i suspect that his line of communication you should keep the eye on. >> pennsylvania legislative liaison pending what we know the rest of the administration. >> i see somebody out there that question. we will go to my left and then my right. >> donald trump broke many of the unspoken rules in the campaign around things he said on things that are considered not ok. peter says listen to any maintenance as this procession of politics. the rules of separating his own personal interest in the institution of the office and not putting his investments in a blind trust. curious if you think the republican leadership will try to influence him on that to maintain the codes that are being considered sacrosanct for the democracy. >> i have no idea what my

foreign colleagues are thinking and leadership for alcide. my own opinion is he needs to do that. he gives to go when nds transparent as possible. that is the essence of who we are as a country. i've covered the world and i've seen these governments whether it is brazil, and china, europe or otherwise, the middle east look to us to know that things work here. so much of that. people play by the rules to judiciary and the institution and certainly the transparencies of our lawmaking process to guard against anything. even having the perception of being unto her. this election showed us the clinton foundation and the rats and all that sort of hung around that controversy, did have and

it the notion that things were too well-paid. my counsel would be certainly have to be transparent, must put an separated out from your official duties. >> first of all, thank you for your comments and insight this morning. we've talked a lot about from the rest style, from the rural areas. in your comments he said voters have generally been accepted into the republican party. one of the other things we've taught in trump's rallies from that group of voters were comments that were negative towards people of other races. people from other countries, people from the algae bt to community. i would like to now how those beliefs and views and values fit into the republican party moving

forward. >> which beliefs? >> views that could be considered very recess. negative comments about people from mexico, for example, this kind of negative comments that we really saw at the trump rallies and people coming out of the rallies. >> there is no room and the republican party for any of that. i think that using president-elect, his campaign to announce a lot of that. it didn't always get the coverage that it should have and perhaps early on it was that thick enough and come in. but i do think you saw leaders on the hill, paul ryan, mitch mcconnell and others denounced those types of statements and sentiments as soon as they arose. my position is absolutely no tolerance for any kind of racism of any kind of nationalism, and the anti-semitism of which i certainly have some

unfortunately some experience. again, zero tolerance i'm not and it should come from leaders when it occurs. >> we've got just enough time for two questions. start here and then the lady in red. >> ranks again for coming. it's great to see you. i wonder what you think will happen now with obamacare. just a small question. >> how long do we have? no question when i think astarte been discussed and it was probably in the works with it if romney had one. the reconciliation packages in this fiscal year geared towards obamacare repeal and replace. it is very difficult and then you will happen the next fiscal year and reconciliation package geared towards tax reform.

we talked about the need for that in terms of the infrastructure funding. there is clearly a huge problem. i get to see it now from the business side. companies they work with and whether it's in the insurance arena, the medical provider of reyna, hospitals, this is a very challenging environment they are operating in. especially if you look at the exchanges and look at individuals who are receiving the premium hikes, which has affected the private markets, insurance markets and the left. there is a real need to fix something, even if hillary clinton were elected, she would've had to go to the congress and pick something. these things are spiraling out of control and downward. there's a great opportunity out there for the republicans to step up and finally coalesce around an obamacare of replace.

again, devil is in the details. when i was on the hill worked a lot with many of the positions us well as committee chairs to try and gain consensus. i think of it there. i really do. to me it is probably going to be -- >> i promise the lady over there. >> or chastity, congressional correspondent or the hispanic outlook. i'm so glad you mentioned the kids back because they wonder how many journalists know that republicans want to pass a law that legalized the children who were children who are brought in illegally and the democrats completely stopped in 2013. i was there that nobody wants to write about it. the narrative is such. that being said, there are other piecemeal deals that republicans

have proposed over the years that never have been a coverage because it's only about comprehend it. so do you think now that there may be a chance for some of those piecemeal deals my key verified for expanding the best pieces are getting green cards to some foreign students. over a million foreign students down in the united states this year. so we start legalizing i start talking about numbers. what about those issues. >> i hope yes there is a bounding together with some of these larger initiatives that president-elect will be about. it's always been a challenge because people buy definitions they piecemeal is somehow a compromise because he's got a vision here. you're compromising the rest. i don't agree with that as every date each month you keep going you ultimately get there.

i share your sentiment. >> view reflected president obama that it's not a straight line. and a spirit of new day and new hope and historic phrase, i want to present u.s. banks of the roll with the rollcall may congress grade again. >> that's awesome. >> thank you, eric cantor. we'll take a short break. [inaudible conversations]

[inaudible conversations] [inaudible conversations]

[inaudible conversations] [inaudible] >> thank you. it is good to be here. if you were to go back and look at the tape from two years ago when i was on a panel, you will remember that i said donald trump would be elected president of the united states. that's not true. the tape is lost, but you'll just have to believe me. i am excited to be here today not only because the election is over and we are all still living and breathing, but i feel like we have a great panel. agnostic group of party strategists, not the ones you

see on cable news and i'm not sure what they do for a living. these are the people working on this race is behind the scenes, working hard for months now, years going back, but this cycle and i'm excited to bring down in front of the curtain and talk about these races. on my far left, not an ideological name. the democratic campaign committee. martha may connect, the two-time director for the democratic campaign committee although not the i.e. director this cycle of, but she is playing that role today. the national republican committee. the director for the senatorial committee. i think i got all that bright. what i wanted to do today is peeled back the curtain and how

we got here. the first question for all of you, were there any clues and would have led you to believe then that we had on tuesday night. >> for us, for jessica and myself that's a little bit hard to answer because our districts are peace now. they would see the whole picture in new hampshire and wisconsin. ours were kind of piecemeal so it's a little bit hard to say if they miss something in the data. i would be curious as well as

how well trump performed in our district. iowa one. we had hitler could win in that pretty handily and today i read one of the morning orders that they -- something we missed may spare and a data. i don't really know if i would say that we missed some and strategically it was sort of a parent or even in retrospect. you look at the polls and no poll is right 100% of the time. you look at what it says an interpreter to the the best of your ability. it is not that you misunderstand. to date msn fan. that is a deeper question that will take longer to try and answer. >> the national polling, public polling, the major network polling, everybody had turnout

assumptions that assumed higher democratic turnout and a slightly lower republican turnout. it is safe to say based on the numbers from tuesday. it isn't specific to me. it's not specific to the house or senate with internal polling for public polling. across the board the majority of the research done was off on the turnout model. it's okay to admit that we made a strategic decision with the best data that we had at the time, but the turnout model was wrong and that is an important thing for us to acknowledge and to learn from going forward. there is always in these elections particularly that we've seen time and time again with a significant group of deciders and in this election we were looking at a lot of data

that said we were away named or tied or down but that we had a significant group of undecided and these undecideds had a very specific role to play in the outcome on tuesday. >> i know one of the best case scenario is dgc would happen on tuesday at the magnitude and scope, what would you say? >> it has interest for us because we were watching from very early on that trump was going to kill us on the ballot. we were polling and nasty and not affecting our house races. at times i thought am i totally wrong because we really weren't seen it. our after action reports after the 12th cycle where we did miss the boat quite significantly in a lot of ways. we open our screens wide up

which were typically voters. we were doing much larger cell phone numbers than we had previously. our polling were showing us on the house level that a lot of our folks are going to be affected so much by the trump stuff and people were saying they were. >> to traditional polling has is stretching the margin but that the thing they give us more confidence, not that we will hold the minority, but some of the model analytics we had. -- it is trending in the right direction and also some of the data at a certain dates. absentee and early vote. we will know more when all the files come back in january and february that there is a key turnout problem in several states.

