oftentimes the patient who has no choice has no clue that they're going to get a $25,000 to $40,000 bill that's going to be a balance bill from a helicopter service. >> time's expired. >> thank you. yield back. >> mr. doggett? >> thank you mr. chairman. mr. chandler, i was pleased you drew attention to the fact that 17% of our gross domestic product is focused on health care and could arise to almost a fourth of our total national economic output. that was certainly a consideration in our writing the affordable care act noting that despite the fact we devote so many resources to health care we don't get the best outcomes versus some countries devoting significantly less. of course, one of the objectives and there were modest improvements in the affordable care act was to address the whole problem of soaring costs.

one of the major omissions of the affordable care act has been the failure to address soaring pharmaceutical costs. indeed, particularly in the last year the cost of the soaring cost of cancer drugs has been almost inconceivable to see those who are facing a diagnosis of death facing not only that but a diagnosis of personal bankruptcy on their co-pays for drug that is are costinging tens of thousands of dollars, over $100,000 for some not only having the impact of personal bankruptcy but threatening insurers and medicare given our inability to negotiate for medicare on drug prices. one of the very modest steps taken in the affordable care act was to set up an independent panel given the inability of congress to address soaring

health care costs, and so, the action that was taken is that yesterday we repealed that modest cost containment provision and paid for the repeal by limiting the prevention fund, money to encourage preventive steps such as treating and preventing diabetes instead of paying for amputations, all of this done without alternatives offered as to how rising health care costs would be addressed. today, we're speculating on an incomplete set of proposed premium increases that will not be finalized for months that some states have the ability to deny or limit in the rate review process and many states do not. against that speculation, we have a certainty and that is that if tomorrow at 10:00 or one

of the next few days the united states supreme court provides an adverse decision in king against burrwell provides the result that chairman roskam, chairman ryan, my two texas senators have sought, that would deny tax credits from families who live in our states that those folks will see an extraordinary increase in their out of pocket cost, about 6.4 million people living in states that have refused to set up private insurance marketplaces at the state level will lose their tax credits. that's a cumulative loss of about $1.7 billion every month. in texas that would mean an average 305% premium increase for 800,000 texans. at least in terms of what their out of pocket premium costs are. i'm concerned about what's happening with rising premiums.

commissioner, is the increase in health insurance premiums, did that start with the passage of the affordable care act or did we have some issues concerning rising health care premiums before that act ever became law? >> thank you, mr. doggett. the issue of rising premiums has been with us for a long time and since i've been serving as insurance commissioner 14-plus years now i can tell you it's been a real problem that is actually looking better right now with the affordable care act than we saw before the routine nature. we were seeing people who were sicker buying health insurance if you're healthier and didn't buy it. you opt in if you're trying to buy it if when you're sick and a negative impact on the market. now with a mandate to have it, it's had the affect of helping to hold down the rate increases. but we need to do more than that and one of the issues that you mentioned was the issue of

pharmaceuticals. we need and we're seeing a major transition to generics and i'm very supportive of the health insurers to go generics first and need brand name at the appropriate time. they can't discriminate unfairly against consumers who have bought health insurance. when it comes to the issue of narrow networks, that is not new. that was there before health care reform went effect. something that large employers instituted in the past which we as regulators don't regulate. but if it came into the regulated market particularly inside the exchange starting in 2014. but if it's done right, and that's why i adopted rules on network adequacy and done right to improve quality and outcome and lower the cost. but you need to make sure you're holding carriers accountable. don't let them make the

determine the rules for themselves. >> thank you very much. >> mr. renacci. >> thank you. thank you for the book, mr. lewis. it's an honor to serve with you. i look forward to reading that book and the witnesses i appreciate you all being here. it's interesting. i was in business for 28 years before i came here. i was in the health care business and yes, premiums did go up. but if i ever saw a premium go up more than 8% or 9% it was a shock. today when i go through my district and i hear 62% increase, 48% increase 39% increase, it shocks me when i hear premium costs are coming down or we hear use statistics saying they're coming down. that's not the real world telling me in my district and i go to these employers and going to the employers i ask them to talk to the employees and it is interest because it's a requirement. i want to talk to your employees. i ask every one of them they're buying insurance tell me if your health care costs are coming down. put your hand up.

i realize people are always afraid to put their hand up. i had one person tell me that the affordable care act helped them. maybe i'm going to the wrong businesses. i don't know. i'm going do business after business and talking to employees and i also had a similar situation of mr. kelly had. i had an individual at a local restaurant in ohio say to me congressman, i know am part of the affordable care act but can you help in? my husband and i work 40 hours a week and can't afford this deductible. we don't have insurance. and it's shocking hearing some of those stories as well. i do go around to the hospitals. you know? again, being in health dare i'm trying to fine out what the affordable care act has done. i ask has the emergency room visits increased? you know, increasing. at the same time, we are learning about the insurance premium increases we have been hearing and i have been hearing that emergency room visits are increasing and without objection i would like to enter this may 5th, 2015 "wall wl journal"

article of u.s. emergency room visits keep climbing into the record. >> so ordered. >> the article explains even though people have insurance they can't get providers for get appointments so they're still going to the emergency room. now, for the panel, i think you would all agree doesn't greater emergency room use lead to -- does it lead to higher costs or lower costs? each one of the panel members. higher costs or lower costs going to the emergency room? >> certainly i think higher. >> commissioner? >> i would say also definitely higher but in the state of washington we have seen a 10% reduction in emergency room visits. frequently -- >> washington must be the only state. ohio's hot doing that. but i appreciate you. ms. mcpeak? >> they tell you, if it's not an emergency situation, go down to urgent care down the street and cost you a lot less and that's had a dramatic impact.

>> commissioner? >> i would say higher. >> mr. chandler? >> the issue is that once you're in the emergency room they are a wild number of tests that will be performed. insurers aren't capable of exercising sensitive utilization review and as a result the costs can often be higher. >> it's amazing because i thought the purpose of aca really especially with subsidized insurance to reduce emergency room visits. again, that's what i'm seeing in ohio. commissioner mcpeak you mentioned that many insure earls made changes to provide thelimit the providers people can see. >> we are just now beginning to see very limited networks attached to rates and plans for the 2016 plan year. as i mentioned before, i do think that that is an attempt by the insure earls to moderate the rate increases requested and

provide choice for consumers to have a skinnier network and potentially reduce your own costs willing to take the risk that you may not have full access to the wide provider network to which you're accustomed. >> how's the president's promise that you can keep your doctor if you like your doctor worked out? in tennessee. >> well, that's about the same as the promise that you can keep your policy if you like it. in my opinion. that's not working out very well. we are hearing from consumers who are having difficulty navigating the federally facilitated marketplace to see where the provider lists are maintained and whether their providers are inclouded and they might get into a product that in fact does not have the doctor which they like. >> that's same thing i'm seeing in ohio. this is an important point. having an insurance card doesn't mean you have access to care. i think you would all agree? >> i would agree. for, you know, economic reasons access reasons and utilization, certainly. >> thank you mr. chairman.

i yield back. >> mr. crowley of new york. >> thank you mr. chairman. thank you, as well for the book. i appreciate your kindness in giving it to all of us. and we can never say enough about the honor it is to serve with mr. john lewis here in the house of representatives, particularly in light of what took place last week. in the south and all that he has lived for has put his life on the line for. the horrific events of last week left a scar on our nation and no one knows more than john lewis so thank you. you're a great man. i love you. i'm a little bit baffled by what my colleagues think they're gng to accomplish today by holding this hearing. yes, opponents of the affordable care act tried to scare people from the law. that's nothing new. seem to think that they keep --

if they keep on shouting premium increases obamacare, death panels then people avoid getting insurance through the law which is somehow a victory for them. that's no victory for anyone. commissioner, you have mentioned enrollment plays a big part in keeping premiums stable. that's the concept of insurance isn't it? let me -- just a bigger healthier pool of enrollees spreads out costs? >> it is the law of large numbers. if you dent get good and bad risk, and have large numbers a large pool very hard to control rates. >> so all of a sudden there's outrage of premium increases going to have the affect of scaring people from the aca's insurance markets making it harder to prevent those very premium increases but aside from that i don't understand this nostalgia for the way things used to be before the affordable

care act was in place when insurance companies do however much for whatever they wanted to charge. as if there were never premium increases, never problems with health care in the past. but that's not what my constituents experience in new york. they in queens and the bronx are small business owners who saw the insurance bills go up every year with no explanation. they were families buying insurance on the individual market or couldn't shop around after getting hit with a double-digit increase because they had an old injury that would get called a preexisting condition and they would be denied new coverage. i'm proud that those days are days of the past. commissioner, today, if an insurance company feels like raising rates to pad the profits without spending more on patient care, can they do that? >> mr. crowley, what we see now is insurance companies have to play by standard set of rules so they can't game the system. the game before was try to avoid sick people only insure healthy

people and one of the sick people you were obviously kind of left out. now with standard rules, we are actually introducing real competition between insurance companies and that's one reason i'm so proud that in the state of washington we had a 50% increase in number of insurers and competing with standard set of rules. it isn't the gaming employ in the past. >> also before the affordable care act requires 80% of the premiums go directly to better care. if consumers do get a rate increase, they're left to just dicaprio they were left to shrug their shoulders. that's just the way it is. that's not the case anymore, is it? >> that's correct. in the state of washington, we were fortunate because we had a very competitive market, we had none that had problems meeting the 80% rule. that wasn't true for many other states. and it's one of them now because of the federal law they have to meet as a standard. >> and what can regulators in

