so that -- that is something which i'm not sure of and i think that you need to do an economic analysis on the geothermal. that would probably be one of the more ten with us places for doing that -- tenuous places for doing that kind of thing. host: frank from new york. good morning, frank. caller: thermal makes sense if it's applied to a community. if you have a 30 or more housing area, is it possible to distribute the energy through a central drilling site and distribute it to the homes, for example? guest: if you said we are going to get together and build a community energy system, i think coming off the grid with 30 homes would be far easier than coming off the grid with one home. because then you can share the demands across the various consumer habits. as long as they were metric,, they were measured, so you would know who is using what, but a communal system, even orienting solar collectors on

south facing roofs since not all the houses will be south facing i think you can retrofit an existing community more easily and more efficiently than you could ever attempt to do a single home. . host: william, washington, d.c. caller: i would like to know about insulating existing homes. where the drill holes between the joists on the outside, basically framed homes, and then they blow in insulation and they fill the hole back up, what's the deal with that? guest: can i say if you don't have an expert doing that, don't do it. but there are some good ways to do that that will save you money. i think the challenge you have and what you just described is the product you're using, whether you're closing off the

air circulation, there is just a whole array of questions, but someone should be studying before you approach that. and so i don't know your specific house and i think i could give you some really bad information. so -- but if you have a classically gabled framed house, one of the best ways is to insulate the attic. if you can insulate the attic you can insulate at the ceiling or the rafter. two different products. two different responses. two different opportunities. windows sometimes are beneficial, not always. certainly air leaks are always a great idea. blowing insulation if you are doing some close cell and i haven't seen that evolve. host: we started out this conversation talking about the different tax credits out there for various technologies for retrofitting your home or building a new home, ways to save energy. they're up on the screen right

now for our viewers. of those -- of those different areas there, mr. beliveau, where do you see the job growth the most? guest: ok. certainly heating, ventilating, air conditioning. we have such better systems today. again, you have to have a qualified contractor. and i think that's always the challenge. but if a good contractor can come in and retrofit your existing systems, the efficiency ratings of the new heating, ventilating, air conditioning systems are so much better. so those are -- that's a great opportunity. i think you had up there geothermal. host: right. guest: i think geothermal is a great opportunity. i think insulation is probably the biggest opportunity. host: ok. but for job growth as well? guest: absolutely. host: why? guest: if you are going to retrofit a whole array of home, what a great way to certify the work that they do. and to really build up a great

new business model across the country, retrofit all of the existing homes. host: what kinds of education would these workers need? guest: oh, it's all about safety and what do you and where you do it. there's a whole array of safety issues when you use spray foams. and they have to be trained. it's not a callus thing. although the ones that do it today do it poorly. i'm talking about fiberglass typically. you need a good contractor there we tend to pick the cheapest price. often a big mistake. host: so they need special training, obviously. are you talking about a technical education? guest: to protect their employees and make sure they do it right. host: and what's the average salary? guest: for a good installer, i'm going to guess the installer, good installer would

pay $25 to $30 an hour, maybe more than that. because it doesn't take that much time. it's really the technical skill that's required to make sure it's done right. host: and when you say installer, are you talking about all these technologies? a geothermal pump installer? guest: yes. it's beyond the company executives and people that design the systems, really, the people that do the work, they need to be better trained so that they know that if they're putting in ductwork that they close off the ductwork better so they know their impact so they just don't do it callously. that's one of the challenges we have is that we have really little -- very little well to decide if the work is well done. your end result is quite dramatically different. host: and what does the virginia tech myers school of

construction, what do you have? guest: we teach people the issues of how to build. we now have a sustainability guru, annie pearse, who is very much involved in that area. we have a scientist out of austria who gives us great opportunities of what europe is doing. we have a whole array of people who teach about finance and all of the areas of how to build economically in the world today. host: well, let's talk about what europe is doing. we have a couple more minutes here. maybe main, if you could tell us real quickly what is europe doing on this issue. guest: well, europe certainly in their wind generation has more than doubled the installed wind generation capabilities that we do in the united states. that's a huge difference. if you go to spain, which is this evolving country and you go to their northern plains and you see miles and miles of their windmills, you realize that they've done it very systematically. as the very small -- as a very