>> because of the senate not to overlap significantly in some ways, talking about the senate races, what were you seeing with the trump clinton numbers that may lead you to believe they could have been elected president. >> in pennsylvania, north carolina, wisconsin and ohio we finished ahead of trump and it's interesting if you look at the results between presidential, they got their different paths. pennsylvania for example that over farmed trump. so we always knew we would run ahead in certain states. it's just a matter of where you close the gap. to say we thought he would win on election night i don't think anyone will say that. we knew he was on the hunt and had been getting significantly stronger in the last 10 days. >> i don't think this is something that we missed, but i

want to sort of double-click on the political gravity of a takeover for down ballot. would be an in minnesota three and out by 10 in the head-to-head at the 12, but donald trump was losing the district by 22 points. history would show that a candidate can't over perform that much. i don't want to save something that he amassed, but it was a calculated gamble that at some point political gravity would take over and that is why one of the most interesting things we will be able to do is when we finally get the data back, find out how the presidential actually ended up doing in this congressional districts. if you're making this gamble that they are going to over perform the ticket by 20 points but trump loses the district by six points, then your gamble

will not pay off. >> looking back, played thursday morning quarterback, as you have made strategic changes? in today's roll call, my colleague wrote a story about the house and she has a quote from the director of the house majority pac and she said had we seen more accurate numbers of what the turnout looked like, we may have made some different spending decisions they may not have talked about trump so much in these districts. how does that jibe with looking back now, the democrats go too much in on trump? >> they should be drawn and quartered as well. here's the fundamental point about house races. it is almost impossible to break out from the national narrative. if you look at a race in new

hampshire, we were buried under 135,000 pints of television. in week one there were 57 different political ads running. when you are a house race, now with the outside money there was $180 million in pennsylvania. they can sort of create their own space and tell their own story. to run something outside of the national narrative, you need a unique leave disqualifying -- we spent $5.1 million. you cannot do that in every race. for house races you are much more at the whim of what the national conversation is and we made the conscious decision that should have domain into that because that is really the only

path we are going to take. in rcc did this as well. as about the iran deal and more national issues and local things. for a couple candidate pitted local things. you have to put your shoulder into -- you have to put your shoulder into that because you are very much at the whim of the national race. i don't think i would go back and do anything differently by any means. we just thought that trump would not perform as well. if you could go back and say what would you do strategically differently, maybe not have donald trump runs for president or something like that. all that to say we leaned in and we will get to appoint with so much money in the systems that

house races are basically going to be a parliamentary election. we are going to longer days, the john ferris of the world are going to be gone. you are very much going to live and die by your party and you just got to bring into that. >> one of the fascinating things is it's basically about people at the presidential level by electing donald trump when it's almost a status quo election. we are looking at a cluster of the senate for six in the house, but that is a fairly static election. >> early in the cycle we were doing early polling the entire time and the democratic candidate how much he or she is similar to a similar to their liquid on a variety of measures and early on that was fairly

generic. but as things progress on the senate side, we did make it area much about local issues and get away from the national narrative both for our candidate and for the opposition candidate and they took on unique bread. we will feel it is separate from trump specifically. >> we had the exact opposite. basically some sort of error paulson should the same ideas and policies and however you want to do it. it was like chopsticks. it just kept getting closer and closer. >> i totally agree with what channel said. your plan is so accurate about the volume of ads. if we do and into the narrative

we will get totally swallowed and in iowa three with a lot of testimonial ad. they tried to tap into sentiments in our polling that we've talked about how emily kane was like hillary, which is not something we did in a lot of places but we see back to a big issue there. we did try to bring these issues back to the local level and i was really hopeful for us. >> the second biggest story, is there anything you think your site could have done differently? >> to your point, we've had a number of ways elections. one and a member of places he wasn't expected to. if you look back to 2008 in the first obama election, republicans lost eight seats in the senate.

on tuesday night it took until yesterday that the democrats picked up two seats in the senate, which is hard to do when you are moving into headwinds. looking back to illinois and new hampshire, are the druze and certainly we have three, four new women of color joining the u.s. senate. ..

>> so one of the, one of the many feels like points of strife within the republican party is about expectations. when republicans came in the majority there was expectation among some base voters, all right, now even though president obama is in the white house, we'll repeal the affordable care act. when that didn't happen, it created primary issues. what did you see in your data this cycle? what are base republicans expecting a president donald trump and republican congress to act on next year? >> you know it is hard to say in some respects because we tried to focus on keeping these things localized. there were places, my first election with the committee was 2010, that was totally

nationalized election. we ran every on national issues. we realized obamacare was deeply, unpopular there. that was the main issue we ran on. iran deal, certainly a big touch point for a lot of people throughout the country. we definitely focused on that. but what we really did try to look at smaller, localized issues, really digging on research. i wouldn't say our polling told us there was one overarching issue or two even that people were really angry about and really wanted change on. that is not what we thought the election was about. >> back in our polling across states, the issue people cared most about and stuff that people cared most about were totally different in various states, much more so than '14 and '12 which was surprising of a presidential year. seeing that we ran very candidate specific, state

specific issues and campaigns. so i think the big thing here is economic issues, pocketbook issues that millions of americans clearly feel like washington left them behind. >> all right. so we have a divided country. some tension. i'm going to force you to, all four of you to acknowledge a strategic decision that your counterpart or your the other party made you have to admire. >> bob dole -- hands down. >> tell people. >> i will tell the story. i've been in politics for a long time and it was the, one of the single sort of bravest moves i guess if i can, meghan doesn't have to comment on this at all, because i read on the internet and some people in her party might be upset with it. they ran an ad in illinois 10, national republican campaign committee ran an ad basically said bob dole is independent. and he will stand up to hillary

clinton and stand up to donald trump. that might not seem like a big thing but, for a party committee to say that a member of their party will stand up to their presidential nominee, that is a very politically-risky move. in our polling it was right move, right strategic move. that was bob dole's only path. he came up short, only path if he gets 10 to 15% of democrats maybe in that district, a little bit more. that was his message. that was right on message. when i saw that come up on "the national review" and i you saw the ad, i was, wow, that is putting any sort of political calculus or, oh, what are the, chattering heads in my party going to think, blah, blah. saying, like if we want to win this race, this is a hard path. this is the only way we get it done. and be damned with whatever blow back i get on internet or right-wing sites.

this is path to victory. it was executed well. but he came up a little bit of short. right in the tenor of the campaign. i would encourage you all to check it out because it was, you know, you can say flippantly profile in courage but it was one of those times where i think a lot of us, we don't make the right choice and we say, what is the right strategic choice versus what is the politically expedient choice. so that was, i mean, we had so many email chains with our consultants, with strategists in our party, saying, wow, they're doing this. >> polling going into election day in illinois 10, hillary would win by 20 or 25. it looked like sanders would win by four. >> i'm sure she did. brad ran a great race. i think brad will be a great member. >> again. >> again. it will be like the shea-porter thing back and forth. that was a very smart move. >> martha.

>> i think there is a tendency when you're feeling like you're in the bunker, which i assume that in a number of senate races the republicans felt like they were in the bunker, sort of coming into labor day, because they are feeling, like they were down, right? there were moments in time, i think we have to acknowledge, there were moments in time the clinton campaign was riding high. it didn't happen on tuesday they were riding high. there were moments coming out of the debates. there were moments when trump would step in a dog pile. there were things that happened during the campaign where democratic candidates moved up in the polls, things were within our control and things that weren't but, when that happens, when you're in the bunker and you're feeling like there is no way out, the very often, the knee-jerk reaction to that is to go to the stove and crank it up to power boil, go after your

opponent with the hottest, most personal, ugly negatives that you can. and sometimes it works and sometimes it is the wrong thing to do. so i will say, in wisconsin, where i assume ron johnson was underwater many, many moments in this campaign, he, made a strategic decision sometime around labor day to invest more in positives, and although we all sit around talking about elections and i'm sure many of law meanted negative ads and say you wished people had a reason to vote for someone and wished there were more positive ads, when you're in that back and forth and in that decision-making role a positive ad seems like a gamble not worth taking the risk. i do i this, i will give credit, in wisconsin in particular and maybe other places, ron johnson invested in a positive message in september and october, that i think was the right thing to do strategically and i definitely felt this coming out of 2014, that it is when you are feeling

the heat, the sort of tried and true path is to turn up the negative on your opponent and sometimes the right thing to do is actually take a step back to begin to tell a story about yourself because i think we assumed voters are paying attention, a lot more attention than they really are. making sure we're always making sure, not always, in every race but in many races making sure we're taking the time to give that positive story, i think it is important and i will say that i think in wisconsin it was a smart move on ron johnson's part that sort of flew under the radar screen. >> i think there were several things. i think the buying strategy is always so fascinating to me in the cycles. buys so early, if you look back at the money that was spent, i think that is really, really wise. i think it is interesting they make strategic decisions which candidates they spend money on and which they won't.