states like home state of new york or washington do when they see high rates going into -- or the request for that? what can they do now? >> one is they have an opportunity to shop. they can go if they have a carrier before, if you had a preexisting condition, you couldn't move to another insurer because they wouldn't want to insure you because of your preexisting medical condition. now you have guaranteed issue. you can make choices, decisions. how much out of pocket expense do you want to have? what kind of coverage do you want? and you also want to make sure your doctor and hospital. i'll agree this is one of the challenges that we have had is making it a lot more transparent so it's easier to identify the hospitals and doctors in a particular carrier's network when you make the decision. but you have those kind of choices and didn't before. >> i can tell you in new york state we have consistently as the authority to encourage --

encouraged by the aca to fight premium increases. the state has come to the rescue and to stop that. so, mr. chairman, i just want to say, i would suggest that our three out of the four panelists would be opposed to the aca, just taking a guess and one in favor of it. i yield back the balance of my time. >> it was a rhetorical question but i'll answer it. what are we trying to accomplish? we're trying to accomplish the work of the subcommittee under the house rules which is to evaluate federal programs. we haven't had a bigger federal program since the passage of the affordable care act. there's nobody nostalgic about the past. the irony is when president obama won his election overwhelming majority of americans agreed on two things. they agreed that health care costs were going up at a rate unsustainable and basically scandalized by the idea of not being able to get access to an insurance pool based on a preexisting condition. the loss and the regret is that we're focusing in today is to

say, we should have focused in on those things concentrated there but instead the administration and it was their prerogative went a different direction. the false claim and the false narrative was it's all going to be great. you get to keep your doctor. premiums are going down. so it's not as if we're scaring people away from the affordable care act. the affordable care act is scaring people from the affordable care act. with that, recognize the gentleman from north carolina mr. holding. >> thank you mr. chairman. you know, it's some what striking to me that there are many insure earls out there that appear to have paid out more in claims than they're collecting in premiums. for example, blue cross, blue shield of texas reported that it collected $2.1 billion in 2014 but paid out $2.5 billion in claims. so, does anyone on the panel think that it's sustainable for an insurer to pay out more in

claims than it collects in premiums? kind of a uniform -- >> no. it's not sustainable. and of an observation is our blue cross plan has lost money in the last couple of years and we have seen a reduction in their reserves. one of the reasons that they're coming back with a large rate increase obviously is because they've lost money. the gentleman from new york mentioned that if carriers don't hit a certain loss ratio they pay rebates back to the consumer. so we have got a phenomenon where if you lose money it stays lost. but you can only make it up incrementally because if you make too much it goes back to the consumer. >> right. >> so we could debate mr. whether that's good or bad but you can only incrementally make

any losses back. you can't make it up in one or two years. >> if you're an insurer losing money, under this scenario i mean, your options are you can either raise your rates raise your premiums you can you know, just pack up and leave and stop, you know, insuring people in this segment and you know, leave the state. the -- now, this year, obviously, we have a very complete set of numbers. because we have already had a year, you know the program being in place. insure earls have a good, you know, idea of what they're dealing with. so what impact is the data review for the upcoming year having on the rates? and mr. redmer, you want to talk about that a little bit? >> certainly, you can see on my testimony, we have had one carrier that actually came in and is asking for a small reduction in the individual rates and care first our blues plan is asking for a 30% rate

increase and it's anywhere in between. so that's a result of inl creased cost. it's also a result though, of having a lot of uncertainty in the marketplace. you know with the open enrollment last year you didn't know who you were going to get and what that experience was going to be. if you go back to my testimony, i speculated that blue cross and blue shield, our large carrier they saw phenomenon that because of the disparity between the individual market prices and the small group prices, there were a lot of small employers, thousands of them in maryland that just threw up their hands. they disbanded them. and those folks moved my grated to the individual marketplace. i believe that and this is my speculation, that a lot of those

folks that if they were already sicker and utilizing care and they were with care first, they migrated to care first with the lower individual premiums and those that were young and healthy, they were buying based on price and they went to some of the other carriers so i think they were victims of adverse selection when thousands of these small employers just disbanded their plans. >> representative holding could i? >> she was raising her hand first. >> thank you. i appreciate the opportunity to respond. the year of data is extremely helpful from the 2014 calendar year but our loss ratios were extremely high for that yore. one of the functional challenges, though, is that because of the time schedule arranged by hhs we were requiring insurers to file their 2016 rates before they had a very clear picture of their enroll lees for 2015.

>> right. >> because of the expanded open enrollment period and the 90-day grace period to pay premiums insurers filing rates without knowing who they had for 2015. we take the rate review responsibility very seriously and asking for supplemental information on a month by month basis as real data comes in and it's still very very new and haven't seen a large uptick in a positive trend on loss ratio yet. >> all right. mr. chairman mr. chandler have 30 seconds just to respond the that? he's anxious. >> yes, he does. >> thank you. i would just say the following. don't trust me numbers. trust the become administration's numbers on this. their calculator shows a 14% increase in claims experience projected for 2016. yes, of course insurance commissioners can review rates and if insure earls are greedy they can strike that down. but if they strike down rates

that are, in fact, reasonal due to claims increases, i expect to see exit from the market. it is not sustainable for an insurer to keep losing money. >> thank you. mr. chairman, thank you. >> mr. smith of missouri. >> thank you mr. chairman. i want to thank the witnesses for being here. the president campaigned aggressively on the promise to lower out of pocket expenses for families by roughly $2500 a year. however, insurance -- insure earls that cover my constituents just in the last two years we have seen an increase by one insurance provider of 22.9% in 2014. this year they have requested a an additional 22.7% increase. because of the one-size-fits-all approach under obamacare. everything that comes into place. in my opinion this administration cannot continue to believe that obamacare will

reduce cost for families and individuals throughout my district. that's not what i'm hearing back home. and that's what i don't believe is a reality. but the families in my district need a health care system with more choice, more access and that's more affordable. but what i seem to be reading on a daily basis is that instead of more choices we are getting fewer. the burden on insurers is so high they're consolidating providers are consolidating for the same reason. the extra cost and bureaucracy by the health care system from this administration has created. now, the supreme court decision make may expose another broken promise by the president to my con sit wents who may be required to get health insurance but lose the subsidies. mr. chandler, why do you think the premiums are increasing across the country and in my district? >> i think the reason first of

all, is the continued escalation of health care costs. of underlying health care costs. and the affordable care act did very little -- yes, it did a few things, but it did very little to address that and in some sense providing insurance without effective utilization review to a larger number of people it put yet more strain on the system. the second reason is the adverse selection story which is perfectly foreseeable where you have inadequate controls built into the law. the people who are going to purchase insurance are as has been experienced disproportionately ill. and that is one of the reasons that you see premium increases going up. the phase-out of subsidies is a factor but it is not the primary factor in my opinion. >> so do you think that with say, the increase in all the premiums, i gave the example of 22.9% last year in my district

and then additional 22.7% requested, do you see that my constituent is getting a decrease in benefit or same care or less care? >> i am not aware that insurers are providing additional benefits pursuant to these policies. >> okay. so they're just getting the same kind of care for more expensive probably. mr. kreidler my concern is you made a statement earlier that you felt like things were looking a little bit better. when it comes to premiums and that case. how do you feel like it's looking at individual that is are 27 years old? >> thank you for the question. i think from the standpoint of somebody who's younger, they're not immortal. they run the risks and by virtue of having insurance it's better

for them. if they're under 26, frequently they can stay on their parent's policy policy. at the same time, you know, if you'd looked at the health care spending and thought you were going to actually reduce it in this country, i think that would be unrealistic. both because of an aging population but also because of changes in health care delivery. those costs will go up. what we have to do is bend that cost curve down and doesn't go up as rapidly. >> that's my concern. the cost curve. and i'm the second youngest republican member of congress so when i look at a 27-year-old and according to the manhattan institute the premiums increased since obamacare has come in by 97%, that's not managing a cost curve for the younger americans. that to me says that they're definitely not going to purchase insurance if they're 97% increase prior to the aca. what's your thoughts on that?

doesn't lock like it's getting better to me as a young american. >> i'm not familiar with numbers like that. >> what numbers are you familiar with? >> that you're describing. i'm not saying it's not true. i'm not familiar. my actuaries aren't familiar with seeing those kind of numbers in my office. >> do you have any numbers on individuals in their late 20s of the premium increases? >> yes, we would. and do. >> do you know them offhand? >> no, i don't. >> okay. i'd be interested to see what your numbers are. >> sure. no. it is -- this is clear that i think the real challenge is what we face right now is bending that cost curve down as a nation. and we have to do it fairly and equitably and leaving 27-year-olds without health insurance is obviously going to be a problem. the test is going to be make sure we're bending that cost curve down to get adequate health insurance and don't cost impact the rest of us when bad things happen. >> i would totally agree.

