all people who are watching this lifestream to get involved in this process let it take the 6,000 number and make it a million americans who want keith as the next chair. please get your friends and coworkers involved. please go to our revolution.com and get your friends to sign up. brothers and sisters we are in a peerless in momentous moment in american history. you all know that. and we are gonna need a political party that has the guts to stand with working families and has the guts to take on the big money interests are economic and political life. it is my great privilege to introduce to you someone who i believe is going to be the next chair of the democratic national committee please

welcome congressman keith ellison. [applause]. >> how are you doing out there everybody. if there was ever a moment when people who loved this country and the people in it need to step up and do everything they can to improve the lives of their fellow americans that mom is right now. that moment is now. if i told you you have an opportunity to fight for people who felt vulnerable and scared in this trump america would you do it? if i told you that you have a chance to stand up and fight for working people would you

do it? if i told you that i told you you could be the hero of the folks that pour the cement, teach the classes, take care of the folks in the hospital i mean the hard-working people of america would you step up into something for them? we need you right now to do all of that. let me tell you it's hard to imagine someone like donald trump been elected president but in a few days he will be the president. i don't know what stage in the whole spectrum of grief you may be at but i think we need to arrive at acceptance that he's about to be the president. and that means that each of us in all of us have to do everything think that we can to protect that fellow american in to into advance

the cause of economic and social justice. we have to do it. this is a history moment and this movement may very will be the moment when the american people thought back to get that democracy. trump, he ran saying stuff like more jobs new trade models he said it. he said these things. and as soon as he got in there he said he was going to drain the swamp. he's filling it up with lobbyists and corporate executives. all of these folks. morgan had the richest cabinet ever. if you just had a few million you would be like the poor guy

in that bunch. he said he's going to fight for little people but yet he puts the secretary of education another billionaire who is against public schools 90% of american schoolchildren go to a public school betsy devos is not in favor of public schools. she wants to privatize them. the labor secretary is another billionaire. he makes his buck on the low-wage fast food worker. he is against the minimum wage. he would lower it if he could. it doesn't stop there. he said he will improve our health care system and get his secretary tom price wants to dismantle the affordable care act. this is a cabinet he has picked so far. he was going to appoint the

best and most qualified and yet he admits he knows nothing at all about housing. he says it. i did not say it. so i guess it's no surprise that he nominated a guy who said that there is no such thing as climate change is a hoax by the chinese. at a time when communities are being washed away. and all of these places. he picks the epa leader who is not in favor of protecting it. so people we have our work cut out. ..

the bottom line is, he attacks this man on twitter which you likes to do all the time. that is what the right-wing is doing. the real question is, what are we going to do? that is always the question people, what are we going to do? we can always count on them to say rich people don't have enough money and the poor folks have too much money. we can always count on them to say the rich folks need one more tax cut, one more regulation they don't have to follow and regular working people need one less thing that will help them

make it through the week. okay, that's them. what about us? our are we going to hit the streets? are we going to organize? this is what we've got to do. one the main things we have to do right now is reset the future of the democratic party. we have to reset the democratic party on the basis of grassroots activism. we have to reset the democratic party on the basis of working people were striving every single day to make a better life for themselves and their families right here in america. i'm talking about african americans, white americans, latino americans, native americans, native americans, i'm talking about asian americans and people who are jewish and muslim and christian and buddhist and hindu or no faith at all. i'm talking about folks like you and me, folks like us who need

to say the democratic party has to be democratic and it starts with getting some leadership in there that's going to fight for that democracy. i'm telling you right now, this is the moment we have been waiting for. it's a time for us to stand up and fight back and reclaim our nation. are y'all ready? [applause] now look, i want to tell you, i am very am very proud to have your support, and i am so amazed at the tremendous turnout we have here tonight, here physically and the folks on the lifestream. big shout out to the folks on the live stream. give yourselves a hand. [applause] this moment, right here, is historic. literally hundreds of thousands of people join us right here to talk about the future of the democratic party and our country

people all over this country, listening in, i'm telling you, if the democratic party is going to make any reforms, one of them has to be that we use moments like this one, meetings of hundreds of thousands of people to get together to talk about what we are going to do to make our country better for everyone. we have to include everybody and we should use moments like this and technological moments like this because basically it's not about the technology and the software, it's about us the people and we have to include everybody and if technology can help us get more folks around the table, then, then let's do it. y'all are right with that? [applause] i want to say thank you for youe american federation of teachers. these are the folks that teach our kids every day. the folks who give them a shot. the people, i don't know about you, but when i, i'm from a big family and i remember feeling kind of ordinary and not too special but there was the teachers that said come here

boy, i think you're a smart kid. the teacher grabbed me. m g toivu e prmsdoau k thad fgoodut lfnd ty made other kids feel good. those teachers knew which kids were homeless in which kids were being abused at home in which kids needed to be challenged. the new the kids who needed to be encouraged a little bit more. god bless those teachers. [applause] let me say thank you to the communication workers of america. the communication workers, the people who make sure when you call that the call gets answered. thank you. bless you guys. move on. give him a hand and move on everybody. thank you democracy of america, dsa, awesome. also the afi cio. that's the lower largest organization of steelworkers in america. idw.