florida 18 was a perfect example. randy perkins, would be one of the richest members of congress we would have had. they made a decision not to spend money on the race from day one was one of the toss upraces. that was smart allocation. as much money we raised we could always use more. always feel it is not enough. that was a smart way to different vie -- differ vied and conner. minnesota 2 some. one of those members, you all have a lot of members that conservatively, that sort of match the district. makes it very difficult for republicans to attack them on issues because there are things they are voting with us on. rick is not one of those people. he votes with the democrats. he votes the party line and it was really interesting to see an ad strategy change from this cycle, from last cycle where it was the same two candidates.

they attacked stuart mills the same way, it was very smart, obviously worked, they made rick nolan look like anybody's grandpa. he was nicest man in the world. the ads were fantastic. it made it hard for us to keep beating this negative ideology which really was true but when you contrasted it with the ads that they ran it was very tough to break through. >> in the minnesota 8 district, we'll get returns final but donald trump probably won that district which made rick nolan's path to re-election more difficult. >> correct. daniel. >> i think decision to cut off patrick murphy in florida is one a lot of credit for. they went against the bernie sanders base in their party. they spent money in the primary against a popular, populist primary opponent. they invested millions of dollars and staff time and everything else to prop up double a candidate in major league game and walked away from them eventually. that took a lot of courage. >> martha, to put you on the

spot, how much tension was there between making that strategic decision of hey, florida, we can better spend our money in north carolina, missouri, to parts of the party who are saying we have to stop marco rubio now? you have to look beyond, talk about tension between the 2016 realities and what senator rubio might do in the future? >> well, you play the game you're playing, right? i think it is clear that the committee, i will say, i wasn't in the room while these decisions were made but i can look back in hindsight and say that the money that was not spent in florida and, you could say, spent in new hampshire, or nevada, like, these are tough decisions when you are looking at a spreadsheet as jessica said. feels like a lot of money but when you're looking at spreadsheet of money and states and amount of money it takes to run a week of television on your states in your spreadsheet, it goes quick.

in state like florida which is extremely expensive state, excess of 3 million-dollars a week to run television and you're balancing that with all of the other races that, where you're needed, it is a tough call. this is a tough business. i think that if the money, that wasn't spent against rubio was spent against kelly ayote, it is, that is the payoff that you have to make. that i do think it is important to run the race that you're in and this was the 2016 race and not the 2020 race. and so, you know, i think they made the smartest decisions that they could with data and information they had at the time. i don't think there is a lot of second-guessing for that. >> can i? >> sure. >> one thing unique about this job serving in other roles of the committee and it is thankless job because you're making very, very difficult decisions. we are independent from the committee.

so we've been working with this group of people and gaining from their knowledge and having group discussions about what is best. all of sudden the wall goes up and you're shipped off, you can't have anybody. you have a team and large people on the committee are separate from them. this types of funding decisions are very difficult. that i will we will rejoin the world and look at these name members in the face and have their trust and respect and really, really tough thing to do. >> it is the most isolating job in washington. if you're in the committee, dealing with candidates, dealing with campaigns, dealing with members and all their teams. there is a lot of interaction. if you're a super-pac, dealing with all the super-pacs. priorities usa and working with senate majority pack and unions and emily's list. >> people might not realize outside groups can coordinate with outside groups and can't coordinate with official. >> right. there is three separate buckets. there is the hard side,

candidates campaign committees. there is the super-pac world where they work together and ies. we're all alone. you are sort of on a complete island and as jess says, some of that is freeing, right? some is very isolating when you talk about strategic decisions. you are making decisions on how to spend. we ended up spending $79.4 million. it was between you and your team, and that is, you know there is a lot there. >> i have one more question. i think we'll have time for one question from the audience. so whoever gets to maybe the microphone i can see first. but, my last question is, we have a presidential candidate who won, who was dramatically outspent on television. his own campaign did not have a ground game to speak of. how, are we, what changes will there be?

has campaigning changed going forward into 2018? >> can i make one point to what she said though? donald trump was outspent on paid media on television. his share of voice on television was exponentially larger than hillary clinton. so i think that is a, that is a very important factor when you're trying to extrapolate on, god knows that for colleen deacon and new york 24th, "the today show" wasn't doing three segments a day on her. so before we start to make this blanket statement about how campaigns are changing, like, you need to realize if you were looking at television as a medium, the you flip on your tv, the amount of time donald trump was on tv. versus hillary clinton earned and paid combined was much, much, more, is much more of a complete picture. i just want to double down on that. >> good point. i think campaigning has totally changed in 2018 if you have a candidate that is celebrity for

30 years, billionaire around dominates national news coverage. >> right. >> so yes it has changed. >> i will say donald trump, because of one thing that i think he was very smart with, he realized with 144 characters he can drive the news cycle. not always for the good but i think that he sort of embraced that. that is following that has been developed for 10 years of "apprentice" and home alone 2 and 20 years at miss america. before we start saying hey, random house guy who is running in kansas, you really shouldn't do television. donald trump didn't. >> everyone, candidates up and down the ballot tried to replicate model pretty much universally failed. >> right. >> i'm hoping that you all stay involved in campaigns going forward. do you think you will hear from candidates, have to explain all of this to candidates, donald trump didn't do this or that, so why do i have to go you there the normal steps that

candidates have to go to, go through? >> we can deal with that what we had with president obama when he won in 2008 was that all democratic candidates thought you had to do to raise money, put up a web site and send few emails. president obama the big story coming out of that, online fund-raising was future. it certainly remains a big part of how we raise money for candidates but for a while, we had people who didn't want to do any fund-raising at all and put out a website and money would come. each cycle there is a moment in time where people sort of take lessons, the right lessons or the wrong lessons and you know, test them out the next time around. i certainly think it is going to be less likely that people who are running think that following the trump model of campaigning will be successful for them or healthy for them even. it will be, what may change is how the press covers the president, right?

and how the press covers the administration for the next two years and whether donald trump as president will keep tweeting and go around more traditional mediums of talking to the media as president, but i think it is pretty unlikely that people will say, i want to run and i'm going to follow the trump model. >> just talking, we'll get to the question, daniel, talk about what the committee did with digital and tv, how you handle those on ie side. >> it is pretty technical, you have thousand points of television and change your message, you however much cable behind that great is what it is. totally through that model out. spent more on digital that we had in the past. changed not thousand points on broadcast would we reach aggregate impression level across screen. so we, for the first time totally married our digital and television media plans.

which allowed us to buy fewer broadcast points on higher-reach programing and use cable and digital to drive frequency. that ability to deliver that much more of our message to the target audience big part why we overperformed trump in certain key areas. >> helps us in very beginning, do danielle's point we spent more on digital than we ever had in the past. smartly we created formulas, rarity get leftover, typically honestly is done, looked how expensive cost per point in the media market, how much money the candidate had, how connected and wired the district was. we assigned what we thought would be a logical spend based on lots and lots of factors, we were looking at digital. at same time looking at other traditional mediums, rather than left overmoney. certain places like maine 2, that is not very wired district. hard to get a message across digital there.

there are other places commuter districts, virginia, you have to have a big presence online. >> anytime i think about main second district i think about being, we were in the "roll call" offices years ago i was quarantined with a candidate from main 2, john nutting we had anthrax scare. >> i used to work for john. >> he had a great moustache. i spent at lo time of with john nutting with anthrax scare. >> right outside of augusta, state legislature. he had a dairy farm. >> dairy farmer. >> i worked on the farm, not the campaign, milking cows. >> looking into the future, i know a lot of new members of congress are, you know don't have political experience but the republicans have done such a good job building bench at state legislature level around governorship level, when will the democrats realize they need to start focusing on that, especially to cherry-pick candidates for congress? >> the dlcc did not have a bad night all around.

i think we picked up a number of chambers. certainly chambers that flipped. it was not a clean sweep on the republican side in the state legislatures. i think nevada picked up both chambers about. out west -- >> alaska house i believe went democrat. >> there is recounts happening in arizona, that have that, those chambers. on the brink. so i actually, not to challenge you but i do think that is still time to sort through winners and losers there. but, i think there might be some democratic bright spots there. but i, look i think it is important for lots of reasons for us to fill the pipeline with people who are strong candidates, represent their districts wisely. takes the job seriously and frankly have ambition. you know, because i think we have, we have a lot of, as you know, we have races every two years. we've seen change.

