anybody a job, but having them keep a job is up to them. we have to work on their skill. >> was there a time in your career where you went out of your way to see people after hours that a superior with sethu, your not supposed to be doing that. you're supposed remarking the forms and writing the checks, that's it.

>> there been times where before this program, this program has been really good. start about two years ago. the next generation kids program. before that i was a caseworker working. i did have supervisor who would question the extras that i would want to do. if i wanted to accompany someone to court we have to be very careful that. at the same time this is a 19-year-old girl who's terrified. it's going to going to be huge impact on her whatever happens. so some of those things i had to negotiate carefully and some supervisors are more supportive than other. >> the best practice that comes out of this program and a lot of programs from the country is that we have shifted from an abstract incentive model for moving people from one situation to another to a last mile consultant model. that is what you are. you nor the programs are, you know where the information is. you know what the needs are and you are coaching people to make

that last mile. that is not seen as some kind of charity. that is policy matching. >> that's right. one of the policies on this program in particular that's helping is that my caseload does not shift. i've had had the same people for two years. a lot of time cases will shift because there's a lot of turnover in offices. i'm with these people, whether they work or whether they don't work. i'm helping them stabilize more in terms of their children have that stable foundation and don't end up in the same situation. >> to other state workers in programs like this do the same kind of thing that you do? is there an army of people like you coming down the pipe? i know you have to feel blessed to live in utah. i think it's think it's a condition of utah to feel blessed. thinking about the whole country, is this a skill skill that transfers? i think it does. i been in a lot of webinars and things like that were the two generation approach, which is

the data-driven part of this program that were doing, the two generation approach is successful and i think that filters to other places and helps out. a parent is not an island. when you're trying to get a parent a job and you have a school that's always calling them to come get that child, they don't keep that job very long. >> finally, it seems at the end of the day you actually have, within you a lot of data about the behavior people in real states of economic distress. and that if it went up the changes could be a blunt chill and designing new new policies that would help. is anyone listening to on that update. >> again, i really appreciate that my supervisor and executive director governor have all been very supportive of the work that i've been doing. they hear the success stories that we had. they hear how we are moving people and every success is a

step. we are taking people from intergenerational poverty to self-sufficiency. so every success is a step. they've been very supportive and were moving people for, and other stable enough, another health is stable enough for them to work. now their children are graduated from high school where i had a few who are well behind and actually two sisters who i had just graduate this june because we are able advocate with the schools, get in there and help them. >> and that is something they should be proud of, something you should be proud of, and something the state of utah should be proud of. that is the kind of partnership we like to see. brian let's talk about your story. >> i joined the. >> i join the air force when is 18 years old, i wanted nothing more than to get out of iowa. it took me 24 years of moving around the world to realize this

is where i want to be and raise my children. >> did some really terrible things happen to around the role that caused you to want to be back your? >> it's not being around my family. it was very hard. but then when you leave the military it is very hard. i interviewed for two jobs in my career. then i had to start putting a resume together and translate things from military speak into whatever speak that people understand what i'm saying, i'm a leader and i'm a manager and i can do that. but i'm telling them i'm an intelligence officer and i can can spy on people and there's not a big market in that in the world, not yet. and i don't want to do that anymore. >> so what attracted you about the state and what was that about state programs that were far more responsive than you

ever thought they would be. >> it could not of been easy for me i was in an ever space in omaha to retire there, get a job and stay. or go back to maryland to the national security agency, something like that. but the incentives to move back here were great. the military homebuyers assistance, the pension taxes and all those things, i cannot find a reason not to come home. >> in terms of the partnership were talking about, state and local partnership, what is it that your expertise has been, federally investment expertise, have you been able to use that in the state partnership here and change things on the ground? >> right away i found that the biggest problem that we had in the organization when i took over was information technology. when i worked in national security, the federal government

sent me to get a degree in information technology management. taken those skills paper by the federal government, i'm i'm using the back of the state. >> do you find that when, and again if you want to see really old machines like making textiles, you go to the smithsonian washington, if you want to see really itching computers, computers, you go to state government typically. >> yes. >> so what kinds of changes were you able to make, and how how did you get the message that we can do this, you are empowered to actually make some real changes? >> i'm not sure how to answer this. >> while you're responsible for innovation in information technology. you you have extraordinary degree of autonomy. to do what you do. >> yes. i realize just this week that my boss is saying, okay i'm not gonna make you asked me for permission anymore just beg for forgiveness when he screwed up.

so were doing some great things. i hope to make things better as we say in our organization. were enhancing a lot of violence and that's what i want to do is come back and serve again and with the finance authority, with the finance agency with the state and continue to do good things for people. >> what kind of changes have you made and make the case for me that the state where you work as an innovation center. >> renovation technology. >> the change i've made his been able to explain to people by we are doing things. and you probably understand the people won't listen to you when you say don't use that thumb drive but that's what i'm hoping to be the communicator and help our people, our managers understand why were enacting policies of our return things and help them to build relationships there. >> how far is it to influence change in accounting level. >> how hard.

>> it can be very hard. i think with their talk but is changing culture. so many of the localities have had their culture in virginia, chesterfield virginia chesterfield virginia we better cultures in 1749. these things can be hard to change and it requires communication. it requires a lot of explaining a meeting with people and a lot of putting things in terms that people can relate to. so you have to let the sea of cyber speaking geek speak aside. and you have to put it in people zones terms. >> what kind of power adapters did they use, with a two prong? seriously, when you have a culture that loves the way we have done things for the past 250 years, it is up to the state to come in and say were going to do things differently, sometimes there's real suspicion of the

federal government, but how does the state and local partnership make that change easier do you think in years experience. >> there's not as much suspicion with the state at the local level. i think we tried to stay very close to the state initiatives and know what's coming and be involved. it requires change on both sides. we have seen a lot of change in the way the executive branch has been run in virginia with regards to technology, especially with regards to cyber. the localities are eager for it. they want to be the beneficiaries of this. they're trying to learn and pick up the new processes and the new initiatives. >> there's a lot of discussion on wired magazine and and others that governance and the administrative tech next transaction that takes place at the local level will be the proving ground for a lot of technology in everything from elections to licensing and all

kinds of things we associate is paperwork and for valuing will be barcoded will be a much different transaction. have you thought far ahead on some of the technological potential that exists in the way that you can see it, both you brian. >> is the magic ball kind of question. >> : theory, you could register someone to vote in a nicu, the neonatal intensive care unit they're all set, they turn 19 in the register. >> our society is really move, we move from being formally technology enabled to now being technology dependent. so citizens have an expectation that it's the amazon expectation when they do transaction with government they want a shopping cart and be able take care of all their transactions and in at one time. they want want to be able to register to vote online.

meeting citizen expectations at the local level with technology which is what we spend a great time focusing on. we try not to be on the bleeding edge of technology because he pay price for that in terms of stability. we try to be on the leading edge of the technology. not on the bleeding edge. >> how would you describe that bleeding and versus leading-edge. >> that's a tough question. i'm not sure i understand those mac. >> to see a very different way of transaction transacting information in the future given your knowledge of what capable technology is capable of. >> sometimes is a little scary and thinking that technology is going to go little too far. i don't like that there's too much tracking of people. i would not not pay for anything with a credit card because somebody did

not know one anybody to know where he'd been. i try not to do anything bad so it doesn't really matter to me. it is is scary i think in the future. we could be a little too much data. >> quickly, and aspiration that you think given your success so far that you will be allowed to implement over the next five years? . .

>> no support groups really work. a fight national governors association which a lot of people know is the longest functioning support group for angry white males in american history and has been doing really great. that was a cheap shot, all mine. you, barry what you think you'll be doing in the next year or five years and are you confident the empowerment that you have experienced will allow you to do? >> our former kennedy ministry to respond of saying we are better with the citizens when we can partner with the citizens in the process of government we are better. and so partnering with them through technology in things like social media way using things like predictive analytics where they come in and tell us what they think about our budgeting process and so forth. we are dipping her toes into the

water over the next five years and we will see a more french are an aggressive approach to that. c i will work with the leadership and i talked to jason who's in charge of it and i said let's figure out where the next steps are and how we can make this better and now we can move on forward and make it better for veterans and come back to iowa so we don't lose that crate training and leadership ability to bring them back and use that for our state. >> brian is it you are very good as doing the pokémon go seminar later today? thank you so much and thanks to our panel. they have done some great work and they are available to talk to if you want. thank you for inviting me. it's great to be here and i will be back for a session this afternoon involving direct investment in the united states that many of you have experienced. thank you you have experience. thank you so much and governor herbert i will turn it back to

you. >> thank you. john we appreciate you for taking your time and we appreciate you being with us and this congress and our esteemed panel thank you for sharing her her -- her expertise with us. let's give him another round of applause. [applause] >> more from the nga summer meeting with remarks from guest speaker senator charles grassley who talked about corporation between the states and washington on such issues as drug abuse, student loan debt, tax policy and cybersecurity. this is 40 minutes. >> as your call in our last meeting in an effort to foster better relationships with the congress and to make sure that we are in fact working together, thank you again panel, as we are working together to improve the outcomes and working in concert with congress and we invited

former governors who are now members of the senate. lamar alexander, jill manchin, mark warner from virginia and others. again it was a great panel. to help us understand their perspective is former governors and what can we do to have better relationships with the congress as we work together to develop policy. in that same vein we would like to continue the opportunity in the spirit of working together with our colleagues and partners on the federal side of the equation so we have invited to leaders in the congress on the republican and the democrat side to come and speak to us today. those two are senator chuck grassley here from iowa senior senator and democratic leader nancy pelosi and we appreciate them both taking time to come and visit with us today. we will hear from senator

grassley today and we will hear from democratic leader pelosi to borrow. we have worked with our staff and we have a series of questions we are going to ask after they have made a presentation. it's the same questions we will ask them both to get their perspectives on the republican and democratic side of the house as we foster better relationships. to introduce senator grassley -- grassley we will ask governor brand said he would do that. terry are you ready to do that? >> i sure am. chuck grassley is a dear friend of mine. i met him when i was a student at the university of iowa and my family were democrats and a friend said you know republicans are really not as bad as your parents told you. would you come to this college republican meeting and a young state representative named chuck grassley was the speaker. that was in the 60s.