united nurses and more and more and more. don't be mad if i didn't mention you. i love you and i think you and we all have to be working together. given hand to everybody. [applause] let me tell you something, the democratic party should be the party of the people. the democratic party should be the party for those who want a better future for their children and grandchildren. it should be a party that invest in workers, protects their ability to organize and fight for a fair wage in good working condition. the democratic party should be a party that believes everyone should have equal access to the american dream and equal rights before the law. the democratic party should say, it doesn't matter what your color is, we are going to treat you with fairness and equality and respect. it doesn't matter who you love and go to bed with at night. it doesn't matter who your close

closes of kin is paid we respect and honor that choice. that's who the democratic party should be. they should say whether you were born in america or whether you came here, we respect you, we want or you and we want to see her families come together. the democratic party democratic party should be that party. we believe that the democratic party should be the party of, by and for the people. [applause] and yet, we know that even a good car sometimes needs a tuneup. you know i mean. even a good car needs a tuneup. it needs new wheels, new brake pads, new belts, new hoses, new oil. it needs it needs new spark plugs, maybe needs a paint job. it needs to have that crack window fixed. you need to maintain and update and invigorate everything. if you let it slide it won't work so well. well, now, i know some folks who don't want to hear it, but since

2008 democrats have lost 935 legislative seats and republicans now control two thirds of governor's office. let me tell you, state legislature is very, very important. that is where our voting rights are made. if you've got same-day voter registration like you do in minnesota it's because the state said so. if you have a lifetime ban on voting, if you have a felony like they have in florida, it's because the state said so. if you can vote, if you never lose your right to vote like they have in vermont and maine, that's because the state says so how is it impacting the american people's right to fully participate in democracy when 935 legislative seats five legislative seats in state legislatures have been lost to democrats. how has it affected redistricting. how has it affected the right to vote and cast a ballot and be a

part of this democracy? it has devastated us but how does it affect a woman's right to choose? in ohio, the city has a 20 week ban on the right for a woman to select abortion if that's her choice. let me tell you something, this is none of his business, it's unconstitutional, but he did it because he wants to constitutional challenge and he wants the case to go up there and he wants to see the supreme court strip away a woman's right to make decisions for her family and herself and her body. this is something we have got to take very seriously but it's going on at the state. eleven governor seats lost. you know what, raising the minimum wage is winning on ballot initiatives, but emma kratz aren't winning. they like our ideas, but somehow our candidates aren't getting through. we need to retool. let me tell you, i don't recommend folk smoke marijuana, but it's crazy to throw people

in jail for it. [applause] you see that all over the country, these initiatives are passing it, for medical and even recreational use. why fill up the jails for something like that. that doesn't make no sense at all. i am running for dnc chair because it's time to turn all of this stuff around. it is time and all of us have to step up. each of us. no dnc chair, no president, no elected official can make the changes that have to be made. they're going to have to be made by the thousands, millions of americans across this country who believe in a better quality of life for all people, who believe in the equality of all people in a fair economy and people should have the right to choose and make their own personal decision and believe climate change is going to destroy this world and our ability to live on it unless we do something right now.

this is what we've got to do, what i want to say that we can bring that change that we need and we can stand up to trump and the republicans if you get involved and we remake this party right now. i want to tell you this, i am a person who believes in unity. i do, absolutely. i think the folks who have been around for a long time and i honor their institutional memory and thank them for their service but i also believe it is absolutely time for a very serious injection of energy and reinvigoration. these two things don't need to be at odds. these things actually, if they work together can service all very, very well. we need the new energy. we need the folks who have been around, we need some need community to come together and i stand for that unity. in fact, i tell you what.

i went to nevada to help people who were supporting my dear friend bernie sanders and hillary clinton and who sat in a room for five hours as they hammered out a memorandum of understanding so they could try to work together. that's the kind of thing. unity must befall for. it must be struggled for. we all have ideas about how things should go. we need leadership who's going to say were going to stick together and stay together and hammered out in may because each other out a little bit but at the end of the day we will come out holding hands and being a team. this is the kind of thing we have to have. [applause] we believe in unity. i also believe that we've got to stand up tall for small. what do i mean by that? we cannot, absolutely, howard dean was right to say that the 50 state strategy, but we have to go beyond that now. we need a 3141 county strategy. we need a strategy that gets granular. we need a block by block, we

need a free-speech strategy. we need this tragedy that gets right down to the nitty-gritty because you know what, the resources of the democratic party need to be moved closest to the voter. that's where they need to be. i'm talking about the money, the training, the data, the resources need to be closest to the people to the voter. state legislative folks and local county people and grassroots people do not feel they are being listened to or included. this is the fact. i'm telling the truth. if we want to win, we will listen to our local officials and art grassroots rank-and-file people. we he to get small. i already mentioned to you, we have got to communicate. we have to use live stream like we are right now and it has to be a regular practice. if were not talking and listening we will not be able to take everything that everybody knows and put it in service of all of us. all of us together are smarter

than anyone of us, but if we don't share information and access, we cannot make maximum use of all of the intelligence and creativity that people are coming up with every day. i believe we will do these things. we will make use of the talents that we have available to us, so abundant if only we would let go of our need to control everything in hand over the power to the people closest to the voter. my home state of minnesota, am so proud that i come from a state, and i know you are proud of your state too, but there is a man named herbert humphrey. he is worth and applause y'all. he said, in 1948, at the democratic national convention in philadelphia, he said america needed to walk out of the shadow of state rates into the bright sunshine of human rights and

when the democratic party stood up for human rights for all, some people like thurman and others, they walked out the door because they didn't want human rights for all. the the democratic must always be a party that says that we stand for the respect and dignity of all people. we must always be the party. we will never stop being that party. [applause] when walter said, he spoke at the 1963 march on washington which was not only for civil rights but for jobs as well, he got up there and said the breadbox, he said there's a direct line between the breadbox in the ballot box. he was right too. wasn't he.