i mean six seats in the, six-seat flip in the house when other party takes the white house is not something to look down on. it's a big deal. you know, it is significant. and i think that, you know, i think we have to continue to make investments in recruiting good candidates at state and local level and then supporting them. but i think you're right to say that congress, there isn't as much change at congress, at congressional level as our districts, redistricting have made the districts more conservative or more democratic or more republican along the way but i do think that there is a lot of important work happening at the state level and we have to stay committed to it. >> ty, do you have final word? >> i want to make one point about that and down ballot stuff. the way that our society is moving in terms of information disaggregated.

probably some of us live in communities don't have local newspaper. particularly if you live in metropolitan area. wjla is not covering state legislature. we're all in politics so we know who our state legislature is. many people don't. i think democrats fall victim to there have been two waves in the last four years, 2010 and 2014. and with them, nobody knows who their state legislator is. so they see d and r. they wipe out the ds and bring in the rs. with president trump, bad midterm in 2018 or bad midterm in 2022. you will see more dems and republicans. not just don't democrats care, we can invest more in down ballot. democrats a lot of times don't realize the power of statehouses, particularly our donor base, often doesn't realize the power of statehouses, what i would say, not as much as you don't care. just voters don't know who they are. they see a d and r. when the r wave comes, there

will be more rs. >> my mind is twisted enough that i am already looking forward to the 2018 elections. >> go to hell. [laughter]. >> thing santa claus, it will be huge. i wear a couple different hats. please stick with "roll call" and politics coverage. i'm also editor of the rothenburg and gonzalez political report. if you want a three-month, free trial subscription, talk to beth in the back, in the back corner. but i really appreciate you all for being here and giving us behind-the-scenes look. thank you very much. thank you. [applause] >> this concludes our morning session. please join us in the foyer for refreshments. next session will begin at ten minutes after the hour.

[inaudible conversations] >> so the state conference on the policy implications of the 2016 election in a break now. cq "roll call" is hosting this discussion with journalists and policy professionals what to expect under a trump administration. coming up next health policy experts what will happen to obamacare under the trump administration and how washington could modify standards for key industries. donald trump on his plane departing new york city to washington, d.c. where he is going to the white house to meet with president obama. today's oval office meeting is symbolic start of transition of power. president-elect trump takes office on january 20th. president-elect trump is meeting with president obama at 11:00 a.m. followed by house

speaker paul ryan at 12:30 p.m. and now senate majority leader mitch mcconnell at 1:30. the trump transition team launched a website and twitter account as republican takes office. visitors to greatagain.gov an find information on trump policies and biographical information about the republican. the website looks it is looking to fill 4,000 slots for presidential appointees but doesn't have instructions on how to apply for those positions. the transition team, twitter account, transition 2017 posted its first tweet wednesday night. working together, we will begin the urgent task of rebuilding our nation and renewing the american dream. again we're waiting for the cq roll call conference to resume. here is some earlier discussion on the election results. >> hire is what it failed at. it failed to give certainty in

uncertain event. in a lot of ways that is problem with polling right now. we can go through the methodological issues. that is well-warn territory and something we need to think of as an industry but for all of you, you also think about what you are as consumer of polling and what you're looking for. i will say this boeing into this election as everyone called me, what is going on, doug, what is happening? the question isn't to find out what is going on or what is happening. to reassure them they know what will happen. to that end, i think that we created an illusion for polling, which is that, oh, yeah, that is happening down the road. because we've done this many polls and because we have this much data. we have certainty. and, for better or worse, polling has never been and isn't now very different from weather forecasting. the only difference each day new

opportunity for new weather and new forecasting. >> even on day of the storm, exit polls, got it wrong. we all went to, those of us in the liberal media elites and i will plead guilty to being a member. we all essentially wrote stories saying she won. that is what the exit polls told us we were safe to start writing. >> it is definitely possible that the methodological issues we talked about, which go beyond landlines and cell phones and online polling and all the rest, go to something else, willingness of people to take polls, will lead to most misleading outcomes. i will say briefly, i don't think there was people lying and saying that i'm voting for clinton versus trump. i think there is trump voter never reluctant trump voter but reluctant or difficult to reach. that is a problem we can't solve by adding more calls or by just

turning to big data and to higher levels of analytics. >> jeff, what is your view of the polling industry? >> i think we should separate exit polls from rest of the polls. exit polling has been disasterous i bad. they overrepresent young people in exit polls. there is methodological problems with exit polls. new york state which we lost by 13 points, last exit polls had us down four. getting congratulatory calls from the media losing new york by four. an hour later we were losing by 13. i haven't had confidence in exit polls from the very beginning. in terms of other polling, as campaign, when you look at what it is used for, i think that is the important thing. people want this crystal ball. in terms of a campaign, what you use polling for is not the horse race. of the horse race is least important part of polling. you want to allocate limited resources to persuade as many voters as possible. what polling will tell you, bernie sanders had hour 1/2 stump speech, right?

you can't cram that all into 30 second television ad. what parts are persuasive with segment of voters you're trying to reach? polling was effective telling us what we do in that regard. >> all right. let's move on and discuss what did the, in the aggregate, what do all the polls, should they tell us about where this country wants to be taken next? >> well, the most important polls is one we had on tuesday which is the poll of the american people. i think that is the one that we should look at in terms of where the country should go. >> one 47% voted for hillary clinton and 46% voted for donald trump? >> absolutely. . .

i don't mean this as an outsider from washington. i meet as someone who live here and is from your, but we talk about bipartisan compromise, people come together and everybody wants that. there's only one issue over the last 25 years that has had consistent bipartisan support and that's trade. there's only one issue in washington. there's only one issue that brings together sanders supporters and trump supporters and is the thing that is activating and getting people going more than anything right now and that's trade on the opposite side. people made the argument they just don't understand how trade helps them. at a certain point after 25 years of doing the same thing and sing the same result we had

to realize that maybe in washington we are not hearing people. you can't educate people out a different release projected forget what's going wrong. >> do you think the obama white house feels like it understood the american electorate to the end, and how our, what would be their message, what would be the the president's message to mr. trump today? >> he's coming today. >> it is today. >> i believe the obama white house thought they understood the electorate at least to the point of helping hillary clinton get the two under 70 electoral votes. until about a week and a half ago, and while you may have heard on cable news that president obama is having so much fun on the trail and let's play this clip and he's so good at this, and oh, my god he is the happy warrior, he's going to push her over the finish line, i saw something else. i believe i saw a president for

what he was, the campaigner in chief, 40 was leader of the democratic party for what he was. i believe he realized maybe a week ago that she was in serious trouble in pennsylvania, and michigan, in north carolina, in florida but i think what may be woke up the president or billy got it after likely site last week was michigan, and i think the numbers scared him to death, and you saw the president talking about the republic and the world is teetering on this election. a lot of criticism, but he says what is thinking and feeling. he does not posture a lot. i think that was really striking in his rhetoric on the stump last week. >> what do you think you will tell president-elect trump today entrance of, do you think you

will say here's what you need to understand about the country you are taking over? or will it just be a mrs. of constitutional responsibility for transition? >> i think the latter. president obama was very impressed with how president bush handled, and his team, handled the transition. was very impressed, though it was thorough, professional, very in depth and he said we were ready to roll on day one. they want, they talk about this ofor months and months, even whn secretary clinton was comfortably ahead. they want to make sure that the trump administration is ready to go on day one. they want the trump administration to feel is more prepared than they were coming in the door. i think that's what today will be about, whatever you need, what are your teammates, i'm here for you, i've told my team x, y and z, and that's what, he wants continuity to the greatest extent they can get that. >> thank you.

so the country, the base, right, the base of trump supporters and a collection of your supporters, trying something in what i guess i say they both want to rollback the economy to the last century in some way. that's not happening. so how can donald trump -- >> first of all i think the way you put it is completely wrong. in fact, is why people in washington subtly don't understand what's going on out in the world. >> that's what i ask you. >> all the things that are manufactured in the world are still being manufactured, just somewhere else. people are buying these products and the used to manufacture them. it's not like we are not making televisions. it's not like the days of buggy whips. there are tremendous amount of parts we all by. in many industries you cannot buy an american-made version of a product.