that was in 1966. in 1972 i got elected to the legislature and by that time chuck grassley already was one of the leaders in the legislature chairman of the appropriations committee. i was part of a bipartisan group of being brought together to help control spending incorporated it the budget under control and then in 1974 he was elected to the united states congress. in 1980 and i am looking at governor walker nodding over there. governor walker when he was a kid growing up in plainfield iowa chuck grassley was a state representative so chuck grassley has been a great public servant for a long time. i just asked him when was the last time he missed a vote in congress. it was during the flood of 1993 when he was here with president clinton so he has not missed a vote sense 1993 and an all-time

record for consecutive votes in congress. he goes to every county, every year. he is a farmer who has never forgotten his grassroots and he is a great dedicated servant of the people of iowa and chairman of the judiciary committee in congress. so we are really proud to have a farmer from iowa to chair that important committee and i'm very proud to call him a good friend, our seniors senator, chuck grassley. [applause] >> thank you all very much. it's a privilege for me to be with you as chief executives of your respective states but it's also very good to be here for the reason that we don't have enough dialogue between congress

and governors. we may be between iowa senators and congressmen and iowa governors but i don't think we do it often enough. you hear a lot about partisan rancor in washington. there is plenty of that but sometimes even in an election-year congress gets things done. that's especially true when we hear from states on what needs to be done and we have heard on the issue i'm going to talk about quite a bit, but also don't be surprised that congress may be doesn't listen to the states enough but we all brag about the states being the laboratory of our political system and there's a lot that can be learned. i think in terms of just the meeting i had with the mayor of denver, colorado has recently as tuesday or wednesday and in which he came to washington to

work on a program that i have been involved with senator durbin of illinois and president obama and that is on criminal justice reform. he is very much a supporter of that effort in doing everything that he can to do it and we have learned from a lot of states on that issue as well. in fact i don't think i would be moving forward if i didn't feel that texas and georgia have made a lot of progress in criminal justice reform. the issue that i want to visit with you before you ask me questions as the opioid crisis. the rapid rise of drug addiction in our country has taken a profound and devastating toll on communities coast-to-coast. in many parts of the nation it's being driven by the abuse of prescription opioids and cheap but very deadly heroin and here in iowa meth continues to destroy families. this distract this epidemic

demands a comprehensive response , whether it's the 43,000 deaths a year or 129 americans dying every day from drug overdoses, we don't need statistics on the page to tell us about the catastrophe. we only need to listen to the people of our state's. i hear from iowans all the time just like i'm sure you hear from your constituents about real-life examples of how this epidemic is hitting home. a few years ago i heard the story of kim brown and nurse in davenport in 2011. she lost a son to an accidental heroin overdose. he was only 33. she now speaks out around my state about the need for expanded treatment options for those with substance abuse disorders. she also advocates for increased access to naloxone, and

anti-overdose drug that can save lives. i thought about her just congress recently took on the important task of confronting this epidemic. it was a process marked by hard work, bipartisanship and a commitment to dealing with it in an all-encompassing way. so, the comprehensive addiction and recovery act that we call cara for short is now on its way to president obama, addressing the opioid -- and it covers away by investing $92 million over five years for prevention education recovery and long for his efforts. as all good governors want to know rest assured the current senate appropriation bills are poised to more than double funding for the epidemic since republicans took control of the senate. as funding for this crisis

continues to rise, this build them will serve as a boot print for how to attack the scourge of addiction. the process began when i covered , convened a hearing on attacking the opioid epidemic before might judiciary committee the committee heard from a range of federal and state, federal as well as state and stakeholders generally including governor trumbull and who told us about the excellent success of this program there in vermont. we heard from the chief of police of manchester new hampshire and the head of the rhode island oldest and largest outpatient opioid treatment center. we also heard from a courageous young woman from ohio who lost her daughter to a heroin overdose and subsequently started a support group to assist those in recovery.

as the bill works its way through the process i shaped a bill in a few ways that i think are beneficial to my state and many of your states because rural at area seemed to be left out of consideration too often. i'll just mention a couple of items for those of us in rural areas a fixed portion for the first responder access to naloxone is set aside for rural areas like much of iowa where access to emergency health care can be limited and for states that may have other types of drug abuse problems like meth i made sure the community-based coalition enhancement grants created by the bill would also be available for communities suffering from high rates of meth abuse in addition to opioid. another part of the bill that i feel passionately about is the drug take that are grand. many people who abuse

prescription drugs get them or steal them room friends and relatives. cara authorizes an expansion of the federal initiative that allows patients to safely dispose of old or unused medications of these drugs don't fall into the hands of young people potentially leading them to addiction. it's been a highly successful effort. since 2010 over 2700 tons of drugs have been collected from medicine cabinets and disposed of safely. my state of iowa also has a similar take that program that is expanding rapidly. anything that we can do to encourage these programs is worth while. finally bill also incentivizes and strengthens the use of state prescription drug monitoring programs which have proven to be so beneficial especially by reducing drug shopping for opioids. caro was met with widespread

praise and support. the addiction alosi for them called it a monumental step or word. almost 250 advocacy organizations wrote to congress in support of the bill including that quote this bill is a critical access to needs. it passed congress overwhelmingly and it isn't often that congress can say that it passed legislation that could save lives but because republicans and democrats worked together, this is one of these concerns. another area of frustration i hear about from state and local officials is on federal mandates sometimes washington returns control to the states and takes it back back. the every student succeeds act as one example and i know you were going to have a question on that subject and at that point i

will address that in the future. before you ask questions, because this is on the federal state relationships, i asked my staff to put together some things -- well i got five examples here that i will just simply read to you. iowa has worked closely with us and given us a lot of information that is very helpful in making federal policy and sometimes federal law but way back in i think it was 79, 97 and 98, and it could have included both medicaid reauthorization and the budget reconciliation act of that year that could have included welfare reform but the medicaid erector of iowa came to washington d.c. for several days over long period of time and just a

massive amount of information on how to make the program reform but also to serve the purpose that they were supposed to for all 50 states speaking, not just for iowa. maybe you are governors association or something but he worked with the conference committee on that issue. more recently i had the head of the iowa department of aging testified before the committee on financial exploitation of donors or had a field hearing in des moines on the meth abuse particularly the -- problem and we had a lot of testimony from iowans on that helped us pass the kingpin act which is part of the cara act and they are transnational drug trafficking at that senator feinstein and i worked on.

i would drug czar talk to us about patient satisfaction surveys that encourage opioid pain abuse. this led to senator feinstein and i writing to be senator for medicaid services with this concern and the administration just announced a proposal to remove survey. management questions from the hospital payment calculation. the iowa department of economic development came to us about changing the arm statute to allow for longer lease terms especially certifications. we got that change so the state could attract additional economic opportunities for the rottweiler and arsenal and i were worked the state economic development officials to retain iowa's business when there were mergers between dow and dupont,

and in then the states human trafficking for nader worked very closely with us as the first bill to come out of my judiciary committee was the trafficking act in what is called the justice for victims of trafficking act signed by the president 14 months ago and that testimony was very helpful. now to your questions and i hope i didn't take too much time from what i just said. c senator grassley we are honored to have you here. give him a round of applause. [applause] we know how busy you are scheduled there and we are honored he would take time to come and visit with the governors. we do have four or five questions to ask you. let me start off, our mission that we have talked about really has to do with states finding solutions and we understand and in fact you have mentioned a couple of areas, the every student succeeds it back, the

fast back to me opportunity we have had to help energize bills and help you get them across the finish line. the question is what are some potential areas how that impacts in your particular state. worth a transportation bill that we passed, a five-year

long-range bill which is necessary but only has the funding for a thing three years for pressure on congress to make sure at least at that level where we are now and i'm sure some people would like to go to a higher level but we are at least at the level we are that you help, don't know what you have to help us but you have at least got to put pressure on to make sure that is fully funded, and i think when it comes to terrorism, this is probably more of a federal problem but it's something you can sure advocate for. i don't feel that there's an up operation between our at the icon as good as it is and is fairly successful as it's been in keeping 100 people that are then arrested him probably prosecuted that were going to kill americans that we had five bad instances in our country already. the extent to which the fbi has some aversion to core operating

with local police and maybe you would even say state police, think of something that you ought to be concerned about and work for, assuming that you feel as i do that is an issue and things of that nature. so that's where i would suggest suggest -- oh there's another one, the higher education act is up or authorization next year. it should have been authorized as you are maybe the year before but it wasn't reauthorized. we spent most of the time in that committee on the bill for elementary and secondary education but i think there are two things that you need to think about with higher education rasterization. now i know it sounds politically popular to say that people going to public universities ought to have free tuition. i think everyone of you have

massive numbers like we have in iowa, 28 private colleges. i think you have to think in terms of letting congress know the impact of that policy presuming it is pursued on your private colleges. i have not heard any of the candidates, and this could be for both republicans and democrats, i've been hurt in candidate ever bring up the issue that might have a negative impact on private colleges. then when it comes to too high tuition, i think that's something i learned from president mason, former president mason university of iowa is that kids have 29,000 dollar debt when they leave. if they just borrow money for what they have for tuition and board and room and books it would be $13,000 less. why?

because there's a federal law that says the university has to tell you every penny you borrow and presumably people borrow more than they need to. so i have to know before you all build that they would not have to advise them of every dollar they do in four years before they graduate they ought to be looking at what their major is and what the job is going to pay if they get it under their major so they know before they borrow too much money they will be able to pay off their debt. so that's another example of something i learned from my iowa people contacting me in washington d.c.. i think i will stop there. c governor branstad has a question and governor mcauliffe and then governor malloy and governor hutchinson. c governor grassley thank you for the way work so well with the different agencies in the

state government. you go to every county in you listen to your constituents and we really appreciate the cold -- collaboration we have had with you. you mentioned the tax reform and i think we all think federal conference of tax reform is well overdue and we would like to obviously see tremendous intergovernmental coif precious we do with that because what the congress does on tax reform will impact the state and local governments on their ability to finance various public projects. as you look at that we would be interested in how the governors can work closely with you to make sure the comprehensive tax reform which we hope will happen in the near future does not preempt states from having the flexibility to do what they need to do to improve their structure and be competitive.

>> first of all, i don't think that tax reform you have to worry about the tax exemption for states and municipalities going away. it's one of the few things, maybe a handful of things that since 1916 the tax code has never touched. but there is a backdoor to problems that probably sounds politically the right thing to do. when you talk about our tax code not being progressive enough but it's a backdoor to harming your efforts that may not get the a tension than if you just talk about eliminating it is pretty clear. and i wouldn't say that it's just a democrat idea because i'm not so sure but with the house ways & means committee two years ago didn't have this in the program as well but it's where

any exemptions whatsoever at 20% so if you include municipal bonds and that a lot of the people that buy the bonds are not going to be enticed to buy those bonds are at least as many pants and you'll find you are into straight affected i believe. if any of you see that differently than i do i would like to hear from you. >> the other one is more of a process and i don't have any advice to tell you how to weigh in but just so you know it's a problem. whether i was chairman of the finance committee ranking member in those years between 2001 and 2010, i found that when you are trying to reach a bipartisan compromise, now in the house of representatives they don't have to reach a bipartisan compromise as long as republicans agree but in the senate when you have got 54 and one party whether

republican or democrat, doesn't matter. you have to get 60 votes to get things done unless done on reconciliation it's difficult to get things done on reconciliation because the rules are so precise. when you are trying to sit at a table with republicans and democrats to reach an agreement i would have to confess to you that not very often, and maybe not at all but at least we say not very often does the position are impact on states get much attention that's because it's just so darned difficult to work to get a bipartisan agreement. if you don't get it you don't get anything done so that the necessity of it. now i don't have any advice for you. you want me to give you advice i don't have it. but be aware of it in the act is. c senator, thank you we appreciate the great iowa hospitality.