yes we have to fight for economic justice. yes we have to make sure that prosperity for working people is available to them and they have it. we don't need to decide between social justice and economic justice. we have to have all of that justice together. do we not? i've heard people talk about the white working class versus the rising middle american electorate. let me tell you, we have to stand for both. we have to stand for all. we could never sacrifice between the two. we have to stand up for each one paid we don't stand up for both, we won't have either one. they will use tribalism and racial manipulation to lower our wages. once they're fighting with each other on the basis of these things, they will always come take the money. let me tell you, ronald reagan went to philadelphia mississippi and gave a speech about state rights. he used racial manipulation to

stir those folks up and then after he gets in, he does what, he fired the air traffic controllers and it begins a. time period of way wage stagnation. when you divide people, you use it to suppress everyone's wages. you understand what i'm saying? with got to stay together. [applause] let me tell you, we have also got to turn out the vote. we have got to turn out the vote people. we have seen in 2014, we saw a 70 a 70 year low voter turnout. we have the smallest house caucus that we've had since truman. in 2016, over 90,000,090,000,000 eligible voters did not vote. we say were only going to campaign in the swing states only going to go to the likely voters that we leave millions

people not participating. when we do that we ourselves to lose wisconsin which is the blue state and michigan which is home of the uaw and pennsylvania and ohio. there's no way we should lose ohio. we also lose florida. as we lose the states that we should win because we have a strategy that were only going to talk to certain people. what we started talking to everybody. [applause] let me tell you this. i was say this to you. there's a word can we not say rustbelt anymore. i'm from minnesota. i don't feel rusty. you know what i'm saying. i guarantee people in pennsylvania and ohio don't feel rusty. they feel ready to move out and bring back this country. this is the industrial midwest, that's what it is.

i will tell you else. places like washington d.c. and new york and california, they should not be viewed by democrats as just a political atm. as a matter of fact, they're not just places you go get a check, they have done really good things out there in california on climate, on criminal justice and we are to look at them as a model of how to organize. we need to stop looking at each other and segments of each other and see each other as true allies to rebuild this party. i just want to say to you, i want to say the right now, we've got to energize activists at the grass grassroots and unite throughout this country. we've got to give black lives matter people a place where they can express themselves electorally. you know what i'm saying? we have to give the fight for 15, they've got to be able to fight for 15.

we've got to give them a party they feel good about expressing themselves electorally. the immigration activists have got to have a place where they feel that there's a party that's listening to them. we have to have a place for the folks who fight for climate justice in addressing climate where they have a party that they can support support this party and they know that party is listening to them. if you want these things, we have to fight for them. i just want to say to you that we are off to a good start because senator bernie sanders and sec. clinton combined to write the best platform the democratic party has ever seen. i'm telling you, i was

privileged and honored to have bernie appoint me to the platform drafting committee, and let me tell you, good things came out of it because of that collaboration and that unity. we got groundbreaking language in the platform on college tests and apprenticeship programs for students who don't want to go to college but who want to get a good job and work with their hands, on expanding social security. on the fight for 15, we've got the best platform we ever had. we have to use it to move forward. we can organize with this very important tool. i just want to say, that if you will take up this battle and you will pledge to yourself and each other that your love for this country outweighs any beef you might have with anyone, if you promise to yourself that you will work hard every single day to make this democratic party really work for the people, then

we are not only looking at victory in 2018, and redistricting in 2020, we are looking at a generation full of successful working people. republicans in 1964 thought they were at the bottom and they were down and out. people said conservatism was dead as a philosophy because coldwater lost to johnson in the historic number, and yet those guys, they're so committed to making themselves more money and excluding people, they climbed they climbed back and they won, and then they want some more. in 1980, they culminated in the election and ronald reagan. i do admire determination when i see it. you and i better have the same level if not more determination for working people. [applause] let me say this, and i want to

tell you what i can ask you to do and then i will stop talking. i just want to say this. as democrats, liberals, progressives, the left, we stand for the right values. we stand for the right values. i think that because we stand for the right values, we think that's all we have to do is stand for the right values. people on the right, they know the program they are pushing is only going to benefit about 1% of people. but, they still live in a democracy so they have to figure out a way to win even if they only stand for 1%. they must divide. they must distract. they must think you just unified and discourage you and they work at it all the time. their push and photo id laws. they're trying to hold your wages down. they're trying to break up the right to organize and get people

to feel that the government just doesn't work and it can't do anything good. they're always on this. we have got to understand that just being right is not enough. we had to be unified engine unified. we have have to be fighting together and pushing the right program. we needed democratic party will help us do that. that's what got to have. if you're ready to do those things, we are ready to win. i need to ask you to do just a few things. we consider doing some things? one is, bernie said it's and can we just think bernie sanders one more time. [applause] think you bernie sanders. thank you. bernie said, we need to sign those petitions. we actually got to get 1 million signatures. can y'all help us do that? that means yet to get on twitter

and facebook and hustle him whatever it is to get us those signatures on the petition. if their dnc members in the state, gently and politely tell them that you would like them to support ellison for dnc chair. and, tell them that you as a supporter of the party would like to see allison. don't him how you feel. don't be too hard on him, but let him know how you feel. also, we need to be doing meet ups all over this country. invite folks to your home, several people talk about what our country needs and what you all can do to make it happen. get some tea or coffee or

whatever you like and say what if we did this or what if we did that and then maybe you could have a listening session to really feel how people are doing. here's the other thing. there's a lot of folks who voted obama, obama, trump. don't reject them. ask them. what are you thinking about question how do you feel now. are you willing to work with us now? did he disappoint you or are you feeling satisfied. the people losing their health care will be annoyed, but don't push them away. bring them in. be kind and bring them in. the last thing i want to ask you to do is just understand there are a lot of folks who might have their family roots south of the border and a guy who just got elected said build the wall. these people need our support. these are our brothers and sisters and we can't let them feel vulnerable and afraid.