peoples and office products. they are buying these products. they are not making these products. i remember a very funny story bernie sanders went to china to visit and he went to a wal-mart in china and he was regaled by the american chamber of commerce about a great was we had a wal-mart in china. we were breaking into the chinese market. he said how many products in the wal-mart into a made in america? that's the point of trade. they said 1%. the problem is people see all the products. they are not making them anymore. look at michigan in many ways a classic example. if you go back and look in the newspapers you will see these 1950s sort of ozzie and harriet, track housing, cars and sobers but they're all african-americans. one reason why the hillary clinton in the primary and general election of problems in michigan, the black vote was suppressed, it was in that community there was a memory of an industrialized middle-class

of african-americans that has been decimated by these trade deals. they don't want to turn back the economy. they want to be able to make the products that the family buys. >> let me take this in a different question and get to the notion of what pollsters are looking at, which is how they feel about the economy, how they feel about their jobs. the reality is the promise of trade has been that you of better jobs, smarter jobs and more jobs than the alternative. that's the promise, you can buy things cheaper. people did not perceive either any sense of job security, and any sense of the job they have to do something they want to have for the long-term. you put those two things together and you have people who come most people have a college degree and some people without a

college degree have no idea what things look like in three years. to say to folks the answer is to have more trade, and i'm not talking about truth come what people expect, talking about the visceral reaction of people who are raising a family when you talk to them and we need to do more listening in addition to polling, you're an insurgent this is why would i trust either side? neither side has delivered for me. i'm not saying that means roll the clock back whatever way you want to talk about it, but people want something real and tangible. i think that's the reason why voter turnout was so much lower. >> thank you for mentioning lower turnout. it was significantly lower. am i not right that mr. trump actually received 2 million fewer votes than the loser john mccain? >> it look like 2004.

2008, 2012, 2000 look similar together. 2004, 2016 looked -- >> but in terms of actual human beings pulling the lever. he got fewer votes than mccain and also from romney, correct? >> that sounds right. >> sorry, that was a depression. can any of us think of something tangible that we could have the trump administration due to address the issues that you two gentlemen adjusted described? >> i think, the truth is as you pointed both bernie sanders and all to talk about it. how the approaches are different. donald trump has talked about putting a guy who's made his career with thing countries apart and firing people. i don't know if that's the guy you want protecting the middle class during trade negotiations. i think bernie sanders would've had a different crew negotiating a. i do think these trade

agreements, if people want to keep losing elections, that's what you do at democracy. you know, ultimately if people want to be elected they have to listen to people in the country. we live in a rarefied environment. i come from a small pet and for what but i live in a nice beautiful suburb here in northern virginia. there are cranes and work building buildings. it looks like the gilded age. drive to iowa, drive through michigan, wisconsin. very different reality. >> go ahead. >> i don't quite understand i guess two hurdles to bring you back to these jobs. number one, how is the administration going to bring back as many jobs as he's talking but in so many places? >> health insurance programs during the obama administration, and dr. mark mcclellan is a former senator medicaid and medicare services administration

director, and fda commissioner. rodney whitlock worked on capital for republican -- capitol hill for republican senators. we've seen a quite interesting election this year and it has a big impact on health policy. so i would love for you to tell us a little bit about what you will be watching in the year ahead. could you start us off a? >> i'd be glad you. thanks for inviting me and for having this panel. clearly we're going to be seeing a lot of change, and i think americans want to see a lot of change in one of the things though that will all have to keep an eye on and to prioritize is what happened with coverage and to make it a first priority cannot do any harm. what the affordable care act has done and this is lots of debates

about the affordable track but it is brought 20 million people into coverage. it has done so without eroding really a major source of coverage for americans which is employer-based insurance. as a result we now have the lowest uninsured rate that we've ever had in, since we've been collecting any data. nine out of 10 americans now have health care coverage and that is by anyone's measure a good thing, not a bad thing. so as we move forward thinking about what the changes might mean for those individuals as well as for the health care providers, health care industry that have been serving those individuals and are receiving payment for the services being changed in the economy. we've also seen a real positive impact on state budgets of the medicaid expansion in particular entrance ways in which it has relieved state and local costs,

lots of repercussions coming from the coverage of the 20 million people that we will need to keep an eye on. it is clear there is a desire by the new administration to repeal and replace obamacare, but what that replacement will do will be of critical importance. notably, we have vice president elect mike pence agenda medicaid expansion in his state. we have governor christie who is head of the transition committee who didn't medicaid expansion. and the end of august did a speech talking about the benefits of that expansion. what is the to the health care providers in new jersey. i think for some foremost we don't want to see backsliding, and the ability for what happened to run coverage. >> i will just pick up on some

of the points cindy was emphasizing. this was quite an election that does have some major implications. we will see exactly what that meant it turns out to be the major implications for reforming the coverage provisions of the affordable care act. what i'll be watching both the steps forward on modifying or repealing some of the major provisions that have been unpopular with the public as well as some of the other provisions in that law. but i think especially how the replacement for these features of the affordable care act develops. a lot of the people who voted for and come the republicans and the incoming president are people who would've been eligible or were eligible for coverage under the aca in one form or another. it's not, while it had some successes as cindy emphasized, an increase in coverage there's a lot of dissatisfaction with the program.

of the people who are affected by it definitely needs a new kind of assistance. i misread of this election to say that lower income americans, including the ones who voted for president-elect trump just want them to think their health care challenges will go away. they are looking for a better alternative. cindy's point about what that might look like, partly it may be federal legislation but i think there's a lot of emphasis in the new administration, republican congress for working more extensively with states to do more fundamental reforms in the way that assistance with health care coverage works to really try to change the way that the expectations around the delivery of care and outfits into people's lives. in our defenses program as he emphasized that a lot of back and forth with cms, which states went to a farther and a program that was partly about encouraging and supporting

people in getting back to work. partly about putting more of an emphasis on prevention and wellness in changing the way that care was delivered. so that's an important part of the steps forward from there as well. what are the replacement features that can really try some changes in the way that care works were lower income americans, and i think there's a lot of room for improvement. if you look at trends in health in this country over the last 20 years, a lot of good evidence on this accumulating now, we've seen since significant improvements in life expectancy just like we've seen it and incomes at the higher end of the income distribution a we haven't seen that among working-class americans. many of the people who voted for this big change in federal leadership, with, in some cases for milk income or lower middle

income, middle aged whites seeing almost no improvements in life expectancy over the last 15 years. things like overjoyed problems or things like risk factors -- opioid problems -- cancer, diabetes going a. i don't think we got the solution yet for that two of those individuals get a better life. i think it does include things like helping to give their incomes up, better jobs and rethinking the way traditional medicaid coverage has worked. so i'll be looking for steps like that. and then finally there was a lot of interest in this pass congress in taking some new steps to promote better, more effective and efficient whether it was around finding cures for cancer or making the development process for drugs and medical devices work more effectively, there's been some bipartisan interest. and support for those kinds of positive changes and biomedical innovation, also things to look for in the weeks ahead.

>> rodney? >> i think one of the important places to look first is to move beyond what effectively have been campaign rhetoric. there's been a slogan throughout for years is repeal and replace. there's another side which is okay, you're going to cost 20 million people their coverage. i think the real is there are not republicans who view this as we want coverage to go away. and repealed and replace when you look at it in a more realistic perspective, it is out of something that is better described as transition. the affordable care act set up the way of providing coverage for individuals, and republicans, particularly if you look at the work done by senator burr, hatch, upton or the better way proposal out of house or click talking about coverage they're talking about it in their structure that they have in mind.

from their perspective they want individuals to have high quality coverage available with a number of opportunities, multiple options with again driving towards low-cost and efficiency. and that is not that far a drive from the affordable care act. the distance is a new variety. moving from medicare towards, to premium support, you might need to pack a suitcase. they are much more along the lines of what is ultimately transitioning to where they believe in ursus the way it was done in the affordable care act. >> even with the replacement plan, millions are likely to lose coverage. so how do senators balance the need to protect their constituents with the need to maintain their commitment to this campaign promise? what you think will specifically be in the replacement plan? >> you started a very good point, which is if you look at

what happened, what was projected to be happening under the affordable care act versus what has happened, cdos number is wrong. congressional budget office present almost twice as many people would be covered today than what. what are we comparing it to? are we comparing it to what was intended fo versus what is? it's entirely possible if you look at a better way proposal to see your way toward them being able to cover people. listen, i'll acknowledge a better way is not crystal clear. you can't see everything. sort of looking at inkblots, is that an owl? is a volkswagen beetle? is it a late enrollment penalty? but if it is more like a late enrollment penalty they do intend to call coverage. i don't emulate give away millions and millions of coverage just because republicans said they want to do something different.