although cybersecurity threats to go on, we are working together to put a platform together. in virginia for four seconds we have a cyber attack and 53 this year. the big issue we are working on an i would love your thoughts on how we at the gubernatorial level can work with the federal government to come up with a copper is a plan that not only affects the states that we can work with a paragraph meant and if i could speak as long as i have your thoughts on the american place fairness act. >> that is one that has more of a political component to it than it has a substance appointed to it. i'm going to say something that is facetious and i don't tell you that ahead of time. you aren't going to recognize it but i know it's a problem and an ongoing problem. this is one where if you buy from outside the state on the

internet that's what you are talking about. here is where we are. maybe 12, 15 and maybe more than that% of the sales are made that way now and they are going to be growing. when it gets to about 90%, congress is going to wake up and say you've got to do something about it. .. because it's hard not to justify

the fact that we have a court decision going back to 1991 or 1992 that says that states can't touch this. and so many states get so much of their revenue from sales tax. but i don't know how bad the situation has to get before common sense is going to overrule the political scene. and maybe you would say never in washington will common sense win out, but i think it does eventually. >> i don't really have much of an answer for you. i'm sorry to say. [inaudible question] >> cyber, yes. first of all, i read -- and since i spend 60% of my days in your state, i ought to know exactly what you're doing, but i recently read.your program on cribber security threats, and i think i would nail it down this way from the standpoint of what congress has already done, took four years and has not done

enough but it was very difficult getting it done because you had to work the private sector and the federal cooperation. eventually we got part of that put together, so what we're -- what we need to accomplish in at least one area, we made successful cooperation, but it's -- or successful legislation. but it's not enough. so, what you're up to -- or taking state leadership is very important but this is something that can't be done just by the states. it's federal, state, and private partnership. so, you're leading the way in that area is very helpful, and i think there's some people that feel that we should do nothing. that's not an option. because we're all going to be affected by this, and so much of it comes particularly when you

have utilities and you have water systems and anything else that a cyber criminal could shut down, you know, local and state governments very much involved in that, as much as the federal government is. so, we've got to work this out. if we're going to protect our critical infrastructure, and all i can say is, we have to continue to work together, and various plans are out there but we got to do more than congress has already done, and we should -- and to what extent? well, as i recall -- federal partnership because we had to work out the sharing of information, and you know, private business was so concerned about their own intellectual property and their own business, and then they were worried about telling the world they had made a mistake and all that, and so we finally got that cooperation where the government

didn't want to share with the business but we want businesses to tell us, now we got this cooperation. so that's the first step. now we got to got the state governments more involved. >> governor? >> thank you, senator. it's been very interesting and i've enjoyed hearing from you greatly. most of my questions resolve around the issue you start with, which is opiode abuse and the recent legislation that authorizes money to be spent but doesn't budget the money. when do you believe that money will be actually in the budget and available for distribution and how will that come about? is that an expected offset or will it be added 0 the budget, separate and apart of an offset? if you could speak to that issued greatly appreciate it. >> yeah. by september 30th, for sure, hopefully before -- well, we don't go back into session until

labor day so in september with can get an agreement. if not, funding that we have in pipeline right now will continue, but it will have to continue under the programs that we have just recently authorized as opposed to money being available for that but not being used very much in a directed manner. so, the money will be available and i've suggested to you based upon what i know from the 56% increase, one recent year and a more recent year, 114% increase in what we authorized, that there will be an increase for next year. and then go out under these programs just as soon as the bill is signed by the president. >> sure. let me just add to some of the things you said about the scourge of drug abuse. one of the statistics which i find most troubling is four years ago in connecticut, of the people who died of drug

overdoses, only 14 had fentanyl in their system, the synthetic version of heroin. this year it's expected to be in the blood streams of 170 people who will die as a result of an overdose, and anything that can we done to address the issue of the growing scourge of fentanyl, the synthetic alternative, is going to be extremely important. it's important because it's being packaged with heroin or as a replacement for heroin so individuals who think they're buying heroin buy a package of for at laos as $3.50 to $10 of something that is five -- potentially a portion of it five times the strength of heroin. so this is a scourge we're seeing particularly in northeast but finding its way to the other states as well. >> heroin in our state is now -- there's a special task force set up in cedar rapids for eastern

iowa, to challenge -- to recognize, i guess, the increasing opiode, heroin thing we have in this state, but still in our state, i think everybody considers meth to be the main problem. thank you very much. >> thank you, senator grassley. the last question is asked to by governor of colorado. he was called back for emergency and asked he mo ask the question. the states would like to havemer flexibility as we implement different programs and it's become lamb cliche of the one -- almost a cliche of the one size fits all mentallate that comes oust washington, dc. met with a cabinet member who said the challenge we face in washington, dc is we don't trust the states to do it correctly. there needs to be accountable. seems to be a lock of trust, and i understand the concern of

accountability, but what can we do as states, as governors to work with the congress in washington and say we understand there needs to be accountability, and needs to be fair but there also needs to be a productive flexibility opportunity and let's get past this lack of trust element that gets in the way of giving states more flexibility. what would you suggest us to do? >> i wouldn't back away from the word "accountability. " and you aren't, either. i would i hope i'm never one that say i don't trust the states. i have heard other congress men and senators say otherwise. but i don't want to fall into that category. what i would do right now is answer with just one example, and that is the elementary and secondary education act, called

"every student succeed act." i'll call it the elementary and secondary education act. i'm not on that committee except for talent and gifted education. i didn't have a lot of input into that but i did get a very strong -- for talented and gifted. here's what i know as a bipartisan bill and mostly reflecting to you the thinking of senator alexander, the chairman of the committee, expressed by a few words he put out that is this biggest deregulation of education policy in maybe ever if you consider the last 14 years as when the federal government tried to take over education, and then the other thing he said, we want to end the congress or the federal government being the national schoolboard, and then -- so what

you're asking for is maximum return to the states of most of the decisionmaking in that federal law based on not only the tenth amendment but based upon the fact that this country is so heterogenerous in our population, our geography is so vast you can't make policy in washington, dc that fits new york like it does des moines, and so what we're seeing now is that it looks to me like the secretary of education is looking for excuses or wiggle room within the language of the bill to continue some of those very strict regulations out of washington as this is implemented. now, think there's almost -- i think we have even sent a letter to him that would say contrary,

he is not looking at it right. you're going to find the next several years as this bill is implemented, the congress riding herd on it because we think that this is -- that "no child left behind" was a mistake even though it was bipartisan between president bush and senator kennedy but turned out not accomplish what we wanted, and led to a national curriculum and we don't need a national curriculum. thank you all very much. >> thank you, senator grassley. give him a round of applause. we appreciate again you being here. [applause] >> we certainly understand making mistakes, and whether we make it in the states or whether they make it at congress occasionally, the intent is for us to work together to have foster better relationships, better trust. we are trustworthy at the state level and we're doing some really good stuff when it comes to delivering services. the government services that we, the people, want to have done. so appreciate your efforts in

fostering better federal and state relation and ins you presence demonstrates your willingness to do that. >> there's no two areas where there into be more deference to the state than at education and transportation. >> give him a round of applause. [applause] >> with that, that will conclude our opening session. we'll have a governors only meeting starting in ten minutes. we have a packed agenda there, too. so, please join later and be prompt as you can to be there in ten mites. we'll get started and that will conclude our opening session, thank you. [inaudible conversations] >> in this part of the nga summer meeting, federal and state officials talk about

efforts to prevent abuse of opiodes and prescription drugs. they talked about the challenges in providing addiction treatment and the recall of law enforcement in combating drug abuse. health and human services secretary sylvia burwell is a speaker. it's an hour and 20 minutes. >> good afternoon, i'm charlie baker, the governor of the commonwealth of massachusetts and the chair of the nga razz health and hum services committee. glad toaround by the vice-chairman, new hampshire governor and as well as by governor bevin, who dropped us

all into this conversation in a big way at the meeting we had back in february. i want to start first of all by saying how much i appreciate the fact that so many of our fellow governors signed on to the compact we developed to deal with this issue. last count we had 46 governors signed on to the compact, representing 250 million americans, and certainly for news massachusetts, and i know for many of the folks around the table this is probably the single biggest public health issue you're dealing with based on the chase had with second burwell and others how big a deal this is across the country. i do want to point to the clock on the screen. so far, it shows an estimate of the number of individual wes have lost so far this year to an opiode overdose, which is according to the latest cdc data, and it will increase every 20 minutes throughout the session to underscore the

urgency with which we must work to find solutions and save lives. this is current he the leading cause of injury death in the united states, and it affects communities, every community across america. many here probably have their own stories. i've heard hundreds of my own or know somebody who has been affected drastically by this. i'm -- directly by this. if you put 20 people in a room in massachusetts i guarantee at least one of them has had a direct experience with this dreaded disease. so highlights far reaching impact of the crisis we'll take an april anonymous poll of the audience and governors and attendance and i want to turn the mic over to frederick, the director of ngas health division to walk us through the poll. >> thank you very much, governor baker. we're going to do a live poll during the session. everyone is invited. everyone in the audience their governors as well, invitessed to participate.

in order to join the poll the instructions are on the screen. you have to start by creating a text message on your phone to the number 2233. 3. exactly. so 22333. and then in the massage line type nga2016 and hit send. let's give everyone a moment to do that. it's 22333, and what you actually write is nga2016. you should receive a text message back that lets you know you have enrolled. okay. >> by the way, fred, i don't have my phone with me but i'm a yes, yes and a yes, on questions one, two and three. >> let's put the poll up live.

the first question is just a test question. have you ever attended an nga summer meeting before? just text yes or no and then the results are aggregated for us. okay. so, looks like half of the audience is new and half the audience -- great to see old friends and new friends. let's turn to the three key questions we wanted to ask. first question was do you know anyone who has struggled with opiode addiction. just text yes or. no all right. so, what we see is one out of every two people in the audience knows somebody who has struggled

with addiction. the next question. has anyone in your family, your directly family, affected by opiode addiction or overdose. that's startling. almost a third or quarter of the audience whose direct family has been affected by opiode addiction. next question. >> has friend or family member died as a result of opioid overdose? that's, i think, sobering moment

there. within the audience, one out of nor of us know somebody who passed away. a third of us have known somebody who passed away from opioid related overdose. that's why we're having this discussion. without that i'd like to turn it back over to governor baker. >> thank you very much, fred, and those numbers don't surprise me. as you walked into the room this afternoon, you may have noticed on the screens the faces of individuals who are celebrated on operation unite hope law. we recognize them and all of those who are rebuilding their lives with the help of addiction treatment and recovery. the second time this year the governors have gathered at nga to discuss the 0o opioid epidemic in february there was frustration. that's one word for it. that despite all of our efforts to innovate and change the trajectory of this crisis, change is not coming quickly

enough. particularly true when it comes to inappropriate opioid prescribing practices that many people believe create the endem ming. the governors passed a resolution uniting governors around changing prescriber behavior to prevent overdisease. and the governor point out many factors contribute to the cries and the nga response to the resolution to support takes states in taking a holistic approach. we worked with fellow governors to develop a compact to fight opioid addiction which is an unprecedent end -- unprecedented effort. we believe by uniting the governors around a comprehensive set of strategies the compact brings new momentum to states' efforts to reign in and ensure a passway. the compact sends a signal that

participate in the partnership is critical to end the human being pavel crisis. the compact was released this week, and as i said previously has the signatures of 46 governors representing 250 million americans. thank you, governor hasin, for your partnership and leading this this is the. i want to think our colleagues who signed the compact and continue our work to lead the nation in fighting this addiction. to further support governors in turning the tide on this epidemic the nga works we state officials and other experts on a road map that highlights evidence based and promising strategies for combating opioid abuse. governors should have a copy of the road map before system you have questions about the tool, please address them to fred during the discussion today or at any point after the session. before we move to the main part of the prime want to turn the

