equality for beneficiaries and to help realize that promise earlier this year there were groundbreaking final rules, the

first major overhaul well before 2008. the rule has a lot of moving parts. to improve access to care, deliver better care, more widely and promote participation and broader delivery reform. recommending all that will be a multi-year undertaking. it will challenge plans, but all our beneficiaries have the potential for it. when medicaid started the only option for many seniors and people with disabilities with long-term care needs was nursing homes. medicaid spending to institutional care. in 2013 for the first time in the history of the program long-term service support went to community-based services. these are critical components of

the medicaid program and part of a larger framework for community integration. in 2008 medicaid rules do not always jive with preferences to beneficiaries for their family. in 2014 after five years of stakeholders, we update community-based service regulation. and make sure these services are truly provided in a community-based setting. we want progress to continue and that is why we issued a request for information looking for public input on ways to accelerate this progress and continue protecting quality care for both quality beneficiaries. if there's any doubt about the importance to the lives of beneficiaries let me tell you about lewis, 56-year-old woman

who lives in an apartment with cerebral palsy and a history of stroke. she has no family to provide care which makes her a good candidate for a nursing home. she is enrolled in maryland's community first choice program which provides a case worker and personal care attendant, very active in the community, particularly close to her case worker and here is what she said about her. i love her like a sister. she goes above and beyond the call of duty. i will call her and she is always there with a nice smile to say everything is okay. i am a busy bee and she knows, she gets me transportation to my exercise program. that relationship brought to you by medicaid. i don't have to tell this audience the quality and access, in 2008 medicaid had no systematic approach to ensuring

access. a year ago medicaid was on access to care during the process we are implementing now. in 2008 medicaid had no standard data on quality and now it does. it systematically measures quality for results with those measures which align with the broader quality initiatives and all the results for transparency. and it is much more than measurement. that is why medicaid's pioneering problems towards important national goals, and maternal and infant mortality. historically medicaid was not well known for innovation and payment qualities. today striving innovation. in 2008 there were no federally established payment models.

today state medicaid programs participate with comprehensive initiatives to question primary care payment to a delivery of payment reform. 30 states participate in strongstart and the district in puerto rico and they are undertaking new approaches to prenatal care for premature birth to medicaid. we are working with tween 9 states on comprehensive approaches which you heard about yesterday. two states were approved and working with 7 more. regardless of the federal model we established states continue to drive innovation on their own in partnership with dms. ask colorado. ask alabama about the potential of regional care organization which we implement next year or massachusetts or rhode island or vermont about their

groundbreaking delivery models, all of which were improved in the last three weeks. to continue this innovation, cms established the accelerator program two years ago. we wanted to support allstate efforts to move toward system reform. starting next month, iap will make available new analytics and payment modeling to continue this program. to sum it up there is serious drama over the last eight years, there has been a dramatic expansion in coverage in a dramatic shift in fee-for-service to managed-care, dramatic increase in community-based services focused on quality and access and a dramatic acceleration. this is the work we have done together and it makes a difference in people's health and in the health and communities in which they live.

i hope you agree with me when you step back and look at it the biggest changes in the medicaid program in 1965. all of that is a lot of work so i want to ask by thanking all of you for the work you have done with us in the medicaid program. i want to thank partners in the audience, providers, for the work you have done to support cms and state in this time. cms and the medicaid program can accomplish our mission. i want to thank our team at the front and tell you they are the hardest working, smartest, most committed group of people they know. i want to thank the medicaid directors. in my view state medicaid directors have the most

important jobs in every state and territory. not everyone understands the importance of that role but we at cms do and we appreciate your commitment to public service. medicaid future progress will depend on you. i expect whatever tomorrow brings see mcs will partner with you in the best way possible. thank you all and have safe travels. [applause] or smack >> all right, i can't end on a better note than that other than to reiterate we have very deeply