spitting do you want to jump in, cindy? >> i agree that nobody has been campaigning on an eliminating coverage for people. so i would agree with rodney about that which is why i stopped the focus on let's look at that 20 million people, the people in employer-sponsored, and let's make sure we don't go backwards and let's hope everybody accountable to that. but if you don't invest some dollars, for example, whether its stabilization of marketplace or a affordability of tax credits or what other kinds of subsidies that people need that people mark was talking about, they are low income people and the medicaid expansion is 100% poverty of medicaid individual that's not a lot of money. affordability has always been our major problem with coverage. so it is easy to say we are offer coverage but there really needs to be some serious

discussion about how we're going to both stabilize the markets to build to make sure that we've got ensures willing to participate but also that coverage is affordable to the group, as mark points out, of the group that supported the trump-pence ticket. so what is, as rodney said i think, easy to talk about repeal and replace and it's easy to pass bills and cbo can make a projection and take a look what the impact it. rand determined people will is covered under the present approach for ever going to get to a place where we really have positive change that we don't lose coverage, i think everybody is going to need to be thoughtful and do some compromising on both sides of the aisle. >> let's talk about how this all might happen. the likely that would be through reconciliation which is a process that allows you to get

repeal through the senate with only 51 votes. vice president mike pence could be the 51st vote. we would have to pass a budget resolution, then they would have to go and have a reconciliation bill. they've already done this in january. they passed the reconciliation bill. president obama was there to be to we. this time it's real. what they did in january, i wonder if anyone was to talk about that, those components in that bill versus the things that would remain. because you can't get rid of the entire health care law through reconciliation. >> the repeal bill that was passed included most of the unpopular elements of all the taxes, the individual mandate as well as the coverage subsidies that were built in to the law as well with some argument given the pending lawsuits about just how much. those should be considered

mandatory funding. if that was passed alone the result probably would be instability in insurance market. so the reconciliation bill did not get rid of the more popular proficiently guaranteed issue and community rating. >> could you find but that is? >> a better way proposal as an alternative mechanism for dealing with that which is more of a person of responsible approach like what medicare uses. basically a feast day enrolled continuously and coverage, then you get those kinds of protections. you can't lose interest. you can't be rated more highly because you're preexisting condition. >> as long as you making maintan coverage. >> that's not in the long enough. i think that's unclear whether insurance market provisions like that could be handled through reconciliation. i think that does not give what we been hearing recently is a lot of discussion about a transition period for implementing any of these

reforms, and i think ben carson has been quoted as saying really spelling of what the alternative path or the way to place this is so that there are not big disruptions for people have been through a lot with the coverage expansions and all the controversy around the law and the difficulties that the exchanges have faced and are facing today in many states. that makes this a bit more complicated of an approach. it means not just look at what can be done to repeal through reconciliation but at the same time getting moving on what the alternative approach would be. i would emphasize, rodney talked about some of the provisions in the bad way proposal related to an alternative for tax credits in the exchanges, better way also includes some big changes in the way states support for a low income assistance program like medicaid works. on the positive side i am sure

if cindy will find a lot to disagree with in that proposal, more about moving to per capita grants to state to support coverage but there are some really innovative things happening in the number of states that are trying to put a bigger emphasis on getting people into better primary care, keeping them out of the hospital, managing some of the root causes of their health care problems, whether it's mental health issues or substance abuse issues or just not having a reliable home, innovative things happening in states that a think the republican leadership would very much like to encourage but that's going to need to be a part of an overall competence of approach that's going to take a little more work than just reconciliation. the challenge today is a lot of the exchanges are not working well of their own accord.

as soon as there's republican action either a major regulatory action or legislative action that could be viewed and attacked as for the disrupting that, then you can own what up until now it's been not very popular program that's been completed associated with the obama administration, the democrats. i do think it's important to match any steps on repeal through reconciliation with some new steps for a better path forward for access to care and innovation, innovative care in the way of delivering. >> a lot to follow up on. we would see insurance lead. they would be for the destruction and we've already seen already was expected a third of the coach we don't have one plan to choose from this year. we saw dramatic increases in the exchanges this year. image in the transition. -- you mentioned the transition. this year's reconciliation that would have repealed all of his as of december 31, 2017.

so do you think that there would be a similar transition? >> okay, so let's start with, particularly pulling off what mark went, these ar these are te different fathers are the three things about bush appointed in 2017. first, it got to conversation with insurers. if you want to build a system or rebuild a sense of our transition to a system, whatever it is, replace the system, whatever words, if you want to put in something else and if you want to work at a certain way, you on to the people you're counting on to deliver the coverage. if you disagree are going to for route you better have a good reason why not. you can look at things that were done in the affordable care act when you look at it and go they probably pushed a little harder than the insurers thought was possible and that the problems we do today because of that. second, transition is critical. republicans will have to

understand that to go from a to b. you have to have a transition process that allows that to occur without massive destruction. i've heard people say hey, we would just like the individual mandate so what if we created, but the ir iris used their authority to great all these carveouts? you can believe in that. you can want to do that and next open season there will be no plans. because the insurers will quit without that mechanism to cause participation. if you don't have a transition ready you are going to own that destruction to the third and final point, this speaks to the staff send antiproton which is -- cindy and i have worked on, the republicans want to sit down with cbo and talk about the coverage and cost consequence of the action. there is no doubt in my mind there will be points where republicans will say we just disagree and they will have to decide, have to decide what

action they willing to take in the face of that. cbo was going to tell them if you reduced the subsidies, the reimbursement to states for this newly eligible population that has covered millions of americans, you have every reasonable expectations that states will say no, we will not cover people anymore. we believe in it but if you reduced our patent we get, dramatically wrapped. republicans will have to decide if they believe it, if they're willing to accept the consequence, or if they believe what they're putting in place to replace it works when people are telling them it might not. >> we talked a little bit about state approaches. there are some flexibilities that states can use through waivers and other things. without federal funding it's

hard to see how states deal a lot with that, but i wonder if someone can jump in and talk about what states might be interested in doing and what the choices they have in front of them would be? >> let me jump in. we got lots of important points that they're stepping back on first of all i think it will be an interest in shifting some responsibility to more responsibility to states. i do know that's necessarily a bad thing but as rodney says if you -- it will not come it will not produce the coverage that potentially everybody wants. i think we have to watch out for shifting in response build and think it's, i did really cut, on your member of congress, i didn't get coverage. i just bring it closer to the people. but without the infrastructure and the financing that's necessary to solidify that coverage and the improvements, i think we all want to see, it's a

promise but without any of the staff to make sure it will happen. we have seen a lot of movement in the medicaid program over the last 10 years but really particularly over the last three or four years. partly to the affordable care act. we related a lot of states nothing of fiscal stress right at the moment. they will again. and really trying to think about how to improve care. how to align themselves with the changes going on in the medicare program, some of the changes going on in the commercial world but also being very mindful of some of the specific and unique needs and characteristics of the medicaid population. we also need to think about what's broken and what are we trying to fix? we've seen a lot of those going into different medicare program where today than we've had years back. if we could do something like a block grant, it changes the dynamic considerably, then every

new individual to bring onto the program or every new cure that comes down on the drug price that goes up, a state has to make a trade off because no longer is there a guarantee of open-ended federal matching payments that says you have a downturn in economy and more people become eligible, or if you have a cure to hep c and you're paying more for a drug, we will show that caused. should be smart, you should give good care management but we wish her and those costs. a block grant is a zero-sum game and states will have to make some hard decisions if they are faced with that. even getting to the point of a block grant, it has been proposed of the times in the past and it is often followed by the wayside one time by a veto by president clinton, but even more than in the past, the

disparities in how you think about how to set those block grants, dollars, will create a very specific formula. think about texas, has a large number of uninsured people, a large program because it is such a big state. but it hasn't taken up the expansion. so you take the amount of dollars it now gets from the federal government and says, and say i'm going to catch up and give it to as a block grant, they will be stuck to the level of not doesn't they will do more for the individuals that are uninsured in texas, which is i'm not sure what political leaders there would want to do. louisiana justified to expand this year. they have put in more than, enrolled more than 350,000 people. and if you block grant is based on their federal dollars for this year, they, unlike the texas counterpart, would be able

to have those dollars in decide how they're going to continue coverage, improve coverage, change coverage. so we have a very i'm even playing field right now in terms of the drawdown of the federal dollars. and last i checked the plan around block grants were really not the raising of dollars that failed to the medicaid program by constraining the amount of federal dollars in the medicaid program. so these are going to be some very hard decisions and very our hard changes and also issues a program flexibility. market mentioned about a 40 build on medicare. most people don't know that medicaid pays for the premiums and the co-sharing are low income medicare beneficiaries. medicaid makes medicare affordable for so many low income seniors and people with disabilities. are we going in a block grant world, take away the requirement? article to separately finance the requirement? is medicare going to assume that responsibility? lots of repercussions.