floor over to the governor for her opening remarks and additional announcements. thank you. >> thank you, governor biker. it's been a real honor and privilege to work with you this year on the nga health and human services committee, as well as with our fellow new england governors to focus on this critical issue which is truly affecting not only both of our states, all of new england but all the states represented here and the others that aren't throughout our country. new hampshire and massachusetts has been pushing for urgent action to combat the crisis and help save lives and i am truly proud of the work we have been able to do with our fellow governors. our opioid compact re-affirms that governors from both parties are committed to working on a multipronged and coordinated approach in our individual states to combat this crisis, and we have worked together as a

group to encourage additional federal action to support states, including much-needed emergency funding. also the group, governors have also been at the forefront of highlighting the importance of increasing medication assist ed treatment. this week we approved funding in new hampshire to help recruit and contract with physician practices to develop or enhance their capacity to provide medication assisted treatment. this afternoon, i would like to take a moment to highlight a couple of other ways that the nga is supporting governors in our efforts to stem and reverse the tide of this truly horrible epidemic. as governors know and we'll discuss more today, growing number of overdoses are linked to heroin and elicit fentanyl. a powerful synthetic opioid often packaged and sold at heroin or counterfeit

prescription pain killers and is more lethal than heroin. this year we took an important step to crack down on fentanyl in new hampshire, bringing the penalties for illegal sale and distribution in line with those for heroin as part of our statewide tragedy that focuses on prevention, treatment, and recovery, and today, we're announcing a new technical assistance opportunity through the nga to help states prepare for and respond to the threat of heroin and elicit fentanyl as a come opinion next of their broader -- component of their broader plans to address opioid abuse. during a six-month learning lab the nga will work with up to seven states to share best practices and take a deep dive into successful state strategies for come batting heroin -- combating heroin and elicit fentanyl. par difference pating states well learn and gain insight from other states and national

experts about using data to more effectively anticipate, detect, and respond to the emergence of heroin and fentanyl pass or the of comprehensive and multipronged approach to combating this crisis in your materials around the table you'll find a request for proposals for the learning lab. if you have questions about this opportunity, please direct them to fred during or after our discussion today. in addition to help strengthen the role of healthcare providers in addressing the opioid epidemic the nga is pleased to announce a new partnership with the national academy of medicine, one of the nation's most authoritative voices on critical issues in health and medicine, and i know in a moment -- i just want to check in with my chair here -- -- dr. mcginnis from the national academy but i'm not sure if we want to go sect burwell first. so, dr. mcginnis, we'll thereof

hear from you. he is a the senior scholar at the national academy of medicine and doctor, thank you and welcome. >> thank you. governor hassan. i'd like to underscore three self-evident points. i'll be very brief but hopefully very clear. first, on behalf of the national academy of medicine, thanks to you and governor baker to the nga and to every governor in this room and in the nation who is giving priority to the prevention, identification, and treatment of the devastating consequences of opioid abuse, misuse and addiction. second, the issue is clearly personal. we saw the faces and the numbers. and i would imagine that there aren't too many people in this room who, when they hear the word "opioid addiction" don't

have a personal face that flashes before their mind's eye. more than that, it clearly is a complex multifaceted so ital challenge presenting con dumb drums for myriad stake homers. for physician the navigating between professional and moral duty to relieve suffering and do no harm in the midst of uncertainties surrounding individual variations and circumstances. for social and health policy, the problem that services are often organized around programs and not individuals, and for science, the con none dream of physiology of addiction, how it fares from substance to substance and person to person, the nature and effectiveness of treatments ranging from molecular to behavioral and social and the critical interactions among each. the list goes on, and because it's ultimately our

effectiveness is determined by local action, neutrality of the leadership that'ses in the road map of the governors is critical as is national support for those efforts that are reflected by secretary burwell's leadership. third, as the nation's formally chartered independent entity, for advice and health and medicine, the national academy of medicine is committed to helping in this work, two examples are important to underscore in the context of this session. first, to help the food and drug administration in its efforts to ensure that its regulatory policies provide optimal guide posts and boundaries. we have a study on the state of the science in effective pain management. opioid use and abuse, as well as the approaches and needs to balance individual effectiveness

and public health consequences. secondly to help physicians navigate the difficult challenges of their practices in the context of the uncertainties mentioned. we are partnering with the national governors association to steward the development of a national academy of medicine white paper that will translate the findings of the study and other contributions into the practical clinician best practices that are needed. we anticipate being able to release it next year in rhode island, and look forward to that partnership and its fruits. so thank you again for your leadership, your partner ship and the opportunity to be here to emphasize the priority for all of us. >> thank you very much, dr. mcginnis, we are grateful to you and all of our distinguished guests here today for your commit independent the fight against this terrible epidemic.

and now i'll turn it back over to governor baker. >> thank you, governor hassan and thank you, dr. mcginnis. today's discussion will be broken up into two parts. first, we're privileged to be joined by u.s. health and human services secretary sylvia matthews burwell. following her remarks and a discussion with the governors here, we'll turn to our second panel of experts from washington state, the dea and vermont. i've had the pleasure of working with and introducing secretary burwell american once. ...

>> toss work that we've seen across the board, the leadership that this aggregation in terms of the road map presents i've seen in individual states as well x. hopefully, we all feel we have heard your voices. these conversations we've had since the first nga the summer right after i was confirmed in terms of the things you all have been focusedded on. that's a lot of what we have spent our time on. and i thought a what i would do quickly is run through an update on some of the strategy and progress we've made there and then touch on a few other things, and then let's have a discussion.

i think you all are familiar with our three-part evidence-based strategy. you all know me, i work in the threes. number one, that issue of making sure we are having health providers or have the tools and information they need. you know, we put out the guideline, and now we are taking a number of steps to make sure that guideline goes out. and we've recently done a number of webinars to educate providers on how to implement the guideline. in addition, in our ihs just last week in indian health service, we have announced they will be using pdmps, and they are the first federal agency that will be required in prescribing both for proscribers and pharmacies to make sure that we are closing that gap. and some of those gaps exist in your states. and we've also heard some of the clinicians say that they were concerned that one of our cms surveys and the payments were causing, encouraging the prescription of opioids. while we have not found evidence

of it because of the way the money works, we went ahead and out of an abundance of caution have actually taken that question out in terms of financing for the is survey so that no one, if people were thinking and believing that, we wanted to take the action. and now going to part two, that medication-assisted treatment which i know you all are working deeply on, we are as well. you may have heard that last week we announced that we have put out a final regulation that will increase the numbers that doctors who are prescribing as long as they meet certain conditions -- because we want to make sure we do this in a safe way -- that they're able to do in terms of that expanding medication-assisted treatment as well as we're also today releasing two reports on ways to help pregnant women and new mothers. because that's a part of this with the medication-assisted treatment. i see head nods because this is

something you all have told us is one of the problems. we've got two reports coming out to help with that treatment in terms of pregnant women. and today we're actually announcing nine million in grants from arc which is our quality tative part of hhs to focus on medication-assisted treatment. and so finally, the other area you know is part of our three-part strategy is making sure there is access to that, and we're making sure we get that access out. we've done some grant making, but additionally fda, also, has approved recently a narcan nasal spray, and that will create an ability for non-experts to produce it. and i know some of your states are leading in an ability to get that out. we also recently convened 18 rural communities about the issue to define best practices so that we can share those more broadly with all of you. and these are good steps.

but we know there are critical areas where we need to know and do more. and last week we also announced 12 additional studies on the issues of pain and opioid use and abuse and addiction. so we are going to continue with our colleagues at nam to work on it. so we're going to keep working. i think you all know one of the things we think is very important is the $1.1 billion we asked more. 920 million of that is about moving money out to the states so you all can get that access to treatment. and these would make sure that folks in your states have that access to treatment, because that is a gap that i think we consistently see. it would help us also develop more effective ways to make sure we're doing that treatment and recovery services. part of that money, actually, is for evaluation so you'll know, so we can work with you to know what is actually working on the

ground in your states. and i think you all know a bill was passed in the senate this week s. and while we'll sign the bill, you know, i think the real question is, does that bill truly make a difference without the attendant funding to get the medication-assisted treatment out. we said consistently that, you know, the legislation includes important objectives, but we are concerned that without funding, and so you'll know, we're already planning for september when they come back, because we want to continue a that conversation. we think it's an important one that should not go until next year. you know, if we watch the clock in terms of the months that could happen before we get that, so we will be back at that when folks come back. but the other thing just in terms of that access is medicaid. and we're working with you all in a number of states to make sure that medicaid is able to provide as much access to treatment as possible. and also while we're on medicaid, i will never fail to

mention for those states who have not expanded, you know my door is always open and and will be for six months and four days. [laughter] is and lastly, i just want to close on zika, because i would be remisif i were not -- remiss if i were not with all of you. while things surprise us and while many of you are not in the states, some of you are in the high-risk states and, certainly, the governor of puerto rico understands this fully, i want to just make sure i touch on it for a second. i want to thank you all for your partnership. each of your states participating in putting together the plans and approaches and moving information. so many of you, even if you're not at risk of the mosquitoes, you have the travelers, and you know that because you're getting the cases in your state. so you know that's an important part. i think everyone knows the severe risk of birth defects. to give you a sense, numbers were updated yesterday. in the united states we have 4 2k 00 cases of zika -- 4200 cases of zika.

and in terms of that, in the continental u.s., there are almost 300 women who are pregnant who have tested positive for an indication of zika. and so a very serious issue. and we expect local transmission which already occurs in puerto rico, meaning the mosquito bites another person and passes it that way. we expect that may happen during these summer months here. and so we're working with everyone to make sure the plans are in place. at the same time, we need to develop a vaccine, and we need to develop better tests. because when this happens, and whoever has local transmission first -- and the governor knows it -- the period of testing is sometimes challenging in terms of how long it takes. and people are going to be very anxious for answers. so continue to work on that and mosquito control tools in terms of what we can do to do that. we've already, we'll be awarding 100 million from cdc in terms of the monies we moved around, and

we stand ready to work with each of your states and send in an emergency response team if you need it. let us know, we will be ready. but i also think it is important again to mention the importance of the financing and the funding without the supplemental during august, we will have to slow the work towards a vaccine. that is going to happen, because we will run out of those funds during that period of time. it also inhibits our ability to get a best practices approach to vector control in place as well as must've forward on the diagnostic -- as well as move forward on the diagnostics. quickly, i'll just close with the fact that this is my last time together with you all, and, you know, whether in the health phase whether it's protecting people from something in a medicine cabinet or a moss key tee -- mosquito, it is something we do together. so in these last months, you all have my commitment we're going to do everything we possibly can to work on the issues that we are discussing today so that

when we leave, we leave both in the federal government and to you all, the states, the best and most progress that we make and pass for more success. so excited to continue working with each of you on this and all the other issues that hhs has that we work together with. >> thank you, governor. >> thank you very much, madam secretary. [applause] questions? observations? i have one. the first nga meeting i went to was the summer meeting, and you talked about 200, and i think it was 240 opioid prescriptions in the u.s. written in 2014 maybe? do you know what that number is for '15? >> i don't think we -- the data is one of the big problems we have in the space, and i think you all have it in the states, and we depend on you all for it. i do think our next numbers we will see some improvements in the number of prescriptions. i don't think we have finalized

numbers, but i think we will have some improvements in the numbers of prescriptions, and i think you're starting to see that in some of states' data. we're starting to see that. i don't think we have good enough aggregate data yet. but i think we will see some. i think the real question we also have to challenge ourselves with and i think kentucky and west virginia are two states that are seeing some of the prescribing numbers go down, but i think we have to check ourselves with are you seeing the number of overdoses going down. because that's the real outcome that i know we are all interested in. and i think we, obviously, have to get the prescribing down, but we've got to get the overdoses down as well. >> so my follow-up on that just quickly would be, and we've talked a little bit about this, but we've also talked with governors. is there something we can work with you folks on with feint mom? -- fentanyl? which i think is driving some of the deaths and some of the overdoses.