i think it causes us to leave people. thank you for your time. >> mr. mcdermott? >> thank you, mr. chairman. i appreciate your letting me be add jukt member to the committee. there's a recent article in "wall street journal" talking about the conglomeration or the merging of health care providers. insurance companies. and they're talking about what's happening in a variety of markets around the united states. and i -- in talking about anti-trust questions and the whole question our fraud laws are really based up this point on a fee for service system meaning the stark law and other aspects of it are really designed to deal with the fee for services system. now we have got managed care and we have got all these things going on. i would like to hear you talk

about where you think health care is going in terms of the mergers in these states where you're going to have -- if the free enterprise system is based on competition, means you got to have more than one or maybe more than two to have anything that's -- could be called real competition. i mean if it's just two gorillas dividing up the pie in the state of whatever it becomes not very competitive. and so, i'm interested in hearing your anticipation of where you think this scheme of affordable care act is going to go in the future. so anybody can pile in. i'm -- if you want to start. >> yeah. i think your instincts are correct. i think, you know, mergers and a reduction of the number of carriers in and of itself is bad for the consumer. and it's probably bad for providers, as well, as the

larger entities can extract greater concessions from the provide earls. another observation though in addition to that, is there are a number of provisions of the affordable care act that are encouraging and resulting in these hospital-owned provider organizations where physicians are becoming employed by hospitals. and i don't know about your states but i can tell you in maryland that market has come and gone a couple of times in the last 30 years. and at least in maryland these hospitals really haven't shown a lot of talent in running efficiently and cost effectively physician practices. so, i'm concerned that that's going to lead to greater inefficiency and greater cost in the long term. >> could i just clarify on that? one of the things that happens of course, if you buy a doctor's

practice an you used to see patients in your practice and now seeing them in the hospital the hospital charges a facility fee of some sort which jacks up the price on -- and people are very surprised i got over here for $30 and now getting it for $75 having it done the same thing. >> well, there is some of that but there's some of that but you know, we are also seeing hospital-owned physician practices that are outside of the hospital setting. i mean you know, sometimes you just see the changing of the sign and they are -- there are community-based and outside of the hospital. but they're not necessarily more efficient nor cost effective than an individual practice. >> thank you. i would agree that your instincts are correct and we are going do see continued consolidation on behalf of health insurers and providers. in a certain sense, while we all need to be concerned from

anti-trust issues, you know, it makes a bit of sense from the insurer standpoint because they're looking to consolidate and gain efficiency and administration and gain provider networks. now, on, you know, the consumer side, when the aca limits the amount of areas upon which an insurer can compete because all insurers have to offer products on the essential health benefits platform, have to offer products on the metallic tiers and certain actuarial amounts, you know, the consumers appreciate that because it's transparency and easy to compare policies but insurers don't have much to compete on that point except for provider networks, administrative efficiencies and anything else that they can distinguish themselves. they can no longer designated products and compete on that basis so the aca in itself limits some of the areas of competition i think are leading to the consolidations we're

witnessing. >> mr. mcdermott i don't know that we can attribute the consolidation that we're seeing right now in the health care environment will whether it's the insurers or providers to the affordable care act. i think particularly in the case of providers, that trend was well under way before the affordable care act. my concern is we are starting to see wit the insure earls and more of a reaction to providers doing it. hospitals buying outpatient clinics and as you point out they can charge higher rates. it means physicians when i took office in the year 2001, most of them were not employees. now you see a very large percentage of physicians who are employees because they're clinics, sold the clinic to the hospital or they were acquired by the hospital. and are now salaryiedsalaried. i worry about that. i also worry about what happens with the consolidation among insurers. i think that's something as regulators we will have a mutual

concern about to make sure we maintain the viability of the health insurance market whether it's providers or the insure earls themselves. >> ms. noem? >> thank you. i want to thank you for mentioning my home state in your opening comments because we do face some unique challenges in south dakota with one of our largest insurance companies recently announcing some of the increases to premiums up to 51% with an average of about 42%. that is a lot for anyone to try to deal with in one calendar year, much less trying to maintain their family and making the best decisions but my question wanted to cover specifically was in the affordable care act is requiring individuals and families to purchase coverage that they don't need. and this is one of the challenges that we've seen and possibly driven up costs in line with that, as well. dr. chandler, i know that you've before in this hearing described

why premiums are increasing. could you just restate for me if you believe that obamacare was meant to address health care costs and what it was, especially considering some of the testimony of mr. kreidler earlier, i want it clarified what obamacare was meant to do to health care costs. what was the intent of the act? >> well, i would say the problem is that obamacare or the affordable care act conceptualized wrongly the problem as one within the insurance industry. rather than a problem primarily located within health care itself as fed back to by insurance. while it attempted to deal with insurance, i believe unsuccessfully by and large, it really failed with one exception i can talk about to address the major problem which is cost

increases for medicine. more procedures more costly proceed yurls as one of the gentleman mentioned higher pharmaceutical drug prices. and so the one exception i would say is the creation of accountable care organizations which may or may not reduce costs. >> but by and large the act has gradually increased the burdens on americans you believe since it's been enacted? >> i do. >> ms. mcpeak, in your testimony you say obamacare significantly changes requirements for health care plans. can you briefly describe some of those changes? >> yes i alluded to those a moment ago. you know, the essential health benefits platform i think does require citizens to purchase coverages they might necessarily need and wouldn't choose to purchase on thain ore and hear tennessee i'm a 27-year-old male i don't want to maternity coverage and i need a plan with something like that. so i do think the inability to tailor products to the needs of

your individual consumers has been affected by the affordable care act and the insurers no longer tailor the plan to the distinct segment of the population they're trying to serve. >> could i buy a policy with fewer benefits to cost me less? >> not unless it was compliant with the essential health benefits. you can certainly modify your cost sharing and your deductible amounts. you can limit the providers that you would agree the see under the plan. but the basic benefits have to be standardized under the essential health benefits platform. >> the federal government is requiring my constituents to buy benefits they may or may not want at a higher cost to them? >> we do hear that from our own citizens in tennessee, yes. >> i wanted to close with we have talked to many families and individuals across my state and the country. i'd be remiss if i didn't mention that rate hikes for small businesses as well. i'm talking about the small group market. the law completely unsets the

traditional small group market. and this definition change would have a huge impact. in fact, studies from the agency for health care research and quality estimates that 22,000 south dakota employees and their dependents will receive cancelation notices and most see a premium increase of 18%. so for obama administration bureaucrats here in washington the 22,000 south dakota citizens are people impacted. it's their real lives and with that, mr. chairman, i wanted to draw light to that. i yield back. >> ms. black of tennessee. >> again, mr. chairman, for allowing me to be here as a guest and have an opportunity to ask questions. i thank you for bringing this critical topic before the public so those listening to this know that we do care about either the lack of care or the cost for them to get care. and i also want to say, mr. lewis, you are absolutely a giant in the civil rights

movement and it is such an honor to serve with you and get to know you personally. and i will get you my book so you can sign it for me as well. ms. mcpeak i want to thank you again for being here and you have in your testimony that there is a consistent uncertainty on the part of the obama administration in the aca's implementation. i can say that we have seen so many changes that the congressional budget office is now said they're no longer able to even score the changes that have taken place. but most recently there was a change that was released and the guidance of the market withdrawal and according to the guidance if insurance company chooses to leave a service area or if they change the type of product that they're offering from for instance a p po to an epo, the company is excluded from operating in that market for five years. the guidance was apparently issued off all the plans had

filed their rates with the department of insurance and meaning that it was too late for any of these carriers to revise any of those filings in response to what this guidance was. can you elaborate why this guidance would potentially disrupt the market in tennessee? >> certainly. and i do have a very specific information about that particular guidance in my written testimony, as well because it was distinct challenge for us in tennessee as you mentioned, the carriers had already filed their service aerl yeahs and the rates for 2016 when the guidance was issued and we have eight different service areas in tennessee and the guidance suggested that leaving one service area was going to be considered a market withdrawal and the carrier would be prohibited for five years from selling insurance in the state of tennessee. also, a change in the plan. so moving from a ppo to an epo plan was considered a market withdrawal. so insure earls filed the rates didn't have an idea that this interpretation was outstanding and then we received the guidance from hhs in this

regard. and for tennessee, that mean that is we would have lost five of our carriers for 2016. because of this guidance. and we were very very searched. we had a lot of conversations with hhs. and finally hhs agreed that they would only implement this guidance for plan years 2017 and beyond. so it was still going to be an issue going forward. >> could i further respond to that? >> yes. >> it's a very important development that you have highlighted, representative black, and i would urge the congress to take a look at two things. first, is that guidance actually within the scope of the affordable care act? this is traditionally an area of state regulation and i really wonder what provision in the aca authorizes it. the second thing i would look at is whether the ferguson act actually prohibits this sort of federal interference in an area of traditional state regulation.

so even putting the wisdom of the provision aside, i actually think there's a serious question that ought to be looked into and for which once there will be standing about to about the he gally of this guidance. >> i have a very brief period of time. mr. redmer did you want to reply to this, as well? no. mr. kreidler? >> i actually agree. i think as regular lay to recalls we found it a very difficult action on the part of h hs and applied and problematic. i think the real question is, is this one where hhs sees the problem and the problem would be that if coming with a new plan you can totally avoid showing your rates as going up precipitously. i think as all members of congress certainly the public wants to know that information. you can't use it as a way to on

vis kate and the only tool available to hhs is a draconian steps they have taken it is obviously one where maybe this is where you could get unanimity to amend the affordable care act in congress so that they have a tool that is much more sensitive rather than saying you're out of business for five years. which is the only option i believe that they have. it was inappropriate to try to do it the way they were doing it, though. >> thank you. mr. chairman, i yield back. >> mr. smith of nebraska. >> thank you, mr. chairman. thank you for allowing me to join the committee today. i appreciate our panel today. i wish we had more time because i think we're covering important topics. i'm concerned about the consumer operated and oriented plans. may be no surprise to you. from tennessee, being from nebraska we've had some issues to date hhs has awarded a $2 billion in federal loans to

establish these plans. i've asked hhs some questions and await the answers even still. co-opportunity in nebraska and tennessee served over 100,000 individuals and it was seized by the state of iowa after only one year and since liquidated adds you know and people on these planls have been left confused understandably and frustrated as well. and once again, being forced the look for other insurance some even lost their plans they were told they could keep and yet lost that, as well. tennessee community health alliance obviously serves some folks there. now, it's my understanding that there have been some troubling signs and actual enrollment was su stendspend suspended. is that accurate? that was suspended when? >> middle of january of this year. >> okay. and certainly appreciate your work on the issue and i know

that things are difficult, things to manage. and to deal with. now, my understanding was that the state of iowa wanted to suspend enrollment but were told they could not suspend and forced to still offer the qualified so-called qualified health plan. and can you walk me through the process that tennessee engaged in to be able to suspend the enrollment? >> well, certainly. thank you for the question. it was a very difficult time for us because we were first approached by community health alliance that had been witnessing their enrollment increase substantially during the open enrollment period and middle of january still during the open enrollment period. we did a quick examination. we shared their concern. we considered the co-op to be at financial capacity. a few triggered in the state constitute were met. we notified hhs.