>> these are all challenging issues. the general principle is, try to make health care more efficient also to try to better meet the needs of people who can use on this election, i just not happy with what they getting in health care coverage and access right now. further to try to infrastructure. infrastructure. one is the dollars but the other is support for finding better ways to do coverage than just expanding payments to hospitals and producing uncompensated care cause. it's about doing things differently. i think it can be done. it's just not easy. that was the point i was make at the beginning, putting just as much emphasis into what is the alternative to obamacare, especially if there is any less the action that it can become a target and political attacks that now you broke up rather

than the program was a working well on its own. the more these alternatives can be flushed out and develop, the more confident states can be going into a new optional model or whatever is worked out as an unaltered, the better the transition woodwork. >> all but 19 states have expanded medicaid and you mentioned governor pence was one of those that expanded medicaid. his approach was very different than what we'v we have seen previously. sandy, utah deeply involved in the negotiations. what do you think a plan like indiana, if other states started to follow that model, what do you think it would mean for the future of medicaid? >> i was on the other end of that negotiation, took a lot of the change changes that some otr states have done through waivers but also added some new ones. so, for example, one of the

things and healthy indiana is that it has premiums. that's not unique to healthy indiana in terms of waivers. but one of the things that was unique was what governor pence what was the 12 month lockout period so if you didn't pay your premium, again talking about people come 101% of poverty about $12,000 a year, if you miss a premium payment for whatever reason you would be unable to get health coverage for a year even if you read it will enable to come back and pay your premiums. the negotiated agreement was a six-month lockout. no other state has gotten of that provision and the obama administration's view was let's have an evaluation can think about whether those premiums are affordable for people at that price before we lockout periods for other states. i would fully imagine in some respects governor pence, vice president-elect, would be interested in spreading the indiana model, less reluctant to

do so than the obama administration but at the same time if the conversation and the proposals are we going to repeal the medicaid expansion and we don't have any confidence of what the financial underpinnings would be, you are not going to have states interested in indiana that expansion or any other type expansion until the very important questions get settled. statesmen word being hands match what could an epidemic risk. they will not be moving ahead with the indiana model or any other kind of waiver model until it's a lot more clear as to what the medicaid program might look like over the next period ahead. >> there are other issues facing congress. we talked about the children's health insurance program. that's another issue facing states and the funding for it runs out on september 30, of the 17. so what do you expect to happen

with reauthorization but there were some changes with funding that went through with the health care law. states got a 23% increase and the republicans did not stop that in the last reauthorization. that means 11 states and d.c. don'helping anything in state matching funds for children's health insurance. anybody want to speculate on what might happen with chip reauthorization? >> i will say that currently if you are a child and a low income family complexity between 133%, up to about 250% of poverty, that you can get coverage through your parents having employer-sponsored insurance plan and you're covered that way. you can get coverage through your parents having a plan that they received in the marketplace. you get coverage that would. you can get coverage basically

stand-alone for you as a child through the chip program. i think what republicans will have to do particularly as they approach is presuming they don't just a cable years, take it down, kick the can down as looking at part of a larger issue. that child who lives in a family with 150% poverty, the needs of the child should very by the bucket of which they get coverage. the needs of the child should be the same and the cubs for the child should meet those needs. i think republicans have to think hard about that as they decide where to go and look at if there are things that were positive about chip that exceed what you can get through either the marketplace or employer sponsored insurance are they could come onto was doing, should we invest in doing them? i think that's the challenge. >> a couple things and why this might be an important opportunity, even for some bipartisanship. chip has been a quiet bipartisan program, more so than traditional medicaid because of

a couple reasons. one is that there is more flexibility for states and how they design benefits. cindy would say kids with a somewhat higher income level have different coverage needs than the more challenging issue at different income levels. i think there are some lessons there that could be learned as rodney was saying, especially if there's a concerted effort by the administration to help states in implementing more coherent and effective approaches. that's something i think republicans would like to see more of in traditional medicaid or in medicaid expansion. second thing is, there is a cap and the total spending. in that sense at least potentially a step in the direction towards the more state-based approach is what the states get more flexible in how they spent the resources but there are some tighter overall limits on what the program can

spend. i think this may end up linking to some of the broader discussions we've been, broader steps within talking about related to medicaid and the affordable care act reforms. >> let me add a couple of things. it is a program that's enjoyed very strong bipartisan support, but we should not overlook the convocations again and it was chip separate. chip works now in many respects because some of the sickest kids, even in the more new report income range end up going into medicaid when they get sick. so it tends to be for some of the healthier kids and somewhat higher income so they can afford greater contributions. but the affordability for the kids and the chip program is better for families than for the most part what's available in the marketplace for kids.

so going back to rodney's point about let's look at the differences, benefits a little bit better in chip than in the marketplace by and large. the marketplace is just not akin to being a pediatric care model. the cost-sharing up premiums are considerably stronger in the chip program. so if it's going to be a change, we have to decide which direction that change doesn't. i would imagine though that given all of the turmoil on company and of our complicity but in the marketplace in the world of repeal and replace, that this is probably not the time to bring in kids from chip and say okay, let's add to that turmoil and get rid of the chip program and hope it all works out for whatever is the replacement for the exchange. so i would suspect that there will be some reauthorization of

the chip, and a little bit of a wait and see as to whether the replacement is in a good position to receive the kids and to make sure that they are cared for in the way that everybody feels comfortable. >> we do want to bring the obvious thing to participate as well. we have microphones over here. i want to tackle a couple of quick question before the obvious. the fda needs to we offer size its user fees next year for devices and drugs on biologic and other things. in the short term there is a bill called the caravel, biomedical bill, mitch mcconnell and appalled by both said would be a priority for the lame-duck. what do you think the chances of cure is getting to and a lame duck would be? do you think perhaps it might fold into the use of the discussion next year? what is your crystal ball tell

you on the issue? >> i think on cures, is part of a much broader conversation going on with regard to lame-duck and its extremist political right now which is bad for republicans now if you want to move legislation, they know they have to work and compromise more with the senate minority and then also this administration, and on every issue out there basically it's going to be a question of what compromises you are willing to make versus ways to come back into in january spill this one is pretty close to the finish but in terms of strong bipartisan agreement. i think the question is for getting democrats on board probably most important, funding for some of those key administration priorities like they can't have been shot for nih and also add as a former fda

commissioner including some funding in this legislation for fta, so many provisions are about really transforming the way the drug development and regulation works. that would be helpful. i think policy agreement could be there. it's just whether putting the funding together as rodney says, it's hard to know right now. if it doesn't happen in the lame-duck, i think a lot of these provisions are going to get some further life in the lead up to the user the legislation, which will pass next year. >> very good. we have a question right here. >> thank you. i know that all the panel is now well that the medicaid program is critical to people with disabilities and also to seniors for long-term services and support. i would like to hear your comments about the impact of the proposals on that aspect of the medicaid program. program. >> well, i'll jump in.