[applause] dear friend of mine said recently when she was called to a meeting with her friend and they were sitting at the kitchen table and she brought her daughter with her who is smarter than whip, my friend told me her friend said her if me and my husband are picked up and deported, one needed was born in america. she is a citizen. will you take care of her? you understand? think that having that conversation. that is real for a lot of people. there are other people who were told they were going to be banned from immigrating here based on their religion, people who are muslim. be a friend. there are people who are gay, lesbian, there are people who

are anti-semitism that has really popped up. you've got these people with swastikas and other ugly stuff. you have to stand with everybody who is feeling vulnerable right now because one of the things trump has uncorked is that hate machine and we have got to resist it, stand against it and our best weapon against it is our own solidarity. let's remake the democratic party, everybody. [applause] [applause] thank you everybody. get home safely and have a good holiday and be ready to fight.

[inaudible conversation] [inaudible conversation] [inaudible conversation] [inaudible conversation]

[inaudible conversation] , what. [inaudible conversation] [inaudible conversation]

[inaudible conversation] [inaudible conversation] [inaudible conversation] [inaudible conversation]

[inaudible conversation] ,.

[inaudible conversation] , trent. [inaudible. [inaudible conversation] [inaudible conversation] [inaudible conversation] [inaudible conversation] [inaudible conversation]

[inaudible conversation] [inaudible conversation]

[inaudible conversation] [inaudible conversation]

[inaudible conversation]

[inaudible conversation]

[inaudible conversation] [inaudible conversation] on.

[inaudible conversation] [inaudible conversation]

[inaudible conversation] [inaudible conversation]

[inaudible conversation] [inaudible conversation]

[inaudible conversation] [inaudible conversation]

[inaudible conversation]

and don't have all the details but i would like to see the platform that's online. >> you can go to his website. >> a look at it. >> let me tell you, i was happy to support bernie and then i supported hillary. we are unifying people. thanks for teaching our kids. a lot of people are doing hard work. >> i teach spanish in alexandria it's probably miles from here. [inaudible conversation] you talk about unity and i think one thing that is really important to that unity is

addressing this very deep sense of mistrust that is surrounding the trump party they could've saved so much emotional abuse. [inaudible] towards young people and progressives. >> let me tell you, we have to unify everybody. we can do it. we need institutional memory. i'm so glad you're here. the other thing i wanted to say is a think a lot of people don't know the best way to involve their skills.

they need to get involved in politics, they just think about policy, that's a lesson i've learned myself. [inaudible] people who think about policy and national policy, it's it's very hard to find a place to contribute. >> do live in apartment for a townhouse. >> a townhouse. tell five or six people to come to your house for cookies and coffee's and then just kicking around for politics until one. then sale come back in a month and asked who wants to host next time. if you do that, you'll be doing a lot of good. >> this is something that

actually bought myself my campaign, but i think it's appropriate to give to you. >> that such a nice thing. [inaudible] i have one myself and they gave one to the people who worked on my campaign. >> i think this country needs to go back to what we used to stand for. >> thank you so much. it was great to meet you. i will remember you. >> can we take a picture. >> i was that your rally last

weekend and we are proud to call you allies. >> i appreciate it. good. >> are you brett? >> i am. >> okay, i was supposed to be looking for you. >> let's take this picture. [inaudible conversation]

>> later today president-elect donald trump will hold a victory rally with supporters in pennsylvania. he will be joined by vice president elect mike pence in hershey. after winning pennsylvania's 20 electoral votes by about 40,000 votes. watch that rally live at seven pm eastern on c-span. here on c-span two, remarks from federal judges on the bill of rights and its relevance today. the bill of rights was ratified on december 15, 1791. 225 years ago today. you do much tonight's can watch tonight's event hosted by the national archives foundation live at 7:00 p.m. eastern. >> earlier today, secretary of state john kerry up updated individuals on the latest on syria. there are still reports of injured people being fired upon. here are some of his remarks. >> this morning, i was encouraged by reports that after

a number of starts that were worked on in paris and we got picked up on and continued in conversation which, by the way we were informed of by russia and turkey that were going to take place to build out on what we've talked about, actually using the same template that we had created, there are individual cease-fires being worked out and individual deals being worked out and it appears, for some time, we don't know where it is, but airstrikes have stopped and the cease-fire may be taking hold. buses and convoys are beginning to move and my understanding is that the first group of 21 buses and 19 ambulances reached a checkpoint. this convoy includes more than

1000 people who are on their way to the turkish border. however, this is a big however, we have also heard reports that a convoy has injured people, was fired on by forces from the regime and its allies. we remain deeply concerned and we are hearing reports of searing men between the ages of 18 and 40 who have been detained when trying to pass through government checkpoints and some of these actually went missing days or weeks ago and we still don't have families, families don't have accountability for what has happened to them. obviously these actions are despicable and contrary to the laws of war him basic human decency. >> that is some a secretary

carries remarks from earlier today from a briefing at the state department. you can watch his remarks in their entirety tonight at c-span2. every weekend that tv brings you 48 hours of nonfiction books and authors. here are some of our programs this weekend. saturday night at ten pm eastern on afterwards, georgetown university professor jason brennan looks at the failure of democratic political system. they call for a change in how government is run. that is his book against democracy. he is interviewed by vice president of the cato institute. >> fairness doesn't get you to democracy. by the people reject that system, why they don't want that is because they think it won't work very well. they think will lead to bad outcome. they're probably right. once you say that, while i care about not just fairness but bad apples, then you're on my side and you're asking how are we going to weigh fairness versus equality of the outcome. >> on sunday at 1:00 p.m.