>> i'm sure you all know better than i do is fentanyl is the problem on steroids in terms of what it's doing. many of the tools we have in place are the correct tools, but the question we're asking ourselves, and i've put together a working group at hhs, is should those tools be enhanced or changed for the specifics of fentanyl in terms of how it gets created and how it's getting used. and so we're working on that. but this is a place where this dialogue and this conversation is so important, because if you're seeing things that are working in your states, please, let us know. because we are very specifically focused on the question right now. >> i would just add to that. one of the things we did in new hampshire was update our criminal code to make the dealing of illicit fentanyl on par with the dealing of heroin. we also are starting to work with our public safety officials and public health in trying to

develop protocols for how you investigate an overdose scene so that you can actually prosecute somebody for causing the deaths through fentanyl. when medical personnel respond, they rightly focus on saving the life of the person before them. but that up means that criminal investigators don't have any evidence to work with effectively to try to prosecute. and while this is both a public health and safety problem and we certainly need to go at the supply of fentanyl and the production of it in a different way, it's worth talking to your public safety and public health and first responder folks about how you can make sure it is clear to those dealing illicit fentanyl that they will pay a price for doing so. >> exactly. >> one quick comment. in reaction, it was a good question. as the number of prescriptions goes down, will there be a subsequent decline in the number of overdoses. and and i would caution folks to realize and has been our

experience to this point, not immediately or necessarily should it be assumed that there will be. because, ironically, it almost exacerbates the problem a little bit. it's prescriptions, legal prescriptions go down, people are driven to feed that habit through other sources. there are no doctors prescribing black tar heroin, and yet there's more people using it as a result of the fact that there are fewer prescriptions. it isn't to say there should not be fewer prescriptions, but there has become already the addiction. and the addiction is going to be fed by something, and this has given rise to the fentanyls and the synthetics that have crept into the marketplace. so i think we're actually at the front end. and it's sobering and scary to realize, i think america is at the front end of the number of overdose deaths we're going to see for some period of time. but that's why it is so critical we start nipping it in the bud now. >> yes. and i think the other thing is there should be time lag, we

think, in the prescription reduction and the catch-up. we think there will be some, but we think we have to quickly focus, and that's why the medicated-assisted treatment is an important part of the strategy. the only other thing i would say is while we don't have governor scott here, florida interestingly -- and governor baker and i were just discussing -- florida actually has seen more of an a parallel movement of the lines. so what we're trying to do is understand why did that happen in florida. and better understand that so if there were things that happened in florida that we need to repeat other places, that we can share that with those of you who are making progress on the prescription reduction. >> i think the secretary's got time for one more. governor hitchenson? hutchinson? >> i wanted to thank each of you for your leadership on this, governor baker and governor hasan. the panelists, i particularly want to thank secretary or

burwell not just for your attention to this matter, but also your cooperation with the governors, your responsiveness every step of the way during your leadership. so wanted to recognize that and, also, i wanted to be nice, because i still have some pending matters before you. [laughter] in regard to thissish i shoe -- this issue, you know, in arkansas methamphetamine is still the number one drug challenge that we face. you know, i want it to decline, but i don't want this to be number one. so we are trying to address this. and i share the concern. i think we have another panel after this on some of the enforcement side which aisle very interested in, because, you know, we have to address the demand side which we're working on. and we have alternative treatment courts in arkansas. we need to invest more in. but it is, ultimately, the law enforcement side has to be a

part of it as well. and is, secretary burwell, are you all coordinating your efforts with the dea and the other law enforcement agencies? >> we are. and i think one of the announcements, you know, over the period -- and i should have highlighted, i'm glad you raised it -- you know, doing the takebacks has been an important part of our dea partnership in terms of that work as an important thing. and, again, this was feedback from the governors. you all have told us get v.a. engaged. many of the steps we've taken. and so this is, the takeback's an important part of the feedback. i think the other thing where the dea is taking lead is the issue of heroin itself and the illegal and illicit drugs that start that way. prescription drugs can become, you know, when they're not used illegal. but so that's the place where they're focusing the most. our connection occurs through the office of the national drug policy coordinator at the white

house, but also the chief of staff, dennis mcdonough, has taken an interest. dennis and i have been interested in this issue for a long time. and so he actually even has a person in his office who works directly on the issue with us together. and that's where we get our biggest connect with our colleagues at dea. >> again, on behalf of the nga, i want to thank you for your help and assistance not on this, but as governor hutchinson pointed out, on so many other issues, and we wish now nothing but -- wish you nothing but the very best. >> thank you. where i began when i came in july of 2014, one of the things that is always great about being with you all is, actually, i think on a day-to-day basis in terms of what you have to do and how you actually have to deliver, you know, in terms of being in the executive branch, it is a place where i am with people who, hopefully, you know i feel your pain. and you feel mine. [laughter] so thank you all for all the

partnership, because with that and with all we work on, there have been so many places as i look around this table that in your state, you know, we have made progress for the citizens of your state, and that is an exciting thing for me, and i look forward to doing more in these six monthses and a few days. thank you. [applause] >> at this time i want to welcome our other speakers up to the stage. they're each going to speak for a couple of minutes. and, by the way, one's going to talk a little bit about medical and prescriber education, one's going to talk about truck enforcement, and -- drug enforcement, and the other's going to talk one state's experience with treatment. dr. gary franklin, one of the most most experts on educating clinicians on best practices for safe opioid prescribing. dr. franklin's a research

professor at the university of washington and medical director at the washington state department of labor and industries. thank you very much for joining us. >> thank you very much, governor baker, governor hassan be, ladies and gentlemen. i'm gary franklin, medical director of washington department of labor and industries and research professor at the university of washington. most importantly, i'm the co-chair of the agency medical directors' group representing all of the public agencies that purchase or regulate health care in washington. i've been working on the issue of prescription opioid overdose for more than a decade. in fact, i reported the first deaths in 2005 from unintentional overdose of prescribed opioids in a scientific journal. these were injured workers who entered the system with common work-related injuries such as back pain, only to later die from prescribed opioids. by 2006 the public programs in washington are -- already had

over 10,000 citizens on doses greater than 100 milligrams a day. this is one of the strongest risk factors for overdose. and by 2008 this resulted in 508 deaths from prescribed opioid, more than half in the medicaid program. in partnership with leading pain clinicians, washington developed the first opioid guidelines in the u.s. with a recommended dosing threshold in 2007. the principles of the guideline were put into state regulation in 2010. the most recent edition of our guideline is highly consistent with the new cdc guidelines. these efforts have led to a 37% sustained decline in prescription opioid deaths in washington state. washington has also seen a reduction in high-dose opioid prescribing in our medicaid population. to reverse this tragic, manmade epidemic, we must, one, prevent our citizens from becoming

addicted or dying from inappropriate prescribing; two, optimize the capacity to effectively treat pain and addiction by incenting evidence-based alternatives to opioids and expanding access to m.a.t.; and, three, to implement standard metrics to monitor progress. i'm going to focus on areas where washington has already had success as well as efforts currently underway or that are pending executive action by governor inslee. the first key to prevention is to repeal the overly permissive language passed in more than 20 states in the last 1990s. in the late 1990s which provided a safe haven for overprescribers. doing so in washington allowed us to take action just yesterday against the most egregious prescriber in state history with more than 18 deaths. states need to adopt and operationalize the new cdc guidelines by setting new prescribing standards through the state licensing boards and leveraging public insurance

programs and their plan contracts. this effort will only be successful if governors take action as governor inslee did to mandate collaboration at the highest levels of state government across all of the public programs and with leaders of the medical community. a second key to prevention is to protect our teenagers from potential abuse and a path to heroin addiction by limiting prescriptions to no more than three days or ten tabs of short-acting opioids for self-limited, acute pain conditions such as dental extractions and sports injuries. there's strong interest in washington to implement such a limit. this type of focused approach is easier to operationalize than limiting all acute prescribing with a wide range of exceptions. the key to improved treatment is to deliver regional, coordinated, step care services aimed at improving pain and addiction treatment. this includes delivery of

effective services like cognitive behavioral therapy and graded exercise aimed at improving function, overdose case management and m.a.t. for patients with opioid use disorder and much broader use of multidisciplinary pain care. because most of these patients are managed in primary care settings, the lack of access to coordinated services is a severe threat to the integrity of our primary care safety net clinics. incorporating collaborative care services would address this issue and is consistent with governor inslee's call to integrate behavioral health with physical health and primary care by 2020. finally, the development of a common or standard set of metrics will be critical to tracking state progress on reversing the epidemic and helping to identify effective strategies. this would also provide guidance to public and private health plans to improve quality. these metrics could also be used

to provide useful feedback to outlier prescribers similar to the provider or report card shown in the slide. i applaud your effort and the substantial work of your staff to date on the road map and the compact. thank you again for the opportunity to present washington's work and siegic direction. strategic direction. >> thank you, dr. franklin. and i must say, i just, i couldn't help but share the headline of your are presentation with -- your presentation with my co-pilot here, reversing the worst manmade epidemic in modern medical history. pretty strong words. >> that's what it is. >> we'll do, we'll get to q&a after we give each of the presenters or a chance to speak. second up is karen flowers who will provide insights from dea on the growing threat of heroin and fentanyl. in charge of the chicago field division, ms. flowers leads dea's efforts to crack down on illegal drug activity in

indiana, wisconsin, minnesota and north dakota. welcome. >> thank you. good afternoon. on behalf of the 9,000 dea employees, thank you for this opportunity to speak to you today. as you know and what you've heard, we are in the midst of a heroin and opioid epidemic that is at historic levels. this epidemic does not care who you are, the color of your skin, your anal or where you live. and the way to push back is not a new tactic. but it needs to be looked at from a perspective of collaboration across all three pillars of our nation's drug control strategy. prevention, treatment and enforcement. there's no surprise, it mirrors the strategy. this effort exerted on each pillar is a decisive factor in the outcome, can and all three are of equal importance. as you can see in this slide,

deaths involving prescription drugs are higher than all other drugs. heroin deaths more than tripled from 2010 to 2014 with over 10,000 americans dead. synthetic opioid deaths, which include fentanyl, also increased in 2013 to 2014. this map shows the rate of heroin drug poisoning deaths per 10,000 population by state. you can see the deaths are concentrated in the northeast, midwest as well as the pacific northwest and new mexico where dea has reported steady increases in heroin use. heroin availability is increasing in most areas of the u.s. seizures have increased 254% since 2008, and the seizure size has doubled. heroin is everywhere, it's easy to get, it's cheap, and --