appreciated our partnership with cms under your leadership, and what the future may bring and looking back it has been a great experience, working with you or the team in whatever form that takes as we move forward. to reiterate i love your point that the work we are doing in medicaid is the most important work that is going on. we are taking the things that matter most, their health, their lives, their well-being, for the sickest, frail or stand most medically fragile people in the country, the system that historically has not done a very good job of taking care of them and trying to change that and that is an enormous undertaking, what has to be done in partnership with lots of people,

and federal partners, with the private sector in a true public-private partnership as well. it was enormously important, i had to stress over the past couple changes, enormously difficult, but that means this is a challenge to figure out how high can we rise to overcome the challenges, because the need to do so is critically important. i want to thank you for coming and attending the conference, for participating in this ongoing dialogue for the state medicaid directors across the country. we look forward to putting on another session like this. a years time from now, we hope to see you there and look forward to continuing to engage with all of you through the month to come, to tell you how we together solve these crises, these problems and provide a better future for the medicaid

population we serve. thank you, everybody. [applause] >> veterans day observances from arlington national cemetery including remarks by president obama and a wreath laying ceremony at the tomb of the unknowns. live coverage at 11 am eastern on c-span, c-span.org and the c-span radio apps. >> fort knox was chosen because it was america's most impenetrable location, the gold bullion depository, opened several years prior, lots of gold had been transferred there

so secretary of the treasury gave permission to use a portion of the depository for these documents. >> sunday night on q&a, stephen coolio talked about the vision to move americans most important historical documents to fort knox on december 26, 1941. >> had to make a decision what documents are going to be there, the original declaration, the constitution, the articles of confederation pre-constitution, for sure. the gettysburg address, considered critical. he makes this decision very methodically on what is going to go to fort knox. these are considered the most valuable document in the country. the magna carta is the document he was asked to preserve. >> sunday night on q and a. at a conference in washington dc

the pension benefit he guarantee corporation the regulates private pensions talk about the solvency multi employer pension plans calling their fiscal house dyer. the annual meeting of the american academy of actuaries, this is just under an hour. [applause] >> thanks, a pleasure to be here. my colleagues will verify the fact that i am more nervous than average about addressing actuaries because it is one of the groups although it is important to the pbgc, it is one of the groups where i am fairly confident everybody or nearly everybody in the room knows more than i do.

that is a nervous task. i also know everybody in the room or nearly everybody in the room is either already totally prepared for their retirement or on track to be so. when i talk about retirement security, i am really talking to the choir. pbgc has had a long close relationship with the academy and we want to build on that relationship, value and benefit from your contributions to pbgc in the form of detailed, clear comments, proposals, proposed regulation, the issue brief tom

mentioned, there are lots of projects we work closely in the academy. we appreciate that very much. we have a collection of the best actuaries in the world, but maybe that is just me bragging, i want to thank the academy for honoring joan with the robert myers public service award, truly a remarkable public servant and serve the pbgc as chief evaluation actuary for 20 years. she let our team of actuaries, not only had to understand everything you do in the private sector regarding pension, had to

calculate the benefits and responsible for the single-employer and multi employer liability is reported in financial statements. that is no minor task, she met that responsibility with grace and skill and every pbgc director to meet the challenge. that they faced. she is exemplified, the public service that i have experienced at pbgc and everywhere i go i hear about the quality of service the pbgc provides. having, as tom explained earlier, i worked in other

agencies, we didn't have anywhere near the customer satisfaction that is documented that i hear about all the time the pbgc has and i am particularly -- going through the confirmation process of being director many people ask me, many senators ask me why would you want this job? i thought they were asking it in just. i would respond with a lighthearted answer, one time a very high level senator said no, why this job? he actually followed it by saying i am not sure i want to vote for anybody who wants this job. i didn't have a great answer for

that. most people in a job interview situation have can't answers for that but once i understood his seriousness i didn't have a great answer. i can tell you one reason i wouldn't want the job is if the quality of professionals we got like joan, at the pbgc. we are proud of that tradition of service, i can't tell you how irritated i get when i hear people bashing public service. it is not justified and the folks at pbgc are evidence of that fact. i have been director for a little bit over a year, celebrated my one year anniversary. i am no longer on honeymoon so people are starting to expect me