eastern, the before columbus foundation presents the 37th annual american book award. it recognizes outstanding literary achievement from the entire spectrum of america's diverse literary community. the awards are presented at the jazz center in san francisco. then at five pm eastern, jonathan zimmerman, zimmerman, professor of history and education at the university of pennsylvania who argues that free speech is under threat on college campuses across the country. that's his book called campus politics, what everyone needs to know. the problem is the second kind of pc. it doesn't taboo words which add nothing to our discussion but taboos ideas. at 40%% of the faculty as opposed to basic affirmative action, we are not hearing from them. that means there's a serious pc problem. >> go to book tv.org for the complete weekend schedule. >> i do think you can learn from failure.

think of the next president wants to aspire to be like somebody, they would probably want to aspire to be washington or lincoln. you can't re-create the country and you can have a civil war. what you do next? do you aspire to be james monroe? i don't know but you can aspire not too be james buchanan. sunday night on q&a, historic and robert strauss talks about james buchanan's presidency and his latest book, worst president ever. james buchanan, the potus rating game and the legacy of the least these to the lesser president. >> i think the differentiation between good presidents and bad presidents, lincoln and fdr always at the top of the surveys, they were decisive men. you can't come to the top of the ladder and not be decisive. buchanan was a waffler. james polk hated him for being a waffler as secretary of state. he always went back and forth on

decisions. your made visor, you to tell me what to do. that's how he was as president. sunday night at 8:00 p.m. eastern on c-span q&a. : >> >> the discussion was part of the american bar

association conference on health care laws in washington d.c.. this is one hour 20 minutes. >> good morning we will get started. i am sure the organizers would like us to start on time. thanks for joining us this morning with this panel with historic government health care of the post-election future of medicare/medicaid and obamacare and in how those programs work. via partner of a health care practice and before joining i worked in the counsel's office.

and i had the pleasure to work with all the panel members in that capacity. as a moderated discussion between me and the panel but we want to hear questions from the audience. and it was two months ago. there was a concept of how that would go. and then with the transition of the newer administration. and of those individuals with uh biggest changes of government-funded health care in the last 15 years. is the medicare

modernization act to bring in prescription drug benefits. but then the affordable care act noted as obamacare it with the implementation of the affordable care act. i will give you some background the senior counsel has regulatory banners also with willes carson anderson as the private equity firm. peat administrator for cms and was instrumental in passing medicare reform would decision. and with that implementation of party -- part d with

dialysis 54 joining cns with the federation of american hospitals to represent privately-owned hospitals in the united states next leslie is currently the strategic counsel with a national health advisers which she represents the private equity firms. she served as the acting in bad as trader for medicare/medicaid services. and with the medicare/medicaid programs and for four years prior to machine served as the deputy

head minister with the implementation of the medicare modernization act provisions with the prescription drug benefit program. blast and but not least currently has an executive vice president caring for a blue cross blue shield of looking at the care coordination policy and the provided network said before he joined that senior leadership position served most recently passed spending most of his time at cms with the chief of operations which of course, puerto regulates not only the fee-for-service provision but the medicare provisions with the prescription drug benefit program prior to cms he

served on the staff with senator baucus absurd as the vice president before he joined cms. thanks to the distinguished panel. so this is intended to be a dialogue to start off with a few questions there will be a lot of people who are interested in what is happening right now with a transition from with the obama administration going into the trump administration. we have the presumptive nominee hhs secretary also cms administrator seven like to start off uh question of

looking at transition policy and then move into more substance. soto kickoff of first question probably the most recent member of the panel to expand that transition from republic administration give us the sense of what is really happening now from your perspective what they are doing to people already come in with a blueprint with the health care policy? for what is created now? and also with us current administration quick. >> i served on uh transition

team and i am unsure every team works differently to run their priorities and policies goals but the one observation that i had that the transition team spent time how to fill campaign promises that were made by at kennedy but the reality is with health care with cms there is the mix of discretionary positions from what they have to and with those statutory deadlines on jiri 22nd so how do they fill those campaign pledges

and health care was not part of that national conversation there was not a rich to bait of from - - debate of medicare or how they would operate. so that transition team tries to fulfill those campaign promises so you may have a well thought out plan of the discretionary decision but for example, looking at cms 2009 with with that health crisis of that medicare regulations of the deadlines setting up the previous steven still had to be decided they need to be

staffed and prepared to function to make those decisions and they will be faced with that the very first a day cut and. in with the current transition team with the campaign pledges them promises. and then get ready to deal with things with the hospital's going bankrupting sat when just pop up on day number one. >> john talk to lot about campaign promises so when you would transition into the of bush did

ministrations what pledges and promises clacks what you see the current in penetration has made to medicare? there is an enormous amount of promises with the affordable care act. >> i was sexually involved with me 88 campaign in march or april mw that is a whole different scale much more than a health care world with the 2000 campaign and then i was called as the old bush flunky. but i was picked the first

of my talk to tommy thompson was dead january be was confirmed in make so the fact that he is a administrator nominated secretary of state shows that the repeal like kidder not was one of the top national issues. >> that is correct once they walk in the door. of it doesn't make much difference. with those top national issues. not sure where they're going with it. they are well ahead of the game.