our interaction was not as efficient as we had hoped at that point with hhs. they certainly had a differing opinion about the financial stability of the company. i took a very conservative approach i think because as iowa and nebraska experienced had something occurred with the co-op it would be my responsibility to take receivership action or seizure of the company and so we were not comfortable with the level of enrollment. there was a tremendous amount of back and forth. eventually, it did take about a week's time for hhs to agree to suspend the enrollment but even that small victory which, again, as i mentioned in the comments we think was the right decision for tennessee is problematic for the tennessee residents business the residents with a plan with community health alliance had extreme difficulty when hhs froze the enrollment and suspended them from the exchange. there was no ability to add a child that was born or adopted

or any other qualifying event because in the mind of the federally facilitated marketplace, the plan ceased to exist and it has not gone smoothly. >> very interesting. i'm curious. were you aware of iowa's request to suspend enrollment? >> i was not aware of the request to suspend before the seizure occurred. i knew that it was possible to stop enrollment and essentially turn off the exchange enroll lees but it was in my opinion in iowa and nebraska only after the seizure was ordered. >> okay. you have pretty good feeling about where the community health alliance stands today? >> at our request, community health alliance has drawn down the full amount of start-up loans from the federal government. we have a finance exam under way so that we know exactly where they stand. we have provided some helpful we thought helpful information about administrative expenses to

the company and the rate request for 2016 that they have filed is over 32% increase. i don't know that that's going to be sufficient to make the company sustainable and to remove the freeze for the upcoming year. >> okay. and to the best of your knowledge, is it true that only one of the 22 plans nationwide did not have an operating loss for 2014? >> i did see a report that was consistent with that figure, yes, sir. >> and would that maybe lead you to some concerns that maybe the loans calling them loans wouldn't be the most accurate description? >> i would agree yes. >> okay. thank you. i yield back. >> thank you. let me just -- i've got just a question for each of you and i'll -- mr. redmer, i'll start with you because i know you have a hard stop at noon. you have your permission to head out when you need to head out but in your written testimony one of the things you said is there's an insurer in you state

prediblgting that their pool is going to be actually older next year. could you speak to that? that seems -- i mean, it is not a term of art but that's a trend that's toxic, isn't it? i mean when's the ramification of that? >> well well, that's true. that will obviously continue to drive up costs. it's something that we're concerned about. again, there's still a lot of uncertainty as to what the effect of the increased penalty will be and whether that's going to drive any younger folks into the marketplace or the flip side is the young folks will sit tight and remain uninsured pay the penalty, and only those folks that migrate into the pool will be those that were uninsured and now are sick which obviously will probably mean even a higher average age and increased morbidity. >> it's a ramification of adverse selection. >> correct. >> okay. >> eventually. >> ms. mcpeek could you give us any insight in terms of long-term trends that you're

seeing in tennessee as it relates to other things? cadillac tax and so forth? how is this playing out for you? >> in tennessee we're hearing a tremendous amount of feedback from large employers concerned about being assessed, what has been described as the cadillac tax for having a high-value health insurance plan available to their employees and secondtivities. of particular concern -- and i share this concern when i hear it from the employers. and i know representative black has probably heard the very same thing. the cost of on-site clinics for employers is being included in the value in the cost of that health plan, high-value health plan for purposes of calculating the cadillac tax. and employers rather than -- that is a decision or a guidance that is underway through the internal revenue service. employers instead of paying that cadillac tax are instead choosing to close on-site

clinics. and it's very troubling because reducing health care costs and certainly convenience to the employees and potentially a lack or reduced amount of co-pay or cost sharing for attending or seeking service at an on-site clinic certainly seems to benefit all of us in reducing costs and providing care. so including the cost of that clinic as a part of the high-value health plan for purposes of cadillac tax is certainly problem attic. we're hearing a great deal about that in tennessee now. >> mr. criedler, i realize i have the benefit of having john lewis' book, many copies around me, and you don't. on page 178 of that book, mr. lewis points out that one of his phrases is "put all your cards on the table and put them face up." when i read that, i thought wow, i've heard him say that. i was at a meeting in the library behind us, and we had the commissioner of the irs at the time. we've had several. but one of the commissioners of

the irs at the time. and mr. lewis, chairman of the oversight subcommittee, said put all your cards on the table, and put them face up. just saying, it would have been better if they had done that. they didn't. but they -- my cards face up are this -- i participated in the white house health care summit. this was when the affordable care act was debated. it was that event at the blair house. you may recall it. it was an all-day-long sort of thing. the president was there, and members of congress and so forth. one of the points that i made to the president is contrary to one of the arguments that you're making. and i want to get just a little bit of a better sense from you about why you're making the argument. and it has to do with medicaid expansion. so one of the things -- i don't recall sort of chapter and verse about there interaction. but one of the points i naed summit is look isn't medicaid expansion simply an expansion of

welfare, and isn't medicaid a terribly broken system? and if you have a terribly broken system, why would you make that a foundation. which you build a whole health care reform movement? a couple of minutes ago you said, look one of the reasons it's working in washington state is because of medicaid expansion. that -- i think that's a problem. i think it's a problem long term. i'm from illinois. our medicaid system is really a mess. you've got huge access issues on the one point. and, okay medicaid has cost shifted in a lot of ways. it's cost shifted on to the federal taxpayer. isn't a cautionary tale in medicare expansion as being part of this remedy? and isn't that almost a

structural weakness to the affordable care act? >> mr. chairman, one of the things that i find unique that we're witnessing because we have expanded the medicaid program is you're starting to drive the medicaid program closer to what we see in the commercial market. that means both on the issues related to the networks they have which tended to be much -- very different than what we saw in the commercial market, and certainly as we've all heard if you're in elected position particularly is you look at the kind of rates that medicaid offers to providers, being considerably lower than what it is in the commercial market. we're starting to see that driven together. i think it inevitably has to. you cannot have the medicaid market significantly underpricing what it offers to providers and not see that in effect almost be one where the commercial market is having to subsidize the medicaid market.

public programs and the commercial market have to operate on a level playing field. and we're starting to see that driven together in ways that we hadn't before. i believe the real driver here is expansion of the medicaid program that's done it. before this time, we had very limited interaction with the medicaid program operated by the state. now we have routine meetings, talking about networks rates, and issues like that. so i think it's having a beneficial effect that kind of goes outside of just what expansion itself would have been maybe the focus of the discussion. it's actually i think helping medicinally to make sure more people are insured and you don't have this huge problem of uncompensated care happening which obviously gets shifted then to other payers. >> you know, any insight that you have on your experience, if you or your staff would be willing to share that with us i think that would be -- that would be helpful. thank you. >> thank you.

>> mr. chandler, let's close out with you. i thought that your insight as it relates to the way i put it down in my moats when you were talking was the affordable care act deals with a symptom but not the cause. symptom atically, health insurance rates are spiraling, but it doesn't deal with health care costs. what insight do you have moving forward? if you could hit a reset button, how would you focus in? you heard my rhetorical answer to representative crowley when he was saying what are we doing, and are we nostalgic about the past? no. there's nobody that's defending the past. there's nobody that's celebrating about various structural weaknesses and so forth. if you had the opportunity to reset and focus in and say how do you do this where would you direct the congress as it

relates to dealing with health care costs, which as a foundational point, if you get that under control you're well on your way to an actual remedy. >> let me talk about two points, one big, one small. the big point is there may be some temptation on the part of congress to regulate more, push it down, push it down. that's unlikely to be effective. that is adding additional complexity to the system which we're already seeing is going to drive costs up. it is going to lead to more gaming behavior and more diversion of resources into how to beat the federal government. what we have in health care is a unique situation in which the consumer is basically taken out of the equation, and instead health care is mediated by insurers who may or may not have the best interests of the patient at heart and who may not have an interest in trying to figure out creative ways using

technology and other means to drive down health care costs. so one of the things i would urge you to look at -- and i know this is abhorrent to some members, but i believe you ought to look more at consumer-driven health care so that we get probably the most powerful force that you have which is individual greed and individual desire to take care of one's self and one family driving down health care costs. let me give you my second little point. you may have an opportunity for better or worse to renegotiate the affordable care act in the coming weeks. i would urge both sides of the aisle to take a serious look at that employer mandate. what it is doing is it is keeping people out of the individual exchanges, keeping healthy people out of the individual exchanges. if you want to stabilize them, if you believe if you happen to

believe in the principles of the affordable care act, those are the very people that you want in those individual exchanges so that we do not see an adverse selection debt spiral. if you also believe in free market principles you ought to think why is it that we should be forcing employers to divert resources into the provision of health care, rather in some instances into the provision of things that employees may value more like a higher paycheck with which to pay rent and buy fresh food and go to parks and engage in other activities that may be more likely to improve their health. and so it strikes me that there is an opportunity, i grant you this is not the biggest issue on earth. but there's an opportunity to do some good here in an area which if people really rethought it and took the blinders and ideology off there's some room for gain.

>> mr. chandler, mr. criedler, ms. mcpeek, and mr. redmer, we are deeply grateful for your time and attention. i know we speak for every member. we value your insight and willingness to share it with us. and lo and behold let the record reflect that the united states congress had a hearing on the affordable care act also known as obamacare that happened to shed more light than heat thanks be to god. so with that, the meeting is adjourned. >> thank you, mr. chairman.