to know answers. i am looking forward to hearing your questions. we can't do the job without interaction with groups like you. i am looking forward to hearing the questions you have and tipping the answers. as many of you know, i am a great fan defined benefit plans which in that role i feel a little bit like the black night at the bridge in the monty python movie, the holy grail. i am here to say i am not dead yet the damage to the benefits system is only a flesh wound. in all seriousness i have to say

we are not blind to the economic trends, and the risk-management cfos are undergoing on a daily basis, and the fact that competitive pressures on the company, and the trend to try to de-risk or transfer the risk of defined benefit plan, i do want to recognize at no time in our history have the majority of americans been covered by a defined benefit pension plan. a lot of times people refer to it as the good old days, everybody had a plan, those good old days never existed. on the other side of the coin, there are lots of employees who are actively accruing the

defined benefit today, there were 10 million of them. the employer's of those 10 million often look to the defined benefit plan, a positive way to attract and retain the quality workforce. we can't turn our backs on those employers and those employees who accrued those benefits. the defined benefit plan is still the best way to provide guaranteed lifetime income that you can't outspend and can't outlive. a lot of folks talked about leaving the defined benefit system but a lot of folks were talking about it but deciding to stay in.

we at pbgc would like to do what we can to help that out. if you heard me speak before you probably heard this referenced before. i want to keep repeating it until everybody i ever talk to is sure but i urge you to google twilight zone and shelter. you find an episode of the twilight zone which gives you an idea where i came from. and what i grew up with. it is a story about a family who has invited some friends over for dinner, it is a bit of a birthday celebration and little johnny comes running in about dessert time, says that everyone

should pay attention, if you are my age you know what the conrad station is, i don't think so, a station that comes on, something bad is going to happen, and say there is a bomb coming and everyone should seek shelter. the host of the event have a bomb shelter but none of the guests have a bomb shelter. the rest of the show talks about -- portrays what happened as people with a bomb shelter keep the people without the bomb shelter out. they only have enough food and supplies for themselves, by the end of the show i don't mind giving away the end, by the end of the show, people who don't have a bomb shelter have torn up

the guy's house, they have a battering ram to get into the shelter, and write about that time the tv comes on and says it is a false alarm, the guys with the shelter come out of the shelter and say do we want to live in a society where some of the people have shelters and others don't. rod sterling, who did the twilight zone, he was interviewed a few weeks after the show came out, and one of the most talked about episodes of the twilight zone but a few weeks later was interviewed, he said he was building a bomb shelter and after he did that episode, stopped building a bomb shelter. it is a good analogy of society

where some of us are prepared for retirement and others are not. we have to ask ourselves, do we really want to live in a society where some people have enough for a dignified retirement. we don't have to talk much about that in this room because most people, especially pension folks, are focused on getting people prepared for retirement. it is a good metaphor for analyzing the importance. as has already been alluded to i don't have to talk much about the status of our pension

programs at pbgc. we have two programs, the single-employer program and multi employer program. both of them are in significant deficit positions, but multi employer program is in more serious condition. in june we sent our projections report to congress and that projection report indicated the single-employer program is likely but not certain, you know what likely means, more likely than not to improve and probably be in an even position in the coming ten years. however, it is not certain, and right now in a $25 billion

deficit, if the walls caved in today, and we are $25 billion short in paying benefits that are promised under the plan. the multi employer system is in a more dire situation. it is only about a third the size of the single-employer system, 10 million folks versus a little over 30 million folks. it's deficit is more than double the deficits in the single-employer system. it is more likely than not to be the pbgc multi employer system is more likely than not to be insolvent within ten years. every time i say ten years in washington, those of you not from washington probably think 10 years is a short period of

time. in washington, ten years is a geologic era. ten years is five election cycle for the house and nearly two for the senate, more than two for the president. congress is constantly dealing with tomorrow or this evening, and when you tell them they have ten years to fixed a problem it is like telling them they have a longer vacation. they get a longer recess this year. most sensible folks who know anything about pensions, or the economy in general, would recognize the longer you wait to fix the problem that is certain to happen the harder it is to