and then it shows them 106 years old. [laughter] and then i talk about medicare part d and then to revitalize the private medicare and then change the name of the agency but then maybe really in day but then when they talking about? it is made out of the time schedule in my experience. your individual that was irresponsible for changing. so maybe you can answer the eternal question why is the center for medicare/medicaid services? if. >> so could not find a way

to work. but it is a small world but then to replace me in the white house as bush lost to president clinton going through a rough year with yankee's and that was big and bureaucratic they did not like these agencies and he said you are nuts. what will you do? if you want to hear the real story. [laughter]

kiwi said what do you think of them he said we hate them and they are terrible people . one what about the others? it is the same company they changed their name. [laughter] he said okay you can change the name. [laughter] so we do have statutes so we try to just find somme fresh perspective. i mumble anyway so want its the center for disease control i did argued that benefit was cms i did little

pull on that to see minnesota eight would not hold up well fitted and to teach 20 did not sound right . >> so i will go back to you in terms of transition media will offer the question in little bit because in terms of implementing to be responsible for prescription drug implementation there will be some sort of change to come about. can you describe your experiences leading the transition what that involved and what that may look like with a significant change quick. >> if i were to give third vice i think it would be

several fold the critical component to be successful would be a health insurer to make sure that those companies are on board so they can appreciate that they will have the reaction of externally and that could set up success or failure going forward. i know that is allied to make sure companies like care first or a&m -- and some who can be successful. and to participate successfully. to have a marketplace with the individual insurance market that the health care

providers can be paid then you'll have networks and beneficiaries can participate as well. at the very least if you look at changing medicate with obamacare looking at those programs and how those changes will impact critical going forward so the lot of the things that will happen to the actuary to determine what it cost that is an important role to determine the policy going forward. and that is something that

we know all too well to determine if it will go for wharf for the controversy surrounding afterwards. but to give and now some advice just listen to your staff for what will happen coming get you from bull's-eye its as the goal is to be successful matter the policy. by the way to be determined by congress rather than and cms. >> that is a good transition because i have been asked what can we expect out of the new cms designator? we don't know what cards are in their hands so that is set up by congress. so on of panel we can

theorize with they will do, but as i promised talk about medicaid would. there is no major change putting it into a block grant program. obviously the new administration will do something with medicaid but also over the last four years with the coverage with a large number of individuals. what sort of thoughts or potential production dec assuming nothing major changes in terms of legislation that they might want to do with the medicaid program quick. >> from the cms perspective the medicaid program that the governors have a lot of discretion of how to reform

medicaid as the domine says there will be a very high priority to modify those programs and to shape them to meet different priorities . there is nothing and the law that requires the agency to do anything with medicaid. that is the state determine eligibility consistent with federal guidelines but the choice to me says you can listen to the governor's to have them place much more flexibility to determine the future of the program. but what is happening right now with the exchanges and

the state medicaid program is tremendous need so first for those who are signing up with the exchange products, have greater health care needs with the general were population with cancer drugs, the use doc hospital more often than the general population. so to work with with providers what they need to realize is to sign up and walk before coverage through the state expansion and they will have to think very carefully of that transition that care is disruptive or change of lot of people going through cancer treatments to or chronic illness. so think about continuity of

care in addition to the provider. that is the very real and very tangible outcome. >> alaska same of question so those states that would like to have flexibility and to be seen as somebody who managed to use that flexibility with the expansion to create medicaid expansion on the terms. >> basically as i said of the radio yesterday even governor romney with ad expansion had zero massachusetts dollars so that problem with that medicaid is the great

program but it will be a complete and total policy failure in the republicans did not like expansion i am a fan but good or bad of what of those. i don't know if they will pass it because there is more state vs. state it is more what happens of what you have so over the last 25 years hist -- those states have cashed out their money. bet now all of money is faking and phantom. so the report what they will

try to do adult think it will be a block grant but that per-capita cap that has more bipartisan support, but if you tell every state we will keep you that per-capita amount adjusted for inflation for your population for women and kids but look at yorkton thousand dollars on average one verses alabama which is 4,000. bay to the expansion but alabama led didn't so the republicans control the white house so they are capped at the artificially low rates so the east and west that took the of money that will not happen so the obvious answer is just give them more money but they are republicans able mike give more money. that will not happen c. will have a massive state by state formula fight that

republicans will say at all what to do this because i of the last republican in your core indiana. so the answer in the past even the first waiver from 1990 find me a state with medicaid expansion or through a baseline scanned so now you are back in the world that will cap medicaid or try to hide the guild me very difficult in then get into the finite budget to say all the southern republican states are losers but actually a california is a pretty cheap program so we will find of way to budget to save equity over the next defied years. good luck. things can be very difficult

and very hard. the easy thing for everybody is they came to see a mass to declare we would be budget neutral one. we have a lot of magic money floating. >> so todd talks about what the per-capita cap as a potential he uses the words camelot. >> like to tell you stories until of cows come home. >> as the general counsel's office. [laughter] we will not call those scams >> but everybody in the audience knows in their state as a taxpayer it is outrageous debt is much money as you can i do not blame them.