>> when congress is in session, c-span3 brings you more of the best access to congress with live coverage of hearings news conferences, and key public affairs events and every weekend, it's american history tv. traveling to historic sites, discussions with authors and historians, and eyewitness accounts of events that define the nation. c-span3, coverage of congress and american history tv. >> on the next "washington journal," south carolina congressman mick mulvany discusses the charleston church shooting and the debate over removing the confederate flag from the south carolina state house grounds. then congressman paul tonko of new york talksbots upcoming supreme court decision in michigan vs. epa. a case looking at whether the epa properly considered costs in determining power plant emission

regulations. "washington journal" every saturday at 7:00 a.m. eastern on c-span. join the conversation with your calls and comments on facebook and twitter. we're back here in the last hour of "the washington journal" on wednesdays. take a look at recent magazine articles. part of our spotlight and magazine series. today we're taking a look at "atlantic" with david graham. has written several stories about what happened in charleston south carolina, last week. and the first one i want to begin with is your look at the council of conservative citizens. and you label them and they have been labeled by other groups as white supremistacist group that inspired a racist manifesto. what is the council of conservative citizens? >> so it's -- by some estimates -- the largest such group in the country. it's descended from the '50s and '60s groups founded as a coalition of businessmen and other people to oppose integration efforts basically.

these groups kind of died away after integration was legally mandated. in the '80s, it was founded by a former field organizer who felt that there needed to be some effort to basically oppose integration efforts. the manifesto says things like we oppose the dilution of the european race, forced integration. we think that european american heritage is important. they host politicians, they give money. and they campaign for things like maintaining the confederate flag in public places. >> do they label themselves as a white nationalist group? >> they don't. they say, we don't hate anyone. they condemned the charleston attacks. they condemned dylann roof and said he may have been reading the material we put on. we believe that black-o-white crime is a serious problem, but we distance ourselves from the events. it's more things they say about opposing integration and the european american heritage. >> what is their tie than what

happened in charleston, south carolina? >> what happened is in the manifesto that appears to be dylann roof's, he says he became interest friday black-on-white crime after reading their website. they maintain a careful record of what they say is an evidence of black-on-white crime. in fact, it doesn't appear to be any such epidemic. after trayvon martin, we became concerned that there was racial violence going on and needed to do something to stop it. >> the ties to politicians here? >> earl holt iii, the president of the group has given about $65,000 over several psych else to a whole range of politicians. mostly conservative republicans. some more mainstream republicans. including several presidential candidates who have now said they're going to either donate the proceeds to charity from others or give it back. >> is this group -- how large is it? are they still influential in politics?

>> that's tough to say. i mean, at the peak the group was repeated to have 15000 members. the southern poverty law center that tracks these says they are the largest such group. it's hard to know how big they are. their hayday may be past. trent lott spoke to them and many politicians did. the guys talked to the groups, then they're called out for speaking to the groups, and distance themselves after that. it seems that they're no longer as influential. their founder died in march. gordon bowman founded the group in the 1980s. >> but now this group, where that r they when it comes to this issue in south carolina of taking down the confederate flag? >> they were a prominent voice when the flag in south carolina was initially flown over the capitol building. in 2000, it was moved to a site on the capitol grounds on a flag pole but not above the building. they were one of the more prominent groups advocating against the move. they thought that the governor had thrown the flag under the bus. he thought -- they thought that it was -- really a step against

the sort of heritage of the confederacy. they were outspoken against that. >> now we see the governor from south carolina say that she believes the flag should come down from the capitol grounds. the debate started in the south carolina state legislature yesterday. you have a story that says the fight against confederate symbols spreads. that it's beyond south carolina now. where else is this issue being taken up and where is the debate headed? >> sure. i think the most prominent place is mississippi where the confederate battle flag is in the corner of the mississippi state flag. it's been there for more than a century now. and it's unclear how the debate will proceed there. there's an emotional resonance in south carolina. there isn't immediately in mississippi because there wasn't a shooting there. you see the governor saying i think we should keep it. voters spoke in 2001 in a referendum. you see the speaker of the house who's also a republican saying we need to pull it down. there are petitions against it. beyond that there are tons of confederate monuments across the country, mostly across the south. you see graffiti, black lives matter graffiti on monuments to

southern generals and leaders from maryland to texas. you see an effort in baltimore to rename a park named for robert e. lee. over the last few years, for example, you see high schools named for confederate generals being renamed. there's a range of things from the very mundane and local to the state level flag stuff. >> how has the politics of this shifted? >> very quickly. i think nobody expected quite how fast south carolina would move. south carolina's had this flag for a long time. even whether it was moved in 2000, a huge controversy. it was really acrimonious. and moving in elsewhere on the capitol grounds was seen by many people as a really -- insufficient half measure, and by others as a really irredeemable betrayal of heritage. so for so quickly, something like this to happen on friday you had senator lindsay graham of south carolina saying, you know if people want to talk about this that's fine. but i don't think we should distract from the real issue which is the material racism. by monday, he was saying, the flag needs to come down.

what we've seen is the debate can move very quickly. we saw this also in merchandise. amazon saying it won't sell confederate flags, ebay saying the same. walmart pulling it. these are all thing where the flags have been sold for as long as the outlets have been around, and suddenly they're being pulled off shelves real and virtual. >> we want our viewers to weigh in on this debate as well over the confederate flag. republicans 202-748-8001. democrats, 202-748-8000. and independents, 0002. some said the debate over the confederate flag is becoming so big that people are forgetting about what happened at that church in charleston, south carolina. and this violence against the people that had come to the church that day. violence at black churches is nothing new. you wrote about that as well for "the atlantic" magazine. >> that's right. there's a long history of this. it goes back it's as old as the united states. you see riots in philadelphia in

1790 where black churches are attacked. you see black churches being attacked frequently after the civil war during the reconstruction era and in to jim crow. i think the 1963 bombing in birmingham is the one everyone knows best. four little girls were killed. then you see even in the 1990s there was a whole string of arsons against churches, mostly black churches mostly in the south, president clinton spoke against them, and there was a federal panel that went to investigate. and now you see that again. i think that although the causes and the organizers are different, the ideas of attacks against black churches is something that's an importance strain of american history. >> you write, you posed the question in your story how much has changed since the birmingham church bombing. how much has changed? >> i think a lot and a little. the fact that we're still seeing attacks, there's a common thread. there are changes, though. in the birmingham attack, it was a group of klan members. there was an organized effort.

you had strong institutional racism. now you see systemic racism in places. if you look at many outcomes in south carolina there's large racial disparities. dylann roof appears to have been a lone actor wasn't part of an organized group. in fact, you see groups like the council of conservative citizens condemning the attack. >> we're talking about the debate over the confederate flag and violence at black churches. we want to get your thoughts as president obama and leaders in congress head to charleston, south carolina friday. the president will give the eulogy for the pastor of the church. as we said, some of the leadership in congress also planning to attend. go to c-span.org for more. bill from georgia, a republican you're up first. go ahead. bill you've got to listen through your phone and turn your tv down. that's a reminder to everybody. eugene in cardington, ohio a democrat. hi eugene. >> caller: hello, how are you? >> good morning.

>> caller: good morning. my contention about this entire issue is that there wasn't -- this wasn't something that came to these politicians as an epiphany of any sort. the bottom line is is that with the killing of the parishioners at the church, the public outrage became so great they basically had no choice in the matter. and the reverend at that church very great man, i think if i'm not mistaken also served as state senator in south carolina. and to me it just reenforces my cynicism about the political class in that state and maybe in d.c., as well, that it took one of their own getting murdered before any urgency was -- before any urgency was applied. that's the sad part of all this.

i thank you very much for taking my call. >> all right. david? >> i think it's the sad truth of the civil rights movement for a long time. often requires deaths before politicians do anything. you've seen major movement on the civil rights family-leave act after the birmingham bombing. you've seen legislation after martin luther king's death. it's often the case that these issues are out there. people know they're an issue. it takes -- the only thing that will actually get the balls rolling on the political process is somebody dieing which is a tragic facts. >> what happened after the birmingham bombing legislatively? what happened after these major events? >> so john f. kennedy spoke shortly after the bombing, the next day and condemned them. in fact, the bombing was parts of tension over and court order to integrate the schools. it was from those speeches that the civil rights act of 1964 got underway, was not passed while kennedy was alive obviously. but lyndon johnson signed into law the following year. >> stygler, oklahoma. lisa in independent?

>> caller: hi. my name is lisa i'm from oklahoma. thank you for taking my call. >> you bet. >> caller: i am so sorry for about what happened. i mean, that is so evil. how a person can go into a church of god and stay there for an hour and just kill people for no reason. people are taking it out on the flag. we have a lot of people that died for that flag. people are crying take it down take it down. we had veterans we had african-american, we had brothers against fathers, brothers against brothers. we have -- native americans died for that flag. it should stay up there. >> okay. take a listen to what hillary clinton had to say running for the democratic nomination.

she was in missouri yesterday and weighed in on this debate over the confederate flag. here she is. >> i know it's tempting to dismiss a tragedy like this as an isolated incident. to believe that in today's animals, bigotry is largely behind us. that institutionalized racism no longer exists. despite our best efforts and our highest hopes, america's long struggle with race is far from finished. we can't hide from hard truths about race and justice. we have to name them and own them and change them. that's why i appreciate the actions begun yesterday by the governor and other leaders of south carolina to remove the confederate battle flag from the state house.