fix it. and if the problem costs money, fixing it the day before it runs out of money is going to be a lot more difficult than fixing it ten years before it runs out of money. in fact, one of the reasons it is in a deficit situation is premiums have been so low for so long, congress passed the reform act in 2014. it is -- many congressmen think they took care of the problem. they only added two years to the solvency of the multi employer program. most recently pbgc doesn't have the reset -- assets or incoming premiums to pay the financial system at current level of

guarantee benefits but the current level of guaranteed benefits in the multi employer system doesn't light a candle to the guarantees in the single-employer system. the guaranteed level and multi employer system is not easy to recite but in summary for a 30 year employee, someone who has been in the program for 30 years, their guaranteed benefit is a little under $13,000 a year, that is not much of a guarantee. if you are in the plan for 20 years of its we 10 years the guaranteed level is lower than that. those guaranteed levels will go close to 0, not completely 20, the trust fund of the multi employer system goes to 0, that

is likely to happen within ten years, more likely than not. there are 1400 multi employer plans covering 10 million people as i mentioned, when i talk about the insolvency of the program i don't want to talk about dire straits for everybody because most of the people in the multi employer system are in plans that are not likely to run out of money. they are not likely to rely on the pbgc for the guarantee. most of the folks, 85 to 90% of them are in plans that are more likely than not to stay solvent. the ones that will be in plans that will be insolvent, relying on the pbgc, 1 million to

1,000,0001/2, that is not a population that americans normally want to turn their back on. those folks are all over the country, and those are a number of participants, if there funds run short. the effect of such an insolvency has been illustrated in recent situations with pension funds, to reduce benefits not to the pbgc guarantee level but down to some amount higher than the pbgc guaranteed level, something many folks, many congressmen and

senators and participants have a big problem with. if the pbgc becomes insolvent, and plans are relying on the pbgc for the guaranteed level, it will be a lot worse. it is important to note thousands of employers participate in multi employer plans and the poor funding levels, troubled multi employer plans represent significant future cost to those employers, whether they continue in the plan or try to get out. this is a concern for businesses, not just employees. the pbgc, the administration has a proposal to address pbgc issues with multi employer plans and focuses mostly on creasing

premiums paid by multi employer plans to the pbgc. several administrations as far back as i worked, i worked for three administrations in the treasury and all three of those administrations propose that the pbgc be permitted to set its own premiums. they set their own premiums i talk to people who find out pbgc doesn't set premiums and they are shocked, how can you guarantee statutory level of benefits, that is a good question. however, no congress has decided

to set premiums to the pbgc or its board. having worked on capitol hill, it is not likely that is ever going to happen. congress doesn't often say giving up power that it has, it is unfortunate the administration has to ask for premium increases that look like a tax increase. a lot of employers plans use premiums as taxes. a lot of congressmen have a hard time voting for increased premiums the administration's budget would increase premiums by $15 billion over ten years and would virtually eliminate

the probability the pbgc program became insolvent within 20 years. the structure of the premium would have to be changed, a flat increase for every one would be totally inappropriate, it would have to involve a variable premium, it would have to involve some form of exit premium and would have to involve some form of pbgc discretion or relief for plans that were unable to afford increased premium or make the matter worse. if you levied the premiums in a way that make the plan worse you would not leverage premiums to make pbgc solvent. we are committed to working with

congress and we look forward to doing that in coming years to pensions, as i know from experience, are bipartisan issues. most congressmen are dedicated to strengthening retirement security. i don't think there is any congressmen, certainly they wouldn't say it in public, they would like to see the pbgc go under. multi employer plans are not well understood on capitol hill, often times when we talk about multi employer plans to focus on the hill, it is getting more attention. the concept of insolvency, nobody wants the multi employer system to become insolvent because of inaction. the senate finance committee