[inaudible] these facts when merged with the large number of people addicted to prescription pain medications are destroying families and taking lives. dea is concerned about the increasing threat from fentanyl be, a potent and dangerous opioid painkiller. fentanyl is a powerful and deadly sin net ec opioid which has high potential for abuse. pharmaceutical grade fentanyl is widely used in medicine as a hay-strength cancer -- high-strength cancer drug and end-of-life drug. in addition to seeing fentanyl laced with heroin sold on the streets, in 2015 there was a marked surge in the sell of fentanyl in prescription opioids. in many cases the shapes, colorings and markings are consistent with authentic prescription medications. hydrocodone, percocet, xanax. fentanyl was also discovered in a black tar heroin form in

california. but it was fentanyl. much of the illegal feint moll is -- fentanyl is produced in china and shipped directly to mexican criminal trafficking organizations. because of its low dosage range and potency, one kilogram of fentanyl purchased in china can generate upwards conservatively of $1.5 million in revenue to the drug trafficker. this map shows large fentanyl seiziers through -- seizures through june 2016. fentanyl-related deaths while yellow stars indicate seizures of fentanyl. in 2015 dea seized more fentanyl than any other year in our history. fentanyl can be absorbed through the skin or inhaled, thereby

endangering our public safety personnel. dea issued a nationwide alert about the dangers of illicit fentanyl and fentanyl analogs. dea continues to use its regulatory authority to make drugs like fentanyl be illegal. in 2015 due to recent spike in overdose deaths, dea emergency scheduled and made fentanyl an illegal drug. this year we made two other analogs illegal. we're working with the chinese government to stop the manufacture of fentanyl. last october china implements controls on 116 new psychoactive substances to include six dependent knoll substances. deas has focused enforcement on cities and areas of countries where heroin and fentanyl distribution are at the highest and target sources of supply in mexico and china.

to complement this action, dea is also piloting its new 360 strategy in four cities which leverages existing federal, state and local partnerships to address the problem on three different fronts; law enforcement, diversion control and community outreach. our enforcement activities are directed at the violent cartels and drug trafficking gains responsible for feeding the heroin and fentanyl into our communities. while working -- while also working with our community partners to reduce demand and educate our very vulnerable youth. this opioid, heroin, fentanyl epidemic is deadly, and it touches every segment only society. we all must recognize that treatment, prevention and enforcement have to work together against this epidemic. i'm going to go off script here and just one comment. yesterday in chicago we made a

seizure of 5.5 pounds of one of the fentanyl analogs that dea emergency scheduled as illegal. along with the 5.5 pounds was a pill press, a rolls royce, and approximately $100,000 in cash. this is not a problem that i see going away anytime soon, and i think it's imperative that we educate our citizens of the dangers of prescription pill abuse and how that might lead us into being more acceptable to use a pill with the name xanax which actually is fentanyl that a friend might give you or that you might find in a legitimate bottle when it's actually fentanyl. thank you for your time. [applause] >> thank you very much. give us a sense on how one state has changed this issue, dr. harry chen, vermont health

commissioner. he's been gracious enough to join us here to talk about their hub and spoke initiative which is leading the nation in many ways in expanding access to high quality addiction treatment. >> thank you, governor. governor baker and governor hassan, faced with steep increases in the number of clients seeking addiction treatment for opioid addiction, increasing opioid overdoses and increasing number of criminal cases involving opioids, governor shut shumlin devoted hs entire state to have the state -- state of the state speech to the crisis in 2014. channeling him, he'd say it was a lonely place to be out in front. the actions he took immediately were to administer funding for treatment -- add more funding for treatment resources in both health and criminal justice systems. vermont at the same time adopted a plan to address this public health crisis.

it is comprehensive strategies encompassing enforcement, intervention, treatment and recovery support. it's essential to recognize whatever we do in all of these spaces, to stem the tide of the opioid problem, it requires a coordinated approach on the federal, state and community levels. so here we were, ready to invest money in treatment, but at the same time our waiting lists were getting larger and larger. we just didn't have the capacity. so it was clear at that time we had to do something different. and doing something different really meant reforming our health care system. we adopted an integrated approach to health care reform combining the health homes provision of the affordable care act to actually get 90% reimburstment for medicaid for eight quarters. we were able to leverage this in our current payments and delivery system reform called

the blueprint for health using community health teams and advanced practice medical homes. this was a partnership between the health agency, which was the substance abuse authority, and the medicaid agency which provided the outpatient recent. importantly, we had to measure our outcomes and our costs to know be we were making progress. -- know if we were making progress. from this came the care alliance for opioid addiction, a regional approach for delivering medication-assisted therapy for minors who suffered. it was designed to coordinate addiction treatment with medical care, counseling and support services using this infrastructure of the community health teams to effectively treat the whole person as they make their way along the path to recovery. we know from the literature that medication-assisted therapy works. it's an effective treatment that involves prescribing

medications, methadone combination -- in combination with coming. we know the outcomes include reduced drug use, retention and treatment, better social functioning, better health, reduced criminal activity, reduced disease transmission and, importantly, reduced drug overdose. getting more detailed about the care alliance, really the pieces include the hub which is a regional opioid treatment center responsible for coordinating the care and support services for patients who have the most complex addictions, those with occurring disorders. patients at the hubs are generally treated with methadone but can be treated with wound nor teen. in addition, there's the spokes such as the primary care practice or health center responsible for coordinating the care and support services for patients with addictions who have less complex medical needs. generally, they are treated with

bupremorphine, and support services may include mental health and substance abuse treatment, pain management, family supports, job adopt and recovery supports -- job development and recovery supports. in terms of health care costs, we all worried about the black hole of substance abuse treatment in our budgets, but overall, the health care costs for individuals treated with medication-assisted treatment did not increase in total. there was a reduction many high-cost emergency department and hospital utilization, there was more primary care and less specialty care. in terms of the important concept of social functioning, employment, family life and quality of life retention and treatment in the hub and spoke system resulted in a much-improved outcome, and those who left prematurely, whether it be from leaving, moving or going into corrections, had a lower level of improved functions. other costs, importantly, must

be considered such as the costs of corrections and social services. we have plans to evaluate that, but as you might imagine, it's a pretty remarkable undertaking. so in terms of recommendations to this group, treat addictions like any long-term, chronic disease. we know that in chronic disease 20% of the people use 80% of the dollars, and this is true of those with addiction. insure add a adequate capacity and a system of care to support individuals through treatment and recovery. do have enough providers that are prescribing methadone or bupremorphine. important integration for ongoing patient support and integrated and holistic system while, obviously, the question is can you afford it. well, i think the answer is you can't afford not to do it. finally, it's clear that everyday reminders have to be part of the solution. to that end, we have two statewide campaigns. one is vermont's most dangerous leftovers, it educates people about how to use and dispose of

drugs. and the second one is paradox, educating parents in their role in talking with children about drugs and alcohol. so thank you for the opportunity to share some of our experiences in the opiate crisis and addiction in overdose in vermont. i'm optimistic we're seeing some light at the end of the tunnel, but we still have a long way to go. thank you. >> thank you very much, dr. chen. [applause] thank you, ms. flowers and dr. franklin as well. questions from the governors? yeah. >> thank you. from the members of the panel, i just wanted to the bring a little bit of a touchy subject but just not to, for the discussion, but to see there's any consideration to having even from any of your states or dea.

when our state senator just -- [inaudible] brings to me some articles is and studies that i, he thought that i should consider. i pay little attention to him until a couple of years later that i went to a conference he was giving to many people. and he explained x then i went back to those articles. i thank the nga staff and my taffe to be included one of those articles, and we all, all of us have it right now is an article by glenn greenwald, a yale professor on drug decriminalization in portugal. and this is a very touchy subject, i know. but just to give you numbers, in

2001 people that died by heroin is and opiate in portugal where it was, 281. in 2006 it was 133. they decriminalized all drugs. just, i know it's a very touchy subject, but i think it's a good article to take a look at. on page 18 there's a table that shows how decline number of dead people by consumption of illegal drugs. it's something that i am, i haven't been able to put forward in pert rio. -- puerto rico. i wish. but i just want to be serious consideration. i just want to know from you, you study these, or what's your

opinion on these case studies that is happening with great success in portugal? >> that's a nice softball to start the conversation with. [laughter] fire away, dr. franklin. >> i didn't have time to go through kind of how all this started. but if you don't understand how it all started in the late '90s, you're not going to be able to reverse it. and one of of the things we recommended, you know, most health care delivery is regulated at the state level through boards of commissions. and the folks who wanted to make it more per permissive to use opioids, we had a language in our state that said no doctor shall be sanctioned for any amount of opioid written, and more than 20 states included language that was so permissive that even if you had an egregious provider or a pill milker it's been very hard for

our medical boards and commissions to take action against that sort of stuff. so it's important to realize that it's the oversupply and overprescribing that has led to this, and it was based on false teachings by some of our leaders and drug companies back in the late 1990s. >> i'm actually looking forward to reading this report too. and the main, the part i struggle with on this when people talk about decriminalizing this is we did. it is legal. i mean, the 240 prescriptions that secretary burwell was talking about, those were all legally-prescribed, for the most part, written in this country. and part of the authorized approach to pain management that grew out of the reforms of early 2000s. and, i mean, i'm one of these people who thinks we're dealing with that right now. so it's very hard to me, for me to understand how that sort of fits with this. but i'm looking forward to

reading it and seeing what it does. >> so the only thing i'd add to that is there's no question that this is a complex issue of addiction which is not all about pills, although we know that doctors overprescribed in the 1990s. and that, you know, hospitals encouraged them to do so because of satisfaction surveys and the joint commission created pain as the fifth vital sign. but at the same time, in essence, when we actually use m.a.t., to some extent you could say that's legalizing, right? we are giving people opioids to make them stable, to make them healthier and to allow them to become productive members of society so they don't have to steal to actually, to get drugs or to risk the overdose related to the illicit drugs. [inaudible conversations] >> a couple of different questions real quickly. just a quick question of the

dea. what, if anything, can be done to stop that flow from china to mexico, the one that you cited? is there, are there simple things that can be done to target like a laser on that channel for fentanyl in this instance? >> yeah. so it's a multilayered approach x we do have an office in beijing and in conjunction with the state department in our headquarters. and inner working groups in the d.c. area in diplomatic relations with china and how we can augment or assist or educate them on the problems here and what these substances, the havoc they're creating. i think that we've had a very successful relationship with the chinese government and their medical community in keeping that dialogue open. so i'm optimistic with their recent, you know, they've basically criminalized over a hundred chemical substances because those were fentanyl analogs. i'm on optimistic in the point t

the dialogue is open, and they are sharing information with us. and as we're seeing more and showing more examples of here's the chain of evidence that shows this came from this location in china, you know, what are you going to do about this, and i think that's something we're going to continue to do and push forward with. >> thank you. another couple quick questions. dr. franklin, i'm curious your thoughts on bupremorphine, your thoughts on the effectiveness of it, and do you know if anybody's ever done a study as to the percentage of it? you mentioned that dr. chen is one of the spokes. has anybody ever studied the percentage of it that's prescribed that's actually used by the individual to whom it was prescribed versus that was sold on the street? >> i'm sorry, i don't know the answer to that. dr. chen? >> but your thoughts on it as a drug. codo you feel it's an effective drug for treating opioid addiction? >> i believe it is an effective