small country. they have regulated better energy efficiency for their windows and for their nermal envelopes and because of that the price of those things has gone down dramatically. they have great products. most of the really good products for distributed air conditioning that you should review if you are going to do that are coming out of japan or europe. so there's a -- there's a huge growth there. host: all right. yvan beliveau with virginia tech, thanks for being here. thanks for kicking off our energy series. guest: thank you for having me. host: on wednesday we'll take a look at natural gas. on thursday, wind is the topic. and on friday we'll wrap up this week's energy series with a look at a more extensive look at solar power. but that does it for today's "washington journal." we want to bring you now to live coverage of the center for american pro impress. they're taking a look at community health centers and job creation. [captions copyright national

cable satellite corp. 2010] [captioning performed by national captioning institute] . >> i will talk a little bit about a different slant of community health centers. i will talk about what they are but first of all what generally people think of is the care they deliver to the individuals

coming in and getting back care. they are in underserved communities and give wonderful primary care. i have a long background with community health centers as a practitioner in philadelphia and i started an adolescent health center and started some academic research. one thing that is exciting that people are not focusing on is when we invest in community health centers, we are actually investing in the communities where they are serving. they are then generating increased economic activity and create more jobs. the paper that week released today for the center of american progress focused on that, the economic activity and the way they are engines of economic activity in their communities and the additional jobs they create. i want to tell you about what community centers are pae. later, you will hear the folks who are working at community centers.

we have someone represent a community center in new york city and loudoun county, virginia. we will try to put a face on these committees centers and the kind of services they provide. i will tell you about who they are and what kind of services they provide, how well they are doing, and the economic activity. one of the unique things about kennedy center's is there are four requirements by law and order to be a community center. that is some of the reason for their underlying success. first of all, they have to be located in a federally designated medically underserved community. that is defined by a number of things. they have a higher poverty and more folks who live in those deborah's are under the federal poverty level. there are fewer primary-care doctors in those areas and there are other health indicators that looked at this such as higher than average infant mortality rates. the second requirement is they have to provide comprehensive

health care services. that is beyond the kind of services you generally think about. they have to provide care for everyone regardless of their ability to peg. there is a standard sliding scale the. when people go there, people will be charged a fair price last like, -- last, they are governed by a community board and this community board, 51% has to be patients that are served by the health center. that is one reason why they can address issues in the community and target those needs. who are health center folks? the slide on the left is the help center population that compares to the red one on the right which is the u.s. population. 70% of the folks scene and health centers -- seen in health

centers are under the poverty level. they see a significantly higher percentage of folks on medicaid. they also do a great job serving minority populations. compared to the u.s. population, about 33% of the folks scene and health centers are latino or hispanic, 21% are african- american and 15% are the balance. when we think about health centers, you think about getting your checkup and shot and seeing -- being seen for your call. they also provide dental and

mental health services and other specialty services. there are enabling services or supportive services. 89% of health centers provide interpretation or translation services. 79% provide weight reduction programs. 91% are doing case management for illnesses as well as other services that folks need. 89% are providing services that ask patients what else they need. all of these services are delivered at the centers and we have seen some great outcomes. we have done lots of studies that have shown how they compare to folks being seen outside of health care centers. many people have been right about this over the 45-year history of health centers. when we provide these services in this way in local

communities, we also see cost savings because what happens is we are keeping people out of the emergency room and keeping them from being hospitalized unnecessarily. between 10% -- between $10,000,000,000.20 $4 billion can't be saved by providing more care to help centers. -- between $10 billion and $24 billion can be saved by providing more care from health centers. they are offering more preventive services and they are showing how minorities scene and health centers are doing better than average. the point of the paper was there was a fairly large investment on the recovery act that went to health centers and they could demonstrate what they did with these dollars.

we think about improve outcomes and all the things i showed you. what is less known and thought about is the extra economic activity that happens in these communities. we described these communities which are poor and have hired minorities. overall, we look at numbers that are in the affordable health care act. in 2015, health centers will be generally in economic activity about $54 billion in these targeted communities. this is going to sustain or create 457,000 jobs. we actually broke that down to see what percentage is directly as a result of the increased funding. community health centers work identified early on in the health reform discussion as being a unique place we needed to put more financial incentives into.