[ applause ] recognizing it as a symbol of our nation's racist past that has no place in our present or our future. it shouldn't fly there. it shouldn't fly anywhere. [ applause ] and i also commend walmart for deciding to remove any product that uses it. >> hillary clinton on the campaign trail yesterday, weighing in on this debate. david graham, what are you hearing from these politicians versus what lawmakers -- you talked about john f. kennedy saying when this has happened in the past. >> uh-huh. well, i think on the flag issue what's interesting is there's really been a sense among many lawmakers i think for a long

time that the flag ought to come down and that it's really a relic. the case that they're concerned about primary voters. they're concerned about voters who are upset about this. the voters -- i think many people who have spoken in support of the flag or declined to say much in the past are republicans. the voters who are upset about the flag aren't going to vote for them anyway. the voters who think it's important to keep the flag up are the ones who are going to vote for them. they're disinclined to speak out. what you see now is the national pressure is so great that they're kind of giving in. i think it's interesting even in south carolina. there was a poll earlier this year. 50% of people in south carolina said the flag should stay up. 48% of people said it was bad for the state's reputation to have it up. >> blocksomsburg, pennsylvania. david, good morning. >> caller: good morning. we're putting symbolism over substance here with this confederate flag deal. you know, it's a battle flag of

virginia. the battle flag of the south. these were all american soldier in a time when america was at war with itself. it's a contributed to those who have fought for a cause. now, if other wa-- if walmart wants to ban the confederate flag and amazon and ebay they should ban the pictures and flags of a communist racist who killed thousands of christians and gays in the pursuit of communism for castro and the revolution and everybody else. now it's not getting to the real point that all lives matter. not just black lives, but all lives. it was a terrible thing what happened in the church down there. absolutely terrible. the person is truly evil, and he should face the ultimate penalty for what he did. but you can't go blaming a flag for it. look at the person. look at the mentality of what is going on. you know, this country is in a downward spiral. 47% of the people in this country are looking for --

receiving benefits from the government. there's no inspiration to go out and work -- >> david, before we go too far down that path, i want to stick to what you were saying. go ahead, david. >> i think david is exactly right. there is a question of symbolism. i think people who believe the flag should come down have say two things about that symbolism. one, it is a symbol of a rebellion against the u.s. government. the people who were -- they wanted to secede from the union, they did not want to be part of the u.s. the rebellion was really about slavery. it was about white supremacy. the question is not is the symbolism but what does the symbolism mean and how seriously should we take that. i think a lot of people think that it's antiquated for the symbol to be here. maybe this is not about directly related to shootings in a church, but it's long past time for the flag to come down. >> middleton, wisconsin. sergio, a democrat. good morning. welcome to the conversation. >> caller: good morning to both of you. i have -- the last caller is

totally wrong. and i just -- i don't understand why he was bringing it up about the 47% -- my opinion, that flag that flag that represents pure evil and hate for all classes. we live in 2015. and that flag was during the civil war, and the union won. and it's not like we're flying nazi flags around the country. you know what i'm saying? this flag represents hate. and dylann roof was caught with photographs, you know, holding that flag. and that flag represents pure evil and hate. i'm glad that republicans and democrats and -- people in the middle also don't forget that attendance in this are having a say so in this. it's just regular people throughout the country are just coming together. >> yeah. that's -- that's the conversation we're having this morning here. i want to keep getting everybody's thoughts on this.

the debate over the confederate flag and also david graham from "the atlantic" is part of our spotlight of magazine series writing as well about the history of violence against black churches in this country. arnold in wichita, kansas, an independent. hi, arnold. good morning to you. >> caller: good morning, c-span. thank you for the wonderful work that you do do. i just wish that everyone who would speak would sometimes do more fact checking. the hypocrisy and the political correctness in this country is starting to turn my stomach. number one hillary clinton in 2008 wore a confederate flag pin on her suit when she was campaigning in alabama and south carolina and mississippi. it was also bill clinton that signed the authority for the -- for arkansas to fly the confederate flag over the capitol of arkansas. it is a symbol, that's all it is. the political correctness in this country is pure hypocrisy.

i equate the united nations flag the flag of the national socialist democratic party with the nazi flag of germany. the confederate flag was nothing more than the flag symbolizing a seceded hopefully to be nation which thank god never occurred. that's all that it recognizes. i just wish that people particularly the young speakers, the young people who appear on these tv programs, would do their fact checking before they buy into the hypocrisy of the left or the right. >> okay, arnold. all right. david? >> i think there is a real shift going on in the politics. i mean arkansas when bill clinton was governor and now, has -- the flag is designed to pay tribute to the confederate flag. and you had as recently as 2003 howard dean saying i want to be the candidate who appeals to the guy with the confederate flag on his pickup truck. it's hard to imagine many candidates, and particularly democrats saying that today.

the politics have really shifted a lot in the last decade. i do think that an interesting thing about the flag that we need to reconsider is while this flag is a symbol of the confederacy, it disappeared largely after the civil war. and it was really only revitalized during the 1890s and particularly the 1916 as a symbol of sort of opposition to integration. south carolina ran up the flag in 1961. didn't fly there before then. while it may be a symbol of the confederacy, the cases in which it was flown up were often cases of trying to highlight white supremacy and opposition to black equality. >> i think caller might be referring to the story on "daily caller's" website. they report although confederate flags and emblems attach themselves to our wiped off store shelves by management and local dmv license plates offices in virginia, then arkansas governor bill clinton and tennessee senator al gore flaunted the symbol during their 1992 campaign for the white

house. rectangular clinton-gore 1992 pin, campaign pins of the confederate flag were passed around as well as circular confederate flag pins showing clinton's and gore's heads atop a agree confederate uniforms with the words "sons of the new south" emblazoned on the pin. that's on "daily caller's" website. clay in north carolina, republican. hi clay. >> caller: hi. i just want to say we just cannot bury or history. due to the circumstances that happened in charleston, it was just hatred. a lot of people, it's -- that have that flag do not feel that way. they're just proud wherever they are, where they're from. and they have no hatred toward anyone. >> clay, what do you think about there debate that's happening in your state legislature to take the confederate flag down?

>> caller: i think they're just trying to pass the ball to something else. let's just get to the serious fact. there's just so much hatred. >> how do you deal with that, clay? >> caller: just try not to be part of it, and to love everyone. we all have to get along. whether that flag hangs or not doesn't represented who we are. >> that was clay. ed is in d.c., democrat, what do you think? >> caller: good morning, c-span. good morning. how are you doing? i think -- i agree with hillary clinton that that flag shouldn't be flown anywhere. and we have to go on to state the civil war is over with, and we're not in the civil war no more. this flag it is done for. i disagree with the caller that said that it represents -- the nation's history and so forth. but things changed. even though hillary clinton may

have won a pin or the president of the people may have worn pins, things change over a period of time. we have to unite this. things must go on and be united in this nation and also the media that broadcast the 50,000-watd clear channel. this is against our people. we need to eliminate these things. so you understand that we -- [ inaudible ] >> ed, our connection not so great with you. i'll leave it there. david, the president's headed to charleston, south carolina. ed was talking about uniting this country. what do we know about what the president will say at the eulogy on friday? >> i don't know that we have a great deal of detail. he's going to speak about unity hooemp talk about violence. you know we've seen him this doo this so many times. really eulogies have been maybe obama's signature speech at this point in his presidency. whether that's sandy hook or beau biden or now clementa

pinckney. >> michael in gerard, illinois, independent. hi you're next. >> caller: thank you for the call. it just seems -- it's a giant waste of time. other countries like germany, more ahead of us have outlawed dumb symbols of racism and slavery and things. get rid of the nazi symbol, it's illegal to show it there. they use the confederate flag. here we are, the news is -- this is all we're talking about. how about talking about the children starving, the jobs economy, immigration? we're wasting our time. we are so far behind other countries that this debate's -- it should have been put to rest 20 or 30 years ago. we're wasting our time. we've got real issues. get rid of this racist symbol. everyone knows it was just made for white people to get in the way of black people doing work because they didn't want to do the work. that's why they have slaves. they were lazy. that's all it was for. anyone who says they were proud of the people that fought for that are just plain idiots.

it makes no sense. let's move the country forward on things that matter to regular people. >> thank you. gary's next, republican in florida. gary, tell us your thoughts. >> caller: i'm wondering if you're going to take it down. should it be retired with some honor by a southern heritage preservation, even re-enactors that receive the flag with honor? otherwise, you just go to the other side and put out the fire with gasoline. >> gary's going wonders what's going to happen with the flag go in a museum, move to a different location. the south carolina legislature hasn't decided. the governor's saying take it down, but she doesn't have the authority to do so. >> that's right. the debate's going to take a while. the vote was to open debate, a formal step. the debate probably won't happen until after the funeral. we're looking at next month. it looks like there's some whip counts of the legislature. it looks like it's likely to be voted against. but it's not -- not the majority

in either house so far declared. we'll see what they decide and see what they decide about what might happen with the flag, whether it could be flown somewhere else or retired. >> it was interesting yesterday that over on the senate side the state senate side you heard from paul thurman son of the late senator strom thurmond. and he said it's time to take it down. >> that's right. it's a remarkable step. >> his father a segregationist. >> right. the dixie-crat presidential candidate in 1948. it's amazing to see this movement. >> tina in wisconsin, democrat. hi good morning. >> caller: yes good morning. thank you very much for taking my call. i really love c-span. it's really an informational and sometimes depressing but encouraging to know that people are aware of what's happening. it should come down. i grew up in the south. in that time of all of the problem that we were having. and we're still having problems but we can work it out. it's a sign of oppression.