drug to treat opioid addiction, but we also need to take an approach. this is a special population that started out with prescription opioids, and our state guideline and our worker's comp guideline are focusing on, first of all, trying to taper the drug in patients and having algorithms for primary care and pain clinics to taper along with the possibility of add youngtive medication by buy prenor teen. and if you can taper it 10% a week or something like that, we actually have no data a as to how often that could be done. so that'd be the first step. and if that fails either in primary care or in a specialty with addiction help, then we would probably allow medication-assisted treatment for opioid use disorder, because some people think that's a brain disorder that's going to be there the rest of your life. but we really have no empirical

data to say you could get half these people off. and we've had examples of injured workers who were on huge doses that got off within a fairly short time and did pretty well. so we just need more empirical data on that approach. >> if i could try to address your question, i think one point is we know from the evidence that methadone works very well. and we've been using it for decades. we also know that bupremnorphine does work in terms of criminal activity, in terms of health. your point about street uses is a good one. i think there are two issues to that. i actually spent a morning in a clinic prescribing it to people. i happened to have my -- as a pinch hitter. and i asked every one of them how they started. i asked every one of them what things they went through. and a lot of them started with

street medicine. some of them said, yeah, i got high a little bit in the beginning, but after that it was just about not withdrawing. and so if you have demand that's not meeting supply, then they're going to buy it on the street. and i think there are ways to be more mindful about how you regulate the prescriptions. you have to be very careful we're not just going to get into another set of pill mill situation. so i think strong regulation, strong best practices about how you prescribe anytime a system of care -- in a system of care is very important. >> and, governor, one final question/comment, and it's something i would challenge us as governors to think about. i don't know what the number is, but i would think a significant portion, percentage of the doctors that are, that are educated every year in the united states are educated in our public universities. certainly, some high percentage of them are. and i think one of the things as i've looked at this, and i'm

hardly an expert, but one that has has affected kentucky significantly, communication is critical. you've been calling people's attention to this for a decade plus. i've talked to doctors who have had no real education whatsoever in pain management prescription. they really haven't. it's not a part of the protocol for them to become doctors. it is starting to potentially become part of it now. but i wonder if we could not collectively in the nga in some way working, perhaps, with you, dr. mcginnis, with you and others who have looked at this for a long period of time, come up with a course, for lack of a better term, that would be standard that every single doctor -- start with our public universities that we have more control over. but, ultimately, that every doctor in america would have some basic level of training in understanding pain management

drugs more so than they now do. and i wonder if we did not be all put ourselves behind it and sort of demand it, at some fundamental level at least within our public university medical schools that we might not be able to turn this. but a i think we are -- because i think we are now reaping what was sewn many, many years ago -- sown many, many years ago. a lot of this prescription problem came out of a lack of understanding and a fundamental trust that was placed in information that has turned out to not be what we believed it to be. so i don't even know if that's a question, it's just a thought -- >> [inaudible] >> dr. mcginnis, if you have any thoughts as to whether that's even feasible. >> just so you know, one of the elements of the compact talks about educating prescribers. and i know in massachusetts, the medical schools -- all four of them -- the dental schools and the nursing schools have all committed to a opioid therapy

curriculum which you can't graduate unless you take and pass. and we also now statutorily require if you're going to be a prescriber every two years as you go through your ceu process, you have to incorporate therapy into that. and i know that's happened in a number of states. and i certainly look forward to what dr. mcginnis and the team come up with for nga in this prescriber education piece. but i tell you, i can't tell you how many clinicians have said to me when we've got into pretty pointed conversations about this, you know, i really don't know as much about this as i probably should. and most of the docs who write most of the prescriptions are not otter pods -- orr no pods and oncologists. they're family practice, primary care. i mean, this is a really big and really important issue in this conversation. and i think the idea of getting everybody's state school if you've got a medical school or a nursing school or a a dental

school, i think that's a really good idea. do you want to -- [inaudible] >> well, just briefly, to underscore and endorse your observation, i would imagine that the piece that we'll be doing in partnership with the nga will not only identify the kinds of guidelines for providers on the front line, but also what's necessary in the educational process to improve the circumstances. >> jonah walker. >> thankses, governor baker. actually, man, on your point, governor bev vin's point, and i'm sure this is true. a lot of the states, both those that have panelists here and other governors that are represented, two things come to mind on your question. partnership and cooperation. and, charlie, you just alluded to this with your medical colleges. we found the same thing not only with our medical schools, but going to speak with our state

medical society realizing this is something we couldn't do to them. we needed them to be invested, and there still needs to be, because t not just changing their mind as the medical schools, it's changing their minds as patients. the example i often give you go to urgent care, and my kids are in their 20s, but i can remember spending about every other weekend in an emergency room or urgent care for some injury along the way. every time you go into urgent care, what's that sign you see up there? it's the sign with the different paces that tell you what level of pain that you have. well, that's instinctive. it's not they weren't trained, it's actually they were trained not just because of reimbursements and things of that nature, but just in general that patients said, doc, give me something, i'm in pain. and so the thing they were missing wasn't the lack of how to deal with that pain, it was how to deal with it effectively without going down the path that we're on today.

and so we've got to get people to buy boo that -- into that, and it's going to take a comprehensive approach. at least we found in our state, and we, you know, i love the things we heard from the panelists here today. we're going to take that back and match it with the things we're already doing. but it's certainly something that we can't either in state or at the federal level just dictate to people and expect it's going to work unless we get them to have some buy-in when it's medical schools, dental schools, our nurses and otherwise. it's got to be a partnership. >> governor? >> i just want to make the following point. our state, connecticut, has been dealing with this issue. i've been governor for six sessions, and we've passed comprehensive legislation on this issue five of those years and thought we got ahead of the problem. and i, and i'm going to say this, and some people certainly

can have the right to disagree. i think the discussion today is largely about where the problem was three years ago, and we're coming up for response for what we probably should have taken on three years ago at this rate. i think what i would say is the lasting effect of the introduction of some of these opioids and now with the addition of easily-accessible fentanyl is the cost of heroin or its alternative is now so low and will remain so low that we're seeing people becoming addicted not, first of all, to a prescription, but it's moved to a very rapid becoming a addicted to something you can buy in a dose in my state for as little as $3.50 to $10. and a product, if it's pure -- if it's heroin without fentanyl,

is up to 71% purity as opposed to 15 or 30% purity when we were all, many of us were growing up in this room. so, yes, we have -- we do have a prescription drug transfer problem. i'm not denying this. but i think people have to understand how cheap this is, how quickly people become addicted to it. and then, of course, the added factor of fentanyl when introduced as a mixing agent or a replacement for heroin when the person runs out of heroin to put in the packets is causing death. as i've said, in a four-year period of time we've seen dependent knoll in our taxology reports go from 14 deaths to this year we're predicting 170 deaths. doesn't mean the person intentionally took fentanyl. they took heroin or thought they were taking heroin. it had a percentage of fentanyl, and they ended up dying of the combination.

final thought, in new haven just four weeks ago we had, someone was selling as heroin mixes that were largely fentanyl. three people died immediately, 15 people in total lost consciousness, and some of those folks this was a relatively new product more their ingestion. final, final point. i think we need to be talking to our high schoolers, our junior high schoolers. we can all worry about people our age having knee replacements or dental surgery, but this stuff is so accessible, it is ubiquitous in our communities, and you don't need to get hooked to something else before you get hooked to this. >> well said, governor. we're about to run out of time here, so i do want to take a minute to thank dr. mcginnis and dr. frank lin and agent flowers and dr. chen for your presentations and your participation today. it was all very educational, and

we look forward especially to working with dr. mcginnis and with you and your colleagues going forward. i do want to give vice chair hassan a chance to offer some final thoughts here. >> thank you. and i join governor baker and all of the governors here in thank our panelists. i guess i'll leave with this thought, because i think all of the comments have reflected where we are, what work we still have to do. but i was -- the saturday, just the day before easter, i was hosting our easter egg hunt on the front lawn of our capitol. and as happens, i would expect to most of us if not all of us, people throughout the day came up to talk to me and often would talk about in this very issue; a loved one they had lost, a child's friend who had just died of an overdose, another person, maybe a colleague they knew who had been rescued by narcan.

but perhaps the most poignant thing for me was a woman who approached me holding a baby introduced herself, introduced her baby. i asked how old he was, and she told me, and i said he was very cute and glad she had brought him to the easter egg hunt. and she looked at me and said, you know, this is actually not my son. he's my grandson. we lost my daughter to an overdose last month. his mother. i admired the bravery of that grandmother in coming to the easter egg hunt the month after she lost her daughter to an overdose. it reminded me of the urgency of this issue, and we look at this life clock today. i think it's three more lives have been lost since we started this discussion this afternoon. i am reminded in that story of the bravery of all of the survivors and people in recovery who have been willing to

overcome the stigma that has been part of this problem, and i also admired her optimism. .. >> it's good to see you. good job.

[inaudible conversations] the next part of the nga summer meeting august on international trade and attracting foreign investment. we will hear from executives on panasonic and toyota air from governors representing two japanese ventures. this is an hour and a half. [inaudible conversations] [inaudible conversations] >> when investors decide to directly invest in your states, if we could get as many governors is possible to sit down, want to say that i really enjoyed the previous session.

i done a lot of reporting on opioid catastrophes in various communities around the united states and it is such a difficult problem and it is so frustrating but also having spent a career trying to get in the same room and on the same program as many of you as i possibly can and some of my colleagues who work at lightning lightning -- nightline they have tried to get as many senators as possible to simulate a working group session between elected leaders and policymakers and stakeholders like like like doctors in this case working on really hired problems and is so hard to achieve and television broadcasts that i really had a strong feeling here that everyone in america should see just how engaged everyone was in that last session. i think you would be such an important optic to use an

overused term these days to see how engaged and authentically involved in solving a significant problem that everything here regardless of politics and it was just a really striking and wonderful thing to see. we are going shift gears and talk about something very different. in many ways part of the problem in communities that have meth addiction problems and opioid problems and the fact that there are few opportunities for other kinds of meaningful roles in the community and direct investment and investment in your economies is a way of changing that. i want to introduce the panel here and we are going to see this issue framed in a way that maybe it's a little more illuminating and inspiring than some of the rhetoric we have

heard about the trade treaties over the last several weeks and months because when we do talk about trade we are also talking about the direct foreign investment and i think foreign investment is a boon. it's been an extraordinary boon and america and its remarks are plain untold story. i'd first like to recognize the governors who are here from japan. first of all -- [applause] it's great to see you mixing with the governors here from united states and in many ways part of the mission here is to create these relationships. as all of you were telling me before and we have an hour and a half to get to know each other and to make all that happen. there are many on the panel and on stage to represent the mechanism of direct investment in people who have benefited in the united states. directed to my left isn't dennis carrigan executive vice president of zürich

vice-chairman for international investment. please welcome him. [applause] the present of the japan external trade organization gendreau in new york. it's a company that monitors business conditions for japanese companies in north america and is always looking for new opportunities for japanese companies. peter fannin is here with us vice president of panasonic here in united states. [applause] the president of torah industries america which is building the economy through generating valuable ideas technologies and products. welcome. [applause] and finally the executive advisor of toyota motors. of course no panel could be