>> but in terms of what tom is talking about, focusing on us potential and his explanation is that might seem attractive so what are your thoughts with the significant legislative changes? >> first it is hard to argue that there will be a fight with medicaid expansion of you have 17 states for those that did not really expanded to take advantage of that match to see what happens there but in terms of cms if you look at indiana plan that was approved and 2015 and who was involved in the development so to start you may say what would happen on that medicaid side?

but in terms of working with governors is to develop the model waiver in this instance i suspect could be a lot more personal responsibility more premium or copayment you have to work if you are able-bodied with surging populations with you were mandated benefits so what they may do to make it easier for governors with whatever that legislation turns out to be and cms can and making it easier to change how the program works.

but with the other populations weren't better above the of 132% what do you do with a are coming off the exchange? and in that medicaid program. so what can you do to increase those individuals who can qualify from the adverse selection as talking about being a insurer with individuals getting those to help those that are providing care and pay for that so there is a lot of things that cms can do of

how they are covered. >> one last question and this is back to john with those model waivers that we might expect looks like what indiana used to get with personal responsibility with the premiums for that beneficiaries for those covered by the waiver. as somebody who presided over expansion so what is the predicted impact what you think?

but that will differ by states. with their own demands for those taking medicaid as a fiscal drain. but medicaid is the greatest source to new coverage of the country so different governors could have different principles of expansion they want more personal responsibility. and with premiums or co-payments. so that will differ and as they argue to waive requirements with a federal

debate of national standards and the oversight agencies agencies, i just because somebody wants to have of flexibility that constrains that flexibility different states in different governors will frame medicaid reform from that standpoint to reduce the requirements with more federal dollars anti-other social goals. >> with the first year you talk about the repeal next month it will be effective

2019 so nothing in the law will change over two years effectively so it is the price the deal let these 19 southern states command for expansion? they want the money bet the radically the republicans is not like any of that to begin with. so before this disappears they will get their fair share also? they will say forget it the bank is closed this fiscally irresponsible. pao they will respond to that and how did ministrations and response will be of big issue. >> just one final thought thought, if you look at what

donald trump is talking about with manufacturing and trade and how important it is to keep manufacturing jobs in the united states, i am not sure there has been a lot of focus on the fact that the health care industry is more likely than not unless you have a big university are manufacturing plant but the health care sector is it. i wonder if there might be a change with the administration is how do you compare fiscal responsibility and the two-party republican focus to have more jobs in this country as a large provider of jobs, how do they go together to determine what it looks like going forward?

as you may well know the rules of repeal we will not just take what was passed in 2010 to make that go way, we will repeal through the reconciliation process you can only repeal what relates to revenue. like tax-and-spend so there are all lot of things in the affordable care act that will continue. doc question that i have spending some time with budget people to figure this out, but once you repeal the tax and spending portion what does that do to the baseline? how might that impact what the replacement looks like? if you replace you will spend more money. is a lot more complicated than repeal and replace and

there will be big consequences for those dealing with what remains for those insurers with pre-existing condition -- conditions on the individual market, a bet yet the longer have the mandate for individuals to have coverage that combined with hospitals depend on the insurer's san the medicare program to keep the mitt employee -- to keep the employees. it will be a lot more complicated with more responsibility from your job. >> so let's focus on the idea is on what might be replaced and i am greek, when she talks about

reconciliation in think the conventional wisdom is this is the way has to have been otherwise there needs to be a filibuster proof majority in the us senate to repeal that does not currency acis so there is the exception to that of the reconciliation process everybody recognizes as the likely vehicle. i was involved with the budget deal before and they are big deals. one of the lessons of obamacare is that they did get by reconciliation the '01 weeks had been numbers with the party line vote and was a mistake i think if they can do with again they would make a bipartisan. in 2003 thank god we had

senator baucus and those democratic senators of had to go along with medicare part d it took the sting out and it was far less partisan and it wasn't a knife fight so i do think they will repeal then you have to work to replace it but in my opinion not just dead giant tax reform bill but trade issues and medicaid reform into a giant first year legislation bill they will have to get democrats where that will blow up there was a lot of stuff in their policy why is. they will repeal quickly because they have today have spent six years yelling that they don't like it but to replace that tax policy on a

partisan basis they're making a mistake and i doubt that will happen with those that work on the global tax reform that will take all year long i hope they do that it will be much more successful without will take all the edges off which is good in the long term. >> if you read the paper if you talk about what is the affordable care act, with guaranteed issue to eliminate the pre-existing condition, so what do you think are the two or three sort of things from the

affordable care act from future legislation quick. >> i am pretty consistent in my view with 67 percent of of population most democrats that i knew i thought we should have 300 start but that is 50 billion people that is the of middle-class. that was fundamental they just went too far the benefit structure was too much they cover everything but the kitchen sink the benefits were to plush and what drove be insurers crazy to begin with they thought we should do five / one that makes a big difference if

you have the 26 drawled runner who only pays one-third than that screws up the insurance pool so they do have to expand the rates and that of republicans will want to scale back that subsidy level. and i think they will scale that back. it probably will not be gentle or graceful but that is what they will do. they will talk about getting rid of the exchanges that they are dead obamacare is said they will have health care networks they will be back to give people access with more catastrophic like benefits the income stream will be much lower and with no little moderation six years ago, fundamentally that structure looks like

the structure of the george bush plan we have health insurance networks in duquesne create insurance pools that work. that is of fact of life so what level benefits rex and when she hit medicaid you should have a smaller benefit and then get 67 percent of the up population it is too big. there is a lot of new names like killed obamacare with a lot smaller subsidies all across the board and will be payable but i think that is what will happen. >> so of those products that

will be regulated they will not be called the changes i agree the name change will be important. but i interested to hear your top two or three and perhaps could you also comment what are the of hallmarks of the affordable care act was the creation of the innovation center. the center for but i think