and it's a sign of hatred. so we can't go forward that. as a race and as a country. it should come down. >> okay. all right, tina. connie in illinois, independent. we're getting your thoughts this morning on this debate over the confederate flag and violence at black churches. what do you think? >> caller: i've got three comments. the war was not fought over slavery. that's a fact. the shooting in charleston was done by a nutcase that took a picture of him and the flag, and this has been -- the flag has been used by racists for forever. but if that kid is so racist against blacks, why was his best friend black? his very best friend was a black

kid. he's been on tv many times talking about his friend, the shooter. >> okay. all right, connie. david, what do we know about dylann roof? you wrote about heim -- his information that he got from the website of the council of conservative citizens, it's been called a white nationalist group. and the headline of your piece is the white supremacist group that inspired a racist manifesto. >> sure. so you know we know that dylann roof appears to have had friends who were black. we also know from talking to his friends that he seems to have adopted this racist ideology relatively recently. he says after the trayvon martin shooting. the aftermath of that. so you know, i think we have to take heim -- somewhat at his word. we have pictures of whim nazi symbols. we have him saying he was inspired by what he thought was black-on-white crime. we have his quotes in the church as he was leaving.

i think that we just basically have to take -- there's no reason to believe it was not inspired by race, despite the fact he may have had black friends in the past. >> covington, georgia joe. good morning. >> caller: good morning. taking the flag down is not going do anything unless we get the whole story out of there. i would like to call on republicans and people in the south, georgia and stuff, to call the southern poverty law center. let's get justice for kenneth gladney. they've been covering it for common cause and public citizen and stuff. they called out the gang on kenneth gladney, a man, town hall meeting in missouri. he was selling trinkets because he had to pay some hospital bills. he had cancer and all this. they singled him out during the health care debate a town hall meeting, out from the tea party. these people from seiu. they called him the "n" word

knocked his table over and started beating him. the tea party stopped them from killing him. we called senator lewis trying to get justice for this man. they're covering it up. they call our churches down here and tell them if they speak again obama or dismiss them they'll be tearing churches down. that's republicans -- that's common cause. >> all right. david in st. louis, missouri, a democrat. hi good morning. >> caller: good morning. thanks for taking my call. first, we have to remember in america that he who lives in the past is doomed to repeat it. so i'm a vietnam-era vet. i don't look at army movies -- not because i'm not a patron of the united states, it's just that i find army movies depressing. and let's look at the first amendment. first amendment says freedom of speech. but we got to remember that if you holler "fire" inside of a theater, you're breaking the law. so all these symbolisms we have out here that goes back to the

civil war, that goes back to slavery, so forth and so on. we need to get rid of all of that. now, i understand that everybody has an opinion about everything because we know what opinions are of the same assumptions. but i think if we start off, if mr. graham would write an article telling people let's start celebrating the living and where we want to go in the united states, and let's put the past in museums, that's why we developed museums. thanks for taking my call. you guys are fantastic. sometimes you do hear callers there make a lot of sense. let's if forward, not backward. >> okay. all right. let's talk about one debate that has come out of this, as well. not just over the confederate flag but gun control, as well. i mean, is it something the president talked about immediately after this tragedy that happened last week? and it's something now that governor -- excuse me former west virginia governor, now

senator joe manchin along with patrick toomey of pennsylvania they've said let's revisit our background check legislation. maybe we can try again. it failed on the senate floor back that 2013. >> that's right. it's remarkable how slowly gun control has come up. obama went straight to gun control in his comments. unusually fast for him. he's tended to take a while to bring it up even in the course of speeches after major shootings. he went right to it and seemed fairly resigned to the idea that it would not happen. the fact that we have joe manchin and pat toomey talking about it is an interesting development. what we saw last time they brought this up was the political prospect is difficult. there's a lot of opposition in congress, although generally the american people seem to support background checks in polling. we'll see whether it gets any further now than it did in past efforts. >> couple of reactions on twitter here. jay is saying that there's

probably change like you're talking about david graham, because of greater awareness of hate due to greater mass media. and then rick on twitter says, "the kansas caller says it is a symbol, and he is correct. it is a symbol of hate. full stop." tampa, florida kenneth independent. good morning. >> caller: yes, good morning, greta. how are you? >> doing well sir. what's your question, your thoughts this morning? >> caller: yes. i'm a retired veteran. and what i look at when it comes to the rebel flag because i -- i originally am from south carolina is it don't bother me to see the flag because once i see the flag i know where that person stands when it comes to me or anything. but at the end of the day, what is the difference between a rebel flag now and the isis flag that we are so upset about taking over the middle east? so what would be the difference

as far as how people express the rebel -- in that time and now in 2015 with the flag? >> all right okay kenneth's thoughts. on twitter "the rebel flag should be treated with respect. it should be folded and put to rest. today it's not a sign of glory but hate "reaction on twitter from dweller. bill in tyler, texas, republican. what do you say, bill? >> caller: good morning. >> good morning. >> caller: i wanted to make a comment. i believe that they should take the flag down for the immediate ceremonies and put it back up. the flag represents an ideology. i'm proud to be from the south. i didn't fight the civil war, but i'm proud of my ancestors that did. it stood for bravery courage, to make a stance against the federal government. the next thing i fly a flag not

at my home because i'm obviously afraid of repercussions from that but i go to oklahoma, my property, and i proudly fly the flag. >> bill, i'm going leave it there because the house is about to come in. i want david graham to give us the timeline for this debate in south carolina. they opened up debate in the state legislature yesterday. when might they take a vote on whether or not the flag comes down there? >> it won't be this week. it will be at the earliest in the next couple of weeks sometime in july. >> you wrote a story recently how the debate is spreading. it's going outside of south carolina. other states looking at taking down the emblem, as well. >> that's right. yesterday, terry mcauliffe, governor of virginia called for -- ordered that a confederate flag license plate be withdrawn. the governor of tennessee made a similar request. i think we'll see other cases where states withdraw license plates and other official documents and signs that contain confederate flags. >> you can continue to follow

the debate by going to "the atlantic's" website, theatlantic.com, reporting on twitter at "the atlantic." david graham staff writer for the magazine thank you for your time. on the next "washington journal," representative milk mulvany discusses the charleston shooting and debate over removing the confederate flag from the south carolina state house grounds. then congressman paul tonko of new york talks about the upcoming supreme court decision in michigan versus epa. a case looking at whether the epa properly considered cost in determining power plant emission regulation regulations. "washington journal" live every morning at 7:00 a.m. eastern on c-span. and you can join the conversation with your calls and comments on facebook and twitter. british prime minister david cameron answered questions from members of the house of commons on border control, renewable energy, and expanding broadband to rural communities.

acting labor party leader harriet harmon also wanted to know about plans to prevent migrants from illegally entering the u.k. from france. this week's prime minister's questions is about 35 minutes. >> other. questions to the prime minister. martin vickers. [ cheers ] >> number one, mr. speaker. >> mr. speaker? mr. speaker, i'm sure the whole house would wish to join me in celebrating armed forces week. [ cheers ] >> armed forces are the best in the world. this week is an important opportunity to pause and reflect on their dedication and their sacrifice in keeping the country safe. mr. speaker, this morning his meetings with ministerial colleagues and others. in addition to my duties in this house, i should have further such meetings later today. >> martin vickers. >> i, too, welcome the prime minister's comments about armed forces weekend. and there is a major event in my constituents to mark the kz -- constituency to mark the

occasion. i thank my friend for agreeing to meet with me and the honorable lady following the announcement yesterday of significant job losses by young seafoods in the area. they are the largest employer. it's particularly disappointing after a run of good news. much investment has been attracted with the help of the regional growth fund. could my honorable friend assure me that perhaps additional help and support may be given to the area through the rgf and it's important to retain the presence in the area. >> first of all, i'm happy to meet with my handle friend. as he says, the recent report surrounding youngs are concerning. this will be a difficult time for employees and their families. the company will be talking to employees. the government stands ready to assist in any way it can. the broader picture is more positive. we've got the able u.k. energy park creating up to 4,000 jobs. also of course the seamen's investment nearby a major

investment for the region. we'll ton provide support for the regional growth fund. 49 awards have been made in the area. we'll keep up with that and keep up with the long-term economic plan. [ cheers ] >> i join the prime minister in paying tribute to our armed services including the reserves. we honor those who are serving today. we remember the sacrifice of twhoez have served in the past. and let's never forget them when we think of the freedom and democracy that we have today. i'd also like to pay tribute to the family's federations. the army family's federation, navy federation and air force family's federation. the great work they do supporting service families contribute so much to the strength of our services. mr. speaker, we've all seen the travelers and drivers are facing harassment and intimidation as 3,000 migrants tried to get illegally into the u.k. the french should be assessing

them as soon as they get to their to decide whether they're genuine refugees or whether they're migrant workers who should be removed. how confident is the prime minister that the french are going to start taking effective action? what's he doing to put pressure on them? and will he be raising it at the eu council this weekend? >> prime minister -- >> i think you for what you say about the forces' family. she's right. at this saturday when many of russ attending armed forces celebrations and commemorations, it's a moment to talk to the families and thank them for what they do whether they're missing their loved ones. she quite rightly asked about the unacceptable scenes that we've all been witnessing for the last day. of course, there was a key role played by the strike that took place in france. she asked specifically about what should be done. let me answer clearly, of course we want to see migrants better documented and fingerprinted. frankly, a lot of that needs to happen in italy where they land rather than in france. the three things we must act on

is first of all better security, working with the french, we've already invested 12 million pounds. i'm happy to do more if that is necessary. we've got to work with european partners to stop this problem at source. to break the link between getting in a boat and getting settlement in europe. thirdly, we've got to do more to make sure that britain is a less easy place for illegal migrants to come to and work in and that's what our immigration bill is all about. [ cheers ] >> he's right that this problem is the responsibility of the italian authorities and the french authorities. but as he acknowledged it's also an issue about the security of our border. can he say more about what steps he's taken to strengthen security at the u.k. border? >> prime minister -- >> the honorable lady is absolutely right. the juxtaposed border controls on the french side are a good thing for our country. and we should be prepared to invest in them. that's what the 12 million

pounds has been about. in talks with the home secretary this morning, we've been looking at whether we can put more personnel and indeed sniffer dog teams that side of the channel to make a difference. and there's also more work being done in terms of installing fencing, not just around the port, but also around the eurostar and euro tunnel entrance. all of these things can make a difference. we should work with the french closely. there's no point either side trying to point the finger of blame at each other. this is a strong partnership that we have in place. we should keep it that way. [ cheers ] >> harriet harmon -- >> i thank the prime minister for that answer and efforts on all sides will need to be stepped up. turning to another issue. the prime minister said in his speech monday there's nothing progressive about robbing from our children. but isn't it inevitable that cuts in tax credits for working families, and less employers raise their wages immediately mean children will be worse off? [ cheers ]