complete without toyota. dennis what i get us started? >> thank you john. on the half of the organization for international investment it's a trade association with more than 175 global companies with u.s. subsidiaries but ever like to thank the governors as well as the nga for giving us opportunity to talk about such an important topic. what i would like to do is frame the issue for direct investment in the u.s. and then also look at the specific lens two japanese companies who have u.s. subsidiaries and the tremendous positive effect that they have had on the u.s. economy. let's start by framing for direct investment in the u.s. or fdi. as you can see more than 24 million jobs supported through foreign direct investment that the u.s. subsidiaries of global companies about that more than 6 million

workers directly employed by those subsidiaries say you have another 18 million and to larry jobs silly multiplier of 3-1 which is quite conservative in economic terms. from a compensation standpoint studies have shown that the subsidiaries pay wages that are 33% higher than the normal average in the united states. now if you are measuring the historical and flows over time it's been more than $2.9 trillion and then if you think about the market share of those inflows the u.s. has 23% of the market share which is a positive figure no doubt that is actually down from the year 2000 when the u.s. was actually capturing more than 40% of those global inflows and did my experience what that shows is it's a very competitive global

economy right now. countries, regions and as you know states are fighting very hard for economic development and economic investment and i know as we go on we will talk more about what we need to do to make sure that each of your states has competitive been seeking foreign direct investment. if you talk about what the impacts are this fdi is interesting, you look at manufacturing which is a crucial part of many of your state economies. pound for pound foreign direct investment shows up very well and the manufacturing sector particularly skills manufacturing. among the fdi community actually 37% of the up to ag jobs are in the manufacturing sector and that's disproportionally higher than the regular u.s. economy which is about 9% through 2 million manufacturing jobs provided by foreign direct

investment in the u.s. right now that's 18% of the manufacturing workforce in u.s. for basically one in five manufacturing jobs in the u.s. is the result of global companies operating u.s. subsidiaries. it's because of that highlights manufacturing is the key benefit of having positive policies seized. policies. likewise from innovation standpoint research and development i think u.s. subsidiaries of opal companies all show show up well pound for pound. u.s. subsidiaries of these global companies spend $53 billion annually on r&d and that 16% of the r&d spend in the u.s. right now if you think about fdi companies as being 1% of u.s. firms you can see what a disproportionate investment they're making. lastly exports which is i think one of the good stories and one

of the untold stories about foreign direct investment in the u.s.. global companies invest in the u.s. often to sell products around the world so it's no surprise u.s. subsidiaries produced 23% of u.s. exports i know we will talk more about the positive effects that japanese companies have had that japanese-based affiliates produce more exports in the u.s. than affiliates of any other nation. just a little bit about my company and our story foreign direct investments, zürich is one of the largest insurance companies in the world and we are proud to have been doing business in the u.s. for more than 100 year starting on state street in downtown chicago and we are about to move in october tour north american headquarters in schomburg illinois which is 15 minutes from o'hare. you're all invited to the ribbon cutting. please see me afterwards. >> that's what they fdi in

insurance premium buys. >> it set in over 700,000 square foot facility at the cost of war than $40 million providing more than 2000 construction jobs including 700 vertical construction jobs. it's a sign of the positive effects that pro-fdi policies can have on the state economy. as part of our work in deciding to build their new headquarters in schomburg we have an economic study commissioned by the university of illinois which showed we had a $1.3 billion effects on the state economy each and every year. by way of metrics we have about 3000 employees in illinois and another 7000 around north america and another 40,000 globally. there are good stories to be told. if we dig deeper particular in the positive story with respect to japan if you look at the historical inflows of japanese

companies that have invested more than three night 73 billion dollars in total over time making them the second largest investor in the u.s. economy and if you go back a year or two ago in 2014 japanese companies invested $34 billion in the u.s. economy which is the second-most behind the dutch but in 2013 japanese companies invested 44 billion in the u.s. which was number one for that year. so it's a very positive story. obviously japan is a very powerful effect on the global economy and as you can see the amount of outward foreign direct investment they have had globally in the white bar chart has been rising over time totaling $1.2 trillion in 2014 and the u.s. has done a great job of attracting that investment but at the same time

if you look at the red line at the relative percentage of japanese investments the u.s. is falling behind so the red line shows in 2000 we were attracting 87% of japanese outward foreign direct investment and that is now dropped to 31% in 2014. one of the questions we will explore as we go along is what policies can we change to make u.s. more competitive in attracting this kind of global market share. just to dig more deeper into some of the japanese numbers of very positive story or japanese direct investment supports over 800,000 u.s. jobs and those workers earn over $65 billion in total compensation. if we move the lens to manufacturing again a critical part of any state economy the investment supports 348,000 manufacturing jobs and that's 43% of all japanese inbound investment and turning to the export side companies coming

into the u.s. to invest to sell their goods to the rest of the world japanese companies exported $69 billion for the goods annually and invest almost $8 billion in r&d. that job is just frames the issue and is very active in creating a level playing field for global companies who want to do business in the west, what we call in sourcing companies. the very positive story and with that i will turn it over to you. >> thank you dennis. i want to get each person on the panel to give us their assessment of what they view of opportunity in united states for japanese investment as quickly as you can can't. i want to get a quick comment from the governors who are here and i want to have an opportunity for you to interact because i know you have to go at 3:30 and i don't want to disrupt the schedule but i want us to begin our good footing here

between governor to governor relationships and governor to governor communications because i do think bypassing the middleman in this case washington d.c. has apparently had some great impacts already and we can see some of those right here before our very eyes. >> thank you. the u.s. has been significantly increasing so i will talk about the background. in december of 2012 the

corporate profit at the japanese company has increased more than 30% in two years and now he will see the data for japanese investment. why? gendreau has been collecting oversee activities for 25 years. in the u.s. more than 80% of japanese companies have positive business profit and have higher than europe and asia and china. japanese investments to the u.s. have significantly declined and now it serves asia and europe and it still maintaining high levels. taking account of the economic

situation in and this trend will continue. when i have top executives at japanese banks, their lending the money to japanese companies. it's only increasing in the u.s. some banks loaned to the japanese company and increase 50% in just three years. lets stop on that fact rates interesting that bank loans are stalled on investment everywhere in the world but the united states and with interest rates this low it would seem this is a boom that anyone in the united states could take advantage of the hold that thought right there. peter, let's get a quick outline from you what you think the principle opportunity is here in the united states for japanese investment. >> i might mention first off while bank loans are positive

there is a threat to further investment for foreign owned companies in the u.s. under the proposed irs recommendation so-called section 385 which would treat loans from your own parent company overseas has equity and in turn raise your tax up a geisha and so companies like mine worry a great deal about whether regulations like that that are intended to stop and versions quite understandably trying very hard to ensure that we can maintain here in the u.s. investments that we need and we don't want them out flowing but at the same time we think this regulation is gone entirely too far and we hope the irs won't rush to judgment into this calendar year which they are currently planning to do and will rethink how things are defined so that companies like mine which literally lie on investments from our parent company in japan , for example to build big ego factory with tesla which

will bring nearly 3000 new jobs to nevada just announced that job fair two days ago, to buy houseman refrigeration company invest hundreds of millions more in that activity in missouri or two by audiovisual software companies in texas but frankly we are hamstrung if those regulations go through the way they are proposed. that is the downside. the upside is the u.s. is perhaps the only place, the primary place. these other global economies are slowing or stalling dramatically and ours is still improving albeit not as much as we would like and this is the perfect opportunity to take advantage of investment in the u.s. and my company is constantly looking for possibilities there. >> there is employment and skilled labor issues that are essentially permanent but there are cyclical issues that relate

to this particular moment in time in a very british us for investment. give me your your sense about the principle opportunity as the united states is you see it. >> it is a company producing the materials. that is conjured into the consumer direct way but as long as the u.s. has positive growth in some sectors of industry that's it business chance and also the nature of -- so they energy advantage is a strong benefit that we can enjoy in an area.

common composite is used for aircraft. there are two big giants in the world one is in the u.s. and one of siniora. fortunately the 1 billion-dollar investment is caring on its south carolina and that is supporting the program. >> some great experiences in the south and again working in the background as long as there is the industry that you support are going to be positive investments. >> also the activity united states. >> nuclear energy.

>> great and toyota, give us your view and we will get the view from the governors in here from the audience here. there you go. >> almost 60 years has passed since we started a business here it's a long time and local long-time commitment and growing together with the community. that enables us to grow together with the people. the short term advantage a lot but at the same time permits -- to ask from the community and the commitment also benefits. later i would like to touch upon the issue of workforce

development. that is also beneficial for us and at the same time i believe the community and the state thank you very much and we'll come back to all of you. this is your chance governors before you leave. if you have questions for our investment panel and we also want you to interact with the governors. do any of you have a question in your mind how come toyota seems to favor kentucky all the time and what's going on there, how come not me? this is an example and a time to assess questions and the governors over here can maybe give you some advice in dealing with the investment with business folks. any questions? >> and fortunately we had to to hop off him entirely so this question may be answered after we put put all of us have people in this room who will want to hear the answer to this. was that a rhetorical question as to why to it at chooses kentucky?

>> it's pretty self-evident. >> we have a wonderful relationship. the question i have for each of your respective companies on investments, electronics automotive subset for a, what is it that not any individual state might do but what is it that states period can do to make it easier for you and your companies to make investments in the u.s. because there is great geopolitical unrest and there's this opportunity for people looking for safety and there are barriers that exist that may be its taxes and maybe his workforce development. i don't know what, if you could tell us from each of your perspectives what is the one thing or two perhaps that what those out of the way there is a repatriation of dollars are the ability to invest without paying taxes. what are those things specific to state so that we can individually and collectively start to address them and make

it easier for you to do business with us? >> that's the essential point before you leave i want to get the governors here from japan from hiroshima governor yukos sake is here. please stand and the current governor of tottori prefecture in japan. did you want to say something in particular to the american governors before they leave? >> i wanted to make one point. the importance of the relationship between the local government for attracting investment and growing those investments and businesses. this is actually a case with mexico. we developed very good

relationships between the mexican state and the investment and jobs that are going -- growing very rapidly. that is why we are looking forward to the u.s. states so we are looking forward to further discussion about those. >> so that will guarantee a callback, right? maybe not from abe's office but from your office. >> governor and colleagues i am very grateful to be here because of the great hospitality and your leadership has allowed us to be here today. thanks so much. first of all i would like to

express my condolences about nice, so this summer we have a special guest in hiroshima. the world was permanently destroyed but in the city children will go through their day in peace. this is a statement of president obama. the statement by a japanese people in the statement was conveyed through the world global network. we share the same values. we are attacking the same -- a job creating and social welfare and health care and things like that. we can share best practices

between the united states and japan so we do hope to enhance this type of conversation and dialogue between us. >> to amplify that the weapon that rights terrorism is corporation, not isolation and anything that can reduce the propensity of people to live in isolation to reach out and embrace communities that is the antidote to terrorism. governor branstad. >> i wanted to mention i've been to japan 16 times through the first time i came to japan mike mansfield was the ambassador and he did a great job of convincing me we need to build a strong relationship but even before it became governor we have a sister state with yamanashi prefecture going back to 1960 and i found the midwest, u.s.-japan

association which represents japanese prefectures and american states in the midwest and also companies from both countries, that has been a great vehicle and it's going to be in missouri this year. .. over these very many years. thank you very much. >> i gather you folks have to go. thank you so much for your time. i know that our japanese governors wanted to give you a sense of respect and thanks for your hospitality here. thank you so much.