i don't know that that's been given as much thought. rodney can jump in and talk about it. but it goes back, i think, to the point i made before about medicaid also being used to help finance low income medicare beneficiaries, to be able to afford the co-pays. medicaid as many different things from a different populations. and as you note, it is the single largest source of payment for long-term services and support. and that is a growing need, not a shrinking need. so that has been proposals in the past around the block grant medicaid which say leave the people with disabilities and elderly provisions in task, and we will make the changes for families and children, and other childless adult population. i think that's really unclear as to what the proposals are and the implications for some of the

medicaid proposals going forward. i think it's really important to keep in mind how complicated and multitier to the medicaid program is and how much it not only supports so many individuals but so much of our health care system. over the last couple of years there's been an enormous focus on strengthening our mental health system. responded to the opioid crisis your medicaid funding has really been critical in doing that. whether its people with disabilities, long-term care, mental health, substance abuse services, thinking about the implications of all of that will be critically important as the debate moves forward speed and people with disabilities, there have been some real innovative programs implemented in recent years. when i was at cms we started and money follows the person

demonstration program which many more states have taken up which gives people a lot more control over how they get their personal services and support, long-term services, making it much more personal program that gives better results. i think it adds a lower cost as well. definitely would like to see more of those kinds of innovation occur as part of the overall effort. >> i think we'll strong bipartisan support, but again you need the financial underpinning to be there in order for that consumer direction to be meaningful. >> are there other questions from the audience? >> yes. wanted to ask about mental health. even with the affordable care act, the services available to support mental health are still, lag behind those for physical health. in the meantime when you've had discussions about trying under

crime, mass shootings, people pointed metal a as alternative s a poster boy to guns as an area where it conceivably democrats and republicans can agree to bolster mental health services as a way to address some of these really disturbed people who go on these mass shootings. but yet with all that, there have been bills better than the sum of that nothing is going to the finish line yet. how do you see mental health issues being addressed in the next congress? >> i think that there is a bill that is very close to the finish on having passed the house with 400 plus votes, that may move during the lame-duck. it's unclear. i think that the political world particularly congress now fully understands the challenges that we face in mental health and trying to come up with policies

that address issues moving forward. i would point out it's not easy. this is not click your heels together three times and make itself. decided public policy that is effective our very difficult. vcu with the imt exclusion which is out there in medicare as a potential issue. there's a lot of challenges to the policy and it's not something easily done. i think congress will continue to struggle with that was to recognizrecognizing they want more. >> in porton as standalone about those are, there's opportunities to get health care cost them by finding more integrated and effective ways of linking the mental health services that certain people need to the other medical and support services. there are a number of states that have limited super utilizer programs or targeted interventions that are going off the fact that the average cost of common medical costs, medicaid gaza people -- 70, 80%

higher than those without. find ways instead had a carved out mental health services program, they're adding on additional mental health services, find ways to integrate those better with the medical services, creating behavioral units, something that arkansas and other states are trying out. there are ways to do a better job with that just adding in more and more funding. it's not easy but it can be done. >> i just hav had to see if we e away funding it will be really harmful. i would say if that was what initiative, and there are many but if there's want initiative i would identify as being one which is really captivate states focus over the last year, two years in medicaid it is exactly the issues that mark identified as strengthening the underling services but also just doing a much better job of integrating and coordinating services for people with mental health

issues, and just new ways of delivering those services. i worry about a hiatus in the effort to move forward but i think everybody is recognizing at the state level how important that is for medicare as well as better control of costs. [inaudible] >> the millions of americans to get a direct health care on the federal government, dod, vha, what t can we expect in terms of those beneficiaries? the nature of the coverage going to change? on the number of beneficiaries going to change? how are those folks going to be affected? >> interesting question. any thoughts? >> i'll jump in if nobody else -- >> jump in. >> i think that's one where, we put on the table for the income in congress and incoming president either repeal, replacing transition, however you want to describe the

affordable care act plus massive consideration of both medicare and medicaid, including the chip program, they might not have time to get to those issues. >> that would be my guess. >> all right. thank you very much. we are out of time to pick if you have a question perhaps the speakers can chat on the way out of. thank you very much for coming, and thank you to our panelists. [applause] [inaudible conversations] [inaudible conversations]

>> this a daylong conference on the policy implications of the 2016 election taking a lunch break. following the break the chief of staff and john brenner joins the panel discussion on implementation of the top administrations campaign promises. speakers will also assess president obama's legacy and openings for the next chief executive to build on or to parts of his agenda. president-elect donald trump is at the white house to discuss the transition with president barack obama. the meeting symbolically begins the transition of power. while present electronic and president obama immediately tactically the oval office michelle obama and outcomes wi-fi meeting private in the white house residence. vice president-elect mike pence is a flight aboard trump forced to back to washington, d.c. for

bees on capitol hill and then he went back to indiana. firefighters gave the play in a water cannon salute before took off from new york city as recorded by a reporter in the plane. >> while we wait for the cq roll call conference to resume, here's some of the earlier this fashion on what to expect under a top administration with former gop house majority leader eric cantor. spent do you think the country can continue to have elections where somebody gets the most votes but doesn't take the office? >> i think that our constitution is quite a document. it's a brilliant document and to know that there are parts of it that some speak to you and say it doesn't work. my sense is right what if you want to change that document, that's a tall order. uphill climb.

but i do think and one of the comments in the parkdale said that if you want to go and concentrate all the dollars, all the conversation got all the money on the coast and in the big cities, that's what you will do if you get rid of the electoral college. the beauty of our country is that it's a diverse and part of that diversity is a geography. clearly i think one of the schematics coming out of this campaign is there is a lot of country out there that does not think like this down things, like new york things, like l.a. thinks. and again part of the richness of our culture and the brilliance of the vision of our founders was to make sure that we didn't get so single vision and maintained that broad sense of vision that the country can offer. so i'm thinking we are fine. >> okay. tell me, my sexual it's a debate, i told him i was into

doing some very important and he said, you always should start by saying how is your day. so wanted to ask him how was your day yesterday? >> listen, i'm good. i really good. >> how surprised were you, really? >> i started the day by thinking, listen, i am no stranger to elections that can give you a surprise. you know, i've talked to my kids. i have three kids, two of them are in this town, one in palo alto. ..

what my family went through was a real shocker. worse things can happen we live in a great country. life will go on. i saw the election returns and couldn't sleep afterwards because of all the thoughts conjured up of what lies ahead for our country. as a republican very heartened to see both house and senate republicans, now able to work with a republican white house. i caution myself in a positive vein of thought saying there are no excuses now. my party has to act. >> the panel started at 3:00 in the morning saying you broke it, you own it but you wouldn't agree with the phrase. >> we can have that discussion.

>> how do we put this together? one reason i am excited you are here is you are a difference man. you have the perspective on how there is a gap. let's start with that. this election, primary and general revealed the gap between the political class and middle-class americans. let's start with that because if you are advising democrats and you say the only hope is obstruction and if so, that is the broken nature of the institution. >> when you look at this election, i don't know who has read that book called hillbilly allergy but i finished the book. i don't know if it was purposely written and published around this election but it is indicative i think of a culture

reflected elsewhere, a broad demographic that was wiped out. generational hasn't seen the hope and aspiration to rise that most of us like to say our kids have. that is what donald trump tapped into, a disaffected sense, the anger, the notion that washington is really broken when it comes to solving problems with that group of people. it is quite something. if you look at the way he spoke to the voters, i was one of the first, when he would say some of the things that were vulgar or distasteful, many people in this

town did on my side of the aisle and denounced him that language, those kind of things, but peter teal said it at the republican convention in cleveland, something very wise which was media, the media in this room, took trump literally where voters took him seriously. that is something to think about because when he said some of the things that seemed so outrageous there was a general sense that he was conveying to people who may not be living in this bubble of washington, new york, la and the rest. i think it is about not speaking in this washington garble, approaching problems in a way

given our society today of 24/7 rapid information flow, to tell it demonstrate that you hear somebody and now you get to the point you execute on the visions you put out there, not a lot of granularity to what that means in a trump white house. >> the legislative agenda provided by paul ryan. the change kevin brady and house ways and means committee working on tax reform for some time. goes back to when we presented the initial white paper, and will be ready. most of us were taken by surprise, no one is really ready until the time comes. and hard-working people in the

hill ready to take -- and clearly is going to have an idea where to take things. and worked in congress, and controlled everything. and a lot of influence of what happened. and how it is going to play out. be change donald trump is the last vessel, billionaire, glitzy, and more modest circumstances, they were not able to speak to that. and how have they absorbed or