those models are seen as a necessary experiment to address those disincentives of the fee-for-service funding of the government-funded health care insurance. but the innovation centers in terms of the affordable care act as negative connotations so will we really see that? we will have that it just will not have the same name. >> first of all sense 1973 the medicare program has had the ability to demonstrate certain pieces of the statute you could wave not everything but there was a lot which in my mind was that i precursor to cmmi and

republicans may not like cmmi data not like controlling that $10 billion but i am fairly certain as the secretary was talking how he wanted congress to have more control over cmmi not that that would have been necessarily but i do think innovation will continue also republicans tend not to like that fee-for-service program and not only that think of what cmmi has done to bundle payments, a lot of that concept has been around for decades supported by the bush administration to make sense if you think of moving away from fee-for-service instead of pay for performance and this could have been with cmmi likewise programs have focused on those that are doula eligible and depending on

what happens with medicaid expansion, and that number could go up for down some of the need to focus on those models that changeover time are not going away so flu has control over that? so if you have us demonstration permanent that if you like ticket become permanent and then you saw the chronic care joint replacement program that is where was put out that cms could roll out if they were so inclined. so you may call it something else or those republicans that might change their mind

of the concern of those funds that our available $10 billion that is considerable, the the concept that maybe these are new ones that program was created 1965 because they had one statute over another and and they don't necessarily relate to one another so you end at with odd incentives for providers that could not be good for beneficiary care either side to mention this will continue with going forward. >> the tools are incredible

previous segmentation's had the team if they liked that for congress the tools are incredible and powerful and my guess is as a democrat republican you want to keep those tools one the next team could think about how pace for medicare private plan but through those authorities of funding but those statutory requirements so congress tends not to like things that are done on the other side but they are tremendously powerful to retain those authorities. >> diane agree.

we have done a lot of bundling it is what republicans have been pushing for 25 years. but they don't like it because it is $10 million when i was set cms riata budget with the appropriations committee so we didn't do anything basically. i think once actually get behind the wheel that 10 billion gives us the authority theoretically we could do support through cn my then they could be shocked and maybe this is less money. >> so that question that replaces sgr year after year

after year bailing out that position we year on us cusp one of the away of up pavement model. dc that continuing the of way that it is? i am not sure there is of regulatory tinkering. >> but in those senators that voted to support as bipartisan support even if you are not a fan to be position friendly tremendous bipartisan support in the house and senate but those

concepts that they have supported for quite some time but based upon my own perception that was acquired by a cms they don't know what this law is to get ready for it and cms has put up a the models with the primary care community of the cardiologists or a neurologist so they have to make the choice to the move to the alternative payment systems? there will be tremendous pressure given that most

physicians have flooded congress put in place and they will face be adverse test to proceed with the current course or modify empress' raid congress to change that that will start to be a tremendous push back and i think some of the physician community will see it as the sign to have a of a clear voice going forward. >> and they have already complained. all lots of this is mandated by that statute now i think it is unlikely. what will they change? but they do totally agreed that the delay a or changes around the margin how would is implemented maybe reid defined for the alternative

payment model to get out of those over varying factors from when they don't qualify one. so whether a data collection search but your dado will count toward your reimbursement. so i do in addition a delay and i suspect that the margins where cms has flexibility there will be a push to alleviate some of the burden to smooth over with the implementation. >> i totally agree. most members of congress i

went through that 12 years with 90 senators voting for it and don't want to open up that cannot forms again. we are done with that block payment when i think they will move onto other issues and not climb back into this legislatively i don't think it is likely to come up as a major issue. >> one more round of questions then we will go to the floor. i know started talking about legislative changes with medicaid, but talk about everybody knows the individual mandate is on the chopping block. from the obama administration perspective that was such a key component as it went to the supreme court. i would like to hear you

talk about, and leslie is said to help individuals whether talk about private insurance or medicaid medicaid, obviously medicaid can be dealt with in terms of expanding individuals, but what is a possible alternative for a mandate? and what about the potential effectiveness? >> if you looked at the pillars to make insurance work become the key issue for the insurance plan to work and from the beginning it was not difficult to see the affordable care act was likely to have adverse selection where six people sign up and not enough

healthy people to support those who were sick and while there was the individual mandate the first year of $85 is not sufficient if you look at several thousand dollar insurance premiums as an individual. if you are 27 years old, you think you are invincible and will never need health care services so they are the ones that needed to sign up said to have a functional margay is to avoid adverse selection and there are things that one could do to keep it uh pre-existing condition exclusion that they have to offer the insurance during the open enrollment period to anyone

who comes in without that exclusion. so then the medicare program has the late enrollment penalty applies to part d you are automatically enrolled then you can opt out of bed part d you sign up. with hundreds of thousands of beneficiaries they hate to the enrollment penalties there is not the mandate to have either but they have these for both of those programs. so do you have a policy that has fewer benefits or mandated benefits like a catastrophic plan so be individuals who want the less-expensive insurance plan can sign up to help

protect them from bankruptcy or cover a big hospital bill. the other piece that the age rating is three / one the and this cohort be the oldest is one-third of the youngest or third the other way around if so the question is to say i would like to run this buy you but you could still encourage healthy people to sign up if you sign up in three years late normally that penalty would be expensive but if you say rather than using the penalty you could use experience some mayday paid

more but if you are healthy and sign up late you don't have abaddon experience senior not penalized. so if you can have some sort of premium that you still encourage healthy people to sign up all matter how long it takes down bed if you only signed up when you are sick and then you pay more in the premium. but of the policy side there could be others that might encourage people to do more event talk about prevention as cheap as possible and a risk pool for those who are sick be. from or those specific reinsurance if they spend a certain number of dollars. >> i hate to agr w