>> first of all, what i said in my speech about robbing from our children of the importance of getting our deficit down and not asking them to pay debt that we weren't prepared to deal with ourselves. what we need to do is make sure we go on with the plan that's seeing 2.2 million more people in work and crucially for children compared with when i became prime minister there are 390,000 fewer children in households where no one works. my program for tackling poverty is to get more people in work, get them better pay and cut their taxes. [ cheers ] >> harriet harmon. >> well, i'm asking about robbing from children who are in families who are facing tax -- tax credit cuts. the ifs have said that cutting five billion pounds from tax credits would mean working families losing on average 1,400 pounds a year. i know he doesn't have to budget, but many families do.

[ all talking at once ] >> it's the truth. it's the truth. it's the truth. think -- think about if honorable members would just for a moment think about a lone parent working part time to compensate her for that loss of 1,400 pounds a year, the minimum wage would have to go up overnight by 25%. that's not going to happen is it? >> prime minister -- >> the problem with what the honorable lady says is the last government didn't budget for the country. [ cheers ] >> she asked -- [ all talking at once ] >> order. order. i'm very worried about the health of the honorable member. she must calm herself. we're in the early stage in the proceedings. a period of calm must descend.

the house. prime minister? >> because the last government didn't budget for the country, as a result, the whole country was plunged into poverty which is what we've been dealing with. let me explain what we're going to do. for those who are out of work, we want to get them a job and a well-paid job. that's the best route out of poverty. for those in work we want to see higher rates of pay, lower taxes. our program is simple. let's have an economy with higher pay lower taxes and lower welfare. what she seems to want is the current failure of low pay, high taxes, and high welfare. that's what we need to move from. [ cheers ] >> harriet harmon. >> you see, mr. speaker you don't get higher pay by cutting tax credits. he seems to be saying that low-income families won't lose out because somehow on the day that he cuts tax credits, every employer in the country will rush to immediately put up pay

to compensate for the loss of tax credits. that would mean employers putting up pay overnight by twice what the obr has said they're going do over a full year. that's not going to happen is it? >> we are seeing rates of pay in our economy go up because we've got a strong and successful economy because of the decisions that we took. what the honorable lady doesn't seem to understand is if you don't get people back to work and reduce welfare, you're going to have to make deep cuts in the nhs which we don't want to see, or you're going to have to put up taxes which we don't want to see. look, if the labor party wants to spend this five years arguing against any change in the welfare system, i say let them. you're end up with the same results. >> harriet harmon. >> what he doesn't seem to understand is that these are people who are in work, who are going out to work providing for themselves and their children.

the truth is the prime minister is going to cut tax credits. he's not going to make up for that loss by putting up the minimum wage overnight. employers are not going to make up for that loss either. he says he is tackling low pay. he's not. he's attacking the low pay so much to the party of working people. >> prime minister! >> the party of working people is the party that's got 2 million more people in -- almost 400,000 children in households where people are working. that is why you can see a party that believes in work against a party which according to what of leadership contenders is now the anti-worker partner that is what they honorable member said. i would say to the honorable lady, in the week when greece teeters on the brink, we should learn the lessons of what happened when debt spiral into

you lose control of your economy. labour is stuck with the same answer, more borrowing, more welfare, more debt. it's the same old labour and it will lead to the same old failure. >> mr. speaker, thank you. would be prime minister agree that one of the best ways of tackling the cycle of child poverty is, in fact, to ensure that we deal with assistance educational underachievement? children get the best start in life, particularly schools, universities and just as importantly in vocational education. >> my honorable friend is right if we really want to tackle the deep and entrenched poverty we have in our country we need to go after the causes of poverty. the causes are high unemployment

debt addiction and family breakdown. those are the things that can make a difference. i was at the school this week on the outskirts of runkorn with 65% free school meals. and yet that school was able to achieve almost two-thirds -- they have a better record frankly than many schools in well off constituents. so it can be done so let's go after the causes of poverty and then we could really lift people out of that entrenched poverty. >> angus robertson. >> -- organizing and will be attending armed forces day across the uk. mr. speaker, the prime minister and other uk party leaders made a promise. they made about that more powers will be delivered to the scottish parliament. the people were promised home rule. they were promised and i quote as close to federalism as

possible. why does the prime minister's scotland bill not even deliver the limited smith commissioner proposal? >> first of all the bill that we put in front of his house does deliver the smith commission. it r will fulfill the vow that all of us kwept. of course, what it doesn't fulfill his of all fiscal autonomy that his party would like that would like scottish taxpayers with a bill of thousands and thousands of pounds. if that this policy can when he gets up he should say so. >> thank you very much, mr. speaker. the house of commons library says that important part of the smith commission proposals are not in the scotland bill that the prime minister proposed. the shortcomings in the bill had been identified by an all party committee in the scottish parliament on which the scottish conservative party state. are all of these people wrong? will the prime minister now commit to deliver the smith

commission proposals in full and all of the powers that were voted for by the people of scotland in the general election? >> we address precisely the point made by the committee in the scottish parliament that he refers to. mr. speaker, this go to a larger truth, which is the scottish national party only want to talk about process. they don't dare talk about which powers that be are being given they would like to use. if you don't like the way things are fixed why don't you put up taxes and spend more money? isn't it time you started talking about the policies you want to put in place, the outcomes? because the truth is that this comp full fiscal autonomy has now become a tough test, full fiscal shambles. >> would be prime minister investigate why some labour control councils including leads -- schools wishing to become academy's?

>> i'm delighted that woodkirk academy and its primary schools have applied to set up a multi academy trust. it often really works if you have secondary schools worked with primary schools to improve the results in those primary schools. i am convinced when you look at the figures, the academies are performed better than the local authority made schools. that's why the change is a necessary. i would say to the labour party don't stand in the way of this change, help bring these academies about. >> i can tell them and we are committed to elected by the great western main line. we are also contributing 125 million pounds to the cost of

the wider valley line electrification. it's a vital this work goes it. we need to make sure network rail gets its costs under control and strong leadership in place and we will make sure those things happen. >> in holland rates. >> yeah, yeah. >> yeah. >> thank you, mr. speaker. full employment is down 61% in terms of -- a strong endorsement of this government's policy to make work pay and also to the hard work and investment of business people in my constituency. what further support will the prime minister offer to help with much-needed investment,

broadband, mobile phone coverage, all of which would further help job creation in my area? >> first of all let me welcome my honorable friend to this place in the work i know he will do on behalf of his constituents. he's absolutely right, in rural areas like the one he represents, better transport better broadband and filling in the spots on the mobile phone network are vital. the mobile infrastructure project is providing more homes and businesses with mobile coverage but we do need to make sure we build -- i'm pleased to say the a-64 is part of our 3 billion pound investment in roads in the northeast and yorkshire. but there's more to be done. >> -- a drug prescribed for epilepsy.

although gps are now more aware of the risk the national archives show the risks are well known by drug companies and government as far back as 1973. yet mothers were kept in the dark. will the prime minister urge his health secretary to meet with me and the delegation of mowers who were affected by this issue to discuss the case? >> first of all, can i thank the honorable lady for raising this case. i'm not aware of the specific drug which she indicates. i'll look closely as someone who had a son with very severe epilepsy. i will certainly fix the meeting between her and health the health secretaries so that make progress on this issue. >> does my right honorable friend agree that the northern powerhouse requires proper transport infrastructure? can the prime minister update me on my campaign to get the a-6 bypass to reduce congestion and increase growth in my constituency? >> my honorable friend is

absolutely right which is why we're increasing transport levels in the northwest. we're investing 4.3 billion on the strategic road network. the a-6 relief road, as he knows, is going ahead. and i am pleased to confirm we provided authority with 350,000 pounds to fund a feasibility study for the next stage of the bypass route around stockport and hazel road my honorable friend refers to. i do understand that if this could commit it will make a lot of difference in terms of relieving congestion. >> with the death of yet another cyclist, and a young woman commuter beneath the wheels of a tipper trouble truck will the prime minister meet with a small delegation of the cycle group to discuss what more can be done to protect vulnerable road users including the call by the acting leader of the labour party for a ban on these killer lorries in

our towns and cities at peak times? >> i'm very happy to the meeting it does seem to me that although a lot has been done and wanted to try to make cycling safer and cycling save safer and cycling strategy, money is being invested. cycle lanes are being introduced. the number of fatalities is still very high and extremely depressing. young lives being snuffed out in this way. so i'm very happy to have that meeting and perhaps also keep in contact with the mayor about this important issue. >> rishi sunack. >> thank you, mr. speaker. as the prime minister to mention ask is all the broadband is essential in today's digital world. can my honorable friend tell us about his plans to get broadband to my constituents and those in rural areas across the country? >> first of all let me welcome my honorable friend to display. is got the job of following in footsteps of william hague which a number of those the very difficult in all sorts of different ways but i'm sure he would do i