held the markup that would have -- that would relieve pressures on significant multi employer plan, the united mine workers, and the bill passed out of the senate finance committee, it has bipartisan support in both houses. they are very optimistic to get past the lame-duck session. i have been asked to not refer to the lame-duck session as such. pretend i didn't say that. i heard of someone who went to their halloween party as a lame-duck. they had a crutch and a cast and

looks like a duck. the house of representatives and education workforce held a hearing on a new proposal to allow a different kind of multi employer plan, there is room for creative ideas. working closely with staff, both houses, to analyze new ideas in a multipart world. we need to make sure any new idea putting existing legacy plans at further risk of insolvency. that is a lens we are going to look at, look at any new proposal. problems facing multi employer plans are complex and deserve adequate time for full

consideration, and open process involving all interested parties. the single employer system as i mentioned, is much more, much less likely to run out of money and less likely to be insolvent. one of the reasons, because of recent increases in premiums, some of those premiums increased for reasons other than -- this is my editorial content, other than pension policy. having been on the hill, i understand, and i think most people in washington understand that because pbgc is on budget,

an increase in premiums is an increase in revenue and although those premiums come to the pbgc they are scored as revenue increases that can justify spending somewhere else. so conceptually we pay highways and build missiles with premiums. not really, only conceptually. that is just the way scoring works on the hill. in another way of looking at revenue through a mirror, funding relief is also a revenue raiser. if you allow employers to put less money into their pension

plans, then the economists say, lawyers often disagree with them, but economists say they will have more profit and give their employees more money. and more profits mean higher taxes, pension relief, is revenue that can be used to pay for highways and build roads. people like to pay highways. there have been two highway bills funded by funding relief. it is difficult to take that off the table. hard to say we won't do that anymore. i do believe congress got the message and the administration got the message that additional

single-employer premiums are not necessary and unwise. i hope it is. and future -- warranted right now. the options to shore up the benefits systems are not going to be easy. all of them involve some form of pain. there will be increases and benefit cuts, it will be contributions by employers. or some kind of revenue from the government. that of those were things that congress has to work for.

we need to work with congress. the programs with the least amount of pain, i looking forward to your suggestions, and great resources for the hill, and outlines options very well and appreciate that very much. i think we have, we have some time, i hope someone will come forward with some questions. >> good morning, thanks for being with us, appreciate your

commentary, and the way the highway bills funded by telling employers about their pension plans, bringing in revenue. i get troubled, and manage those resources, when i look at amendments, and are prepared to car insurance. a good driver has to pay something. those got 450% in 2012.

and has congress missed the third piece of it which is a variable rate premium. the is up 25%. the protecting the person the drives into a tree, therefore are we protecting -- are we protecting by not increasing the variable rate of premium caps are we protecting the most troubled of plans from paying their fair share of premiums? >> i don't know that i am going to weigh in with a personal view of where the cap should be but i agree with the sentiment. i don't think congress ignored it. they don't have to constantly

walk the line, whether or not they make the problem worse. i think if i were a dictator, and i'm not, or if i was a magician, i am neither a dictator or a magician, i am working on the magic. if i could redesign the pension system, i would certainly do it in a way that encourages people to fund up. if everybody is well-funded, you don't need much of an insurance system and that is certainly true in the multi employer system, much less incentive to fund up, i do think i know that the administration is focused more on premium designs that

encourage people to fund up, and a lot of people do. we should tax stuff that is good, and tax stuff we don't want, tax, people leaving the system. tax underfunded, tax things, don't tax folks who are covering people in active plans that are well-funded. those guys should pay the bare minimum like you mentioned in your analogy to car insurance but they if they are doing the right thing shouldn't have to pay the variable rate premium for someone driving the car into a tree. >> thank you very much.

very interesting comments. most of the time we hear anything about general revenue going into pbgc the argument is given those people who never had a pension plan are being taxed, subsidize the people who do. any thoughts given to having participants recovered by the pbgc. and the benefits they receive, the benefit is a participant not to the plan, whether you are active or a retiree you pay $10 a month to the pbgc for the privilege of having your benefit guaranteed. that would generate $1 billion a year in revenue for the pbgc and would tax those people who are getting the benefit. >> revenue estimators on the

spot. you are absolutely right. there is thought about a participant premium, or along the lines you just expressed, not the amount, the reasoning is based on the reasons you expressed, don't think it would be appropriate to say where i heard it but i hear it often and in high places. advocacy groups and folks on the hill, and anything involve some kind of pain, that wouldn't be painless, if you talk about shared pain that may be a way to do it. everyone would regard that as point out in the issue brief, anyone would regard that as a

benefit cut. it is $10 a month, something on the order you mentioned, not a huge cut as had been discussed in other context. it may be appropriate especially if the premium is based on the amount of benefits you use. some plans like coal miners where benefits are not high at all. and other plans, the benefits are pretty significant. if a participant premium was based on the benefit they receive it might be more appropriate. there is also a discussion. i know this was a big discussion when i was on the hill how far you could raise premiums on it participants or employers of the

plan. without raising guarantee levels. or people might not be willing to pay what was in the premium for guarantee of $12,000 a year. people on the hill and off the hill thinking about that very thing. i wouldn't be surprised to see it reduced to legislative language before the end of the year. >> i want to echo your comments, a wonderful dedicated employee working at the agency's, pretty devoted -- i think particularly, a little disappointed in the lack of appreciation of that, i appreciate you bringing that up

as looking at not just the db but the entire us retirement system, it is quite challenged and we head into unknown waters that will be pretty troubled as well. i want to know not just what i as an actuary but we in the american academy of actuaries can do to better support you in your role as other people at different agencies and on the hill to solve this problem and move toward something that will actually work. >> i think you are already pretty involved, but i do think the education efforts, the value of lifetime benefits, i think especially among millennial's

there is an increased appreciation for retirement security and there has been recent research on that issue and millennial's expressed an interest, cash compensation in favor of more retirement security but i don't know people understand retirement security means more than a pot of money. it is important for people to understand how much money is necessary and a lot of people retire with $200,000 and think they are wealthy and going to be fine but they don't have a lifetime stream of income. we hit a certain age, and when

i'm 85 i don't want to be thinking about where my money should be investigated and defined contribution plan. and an annuity lasting the rest of my life, and they had taken off, and people at pbgc don't have a really good understanding of what it means to have lifetime income, and when you

are 40 you are in a hurricane in your roof. shouldn't you get some of that pension? it is hard to argue with that. but doesn't seem to be too strong an argument. and exceptions of things is long. and and and when katrina wipes out new orleans it is hard to say -- paying a penalty.

and the defined benefit plan does it. i am continuing to preach for defined benefit plans, but some other vehicles. coming up with the other vehicle, listening to one just now. you get a defined plan the employer and the employee have a shared risk. and if you transfer less risk, where employer have all the risk

about living there. >> time for one more question. >> thank you for being here. we talk a lot about policies and premiums in particular. you don't have the ability to set your own premiums. to what extent can you influence policies including setting premiums, should that be enhanced, or how could it be anymore given the complexities? >> we mainly have a lot of input in setting the administration's budget. we play a role in establishing the administration's budget with respect to pbgc issues and that includes premiums. congress rarely -- takes its

budget - less than rarely. it is pretty remote, and the biggest tool in setting premiums, the tools we have to measure the risk especially the model that we use to evaluate the risk that we are going to run out of money. i think congress is getting more and more trust in that modeling system, and they now rely on it, the congressional budget office rely on our model in evaluating proposals on the hill and that is the biggest tool we have to

help congress to realize the importance of premium setting. i keep coming back to the fact congress sees premiums like a candy jar. it is difficult to take the candy jar away. as many parents know, having gone through halloween, hard to say you are dollars candy, now i am going to take it is so i don't have a lot of promise for getting it. getting power to set the premiums, every time people complain about where their premiums are, i can say if we were setting them it wouldn't be where we are. not telling you where they would

be, but they wouldn't be where they are. thank you. [applause] >> you are watching booktv on c-span2 with top nonfiction books and authors every weekend. booktv, television for serious readers. ..