they can serve 32 million americans that will have no coverage. there are $9.5 billion in operating costs over the next five years going to community centers. let's look at this investment. we can see from the investment we have an additional $33 billion as a result of the health care act. 284 million jobs are because of the affordable care act. is important to realize that we put this money into community centers but it does not just stay in those walls. it allows them to ramp up and see more patients for they have extra rooms. they have after wings. sometimes they have an extra entire location curre. they will increase jobs as a result.

there is a very elegant model that allows us to look at what is happening outside the health centers. there is a reduced cost. the health center has to buy more furniture, new computers, all of those things that generate indirect cost in the neighborhood. those indirect costs were hiring more people and those folks, some of them have jobs for the first time or better jobs and they can go buy a washing machine or other cars. they are generating additional income. you can see over the $54 billion of total economic activity that will be generated by health centers in 2015, $31 billion is inside the health center but the balance is outside.

the 457,000 jobs, 286,000 of them are with and the walls of the committee center and about half of them are health professional jobs. about 40% are the ancillary staff that helps within the health center and 171,000 jobs are jobs that are created because of the increased economic activity. that is the exciting dollars and cents piece of this. we will turn it over and hear from some folks who are doing the real work. they are providing the services. they can help you see what it looks like when this money comes to a community center and what they have done inside the walls and outside the walls. bacon also tell you what they can do because of the economy and what they -- they can also tell you what they can do because of the economy and what they have done.

we will walk up to the dais to introduce the rest of our panel. >> thank you. hopefully, you guys will enjoy the discussion. i have the chief operating officer at london community health center. stephanie is the chief operating officer. she also served as a national spokesperson for recovery experts for the red cross. -- she has lived in loudoun county for 20 years. rebecca zse is the director of the community health center in new york city.

she holds a master's in public administration from new york university and is a licensed family nurse practitioner. she lives in queens, new york. finally, daniel hawkins is a senior vice president for public policy and research at the national association of community health centers. he provides federal and state policy related leadership. he was the director of a community health center located in south texas was a an assistant -- an assistant to the hhs director during the bush administration. he has been named one of america's most influential health policy makers.

thank you all for joining us. why don't we start with you, dan? tell us what health centers are and what they do and who they served. >> thank you. i want to thank the center for american progress. i want to thank ellen-marie for a fabulous report documenting a forgotten side of the benefits that come from the presence of a community health center in a typically low income community. health centers -- this is the 45th anniversary of health centers. they started in the mid-1960's. they were a direct response to a unmet needs that were not being met by the rest of the health- care community.

we decided some years ago that even for those who work day in and day out at the health centers and it can be enervating work beckon with you down, everyone needs a pick me up. a way of celebrating the great work that help centers do was to designate a week as national health center week. we have done this for the past decade or more, recognizing the work of the health centers, but most importantly, the work of the people who are in the health centers providing care every single day. so many of the folks that work in health centers are community residents. many of the professionals, many of the positions and nurse practitioners and pa's and ceo's of health centers come from the community.

close to 90% of the health community -- health center committee professionals live in the area they work. this is a tremendous benefit to the community not just economically but in terms of being an anchor in the community. my own health center helped keep the lab services company, a dental supply company alive. in that community and allowed them to continue providing their benefits and services and supplies. because of our presence in that community. they really are an anchor in communities that have too little in the way of economic development. a couple of my colleagues here, one of home ran a health center in the early days and came into

work in washington, d.c. and john marshall who ran the federal agency that oversees and administers the health center program in the 1960's enter the mid-1970's. they are both here and they can tell this story well. >> you mentioned earlier the crucial service the community health centers play in terms of defining illnesses in health care crises in our nations. >> what is the secret of their success? the health centers are firmly grounded in their community. that community board, there may be some who are expected -- are skeptical. i remember my own board early on in my tenure as a health center

director, i was young. some of the consumer board members came to make and told me and spanish that they did not know what they were doing. they asked if they wanted to -- if they should step off the board and -- be replaced with pharmacists and doctors? i said that is not your job. i said their job is to know the community and understand the needs of the community and to bring those needs and to the governing board and speak to them and do something to respond to the needs. no one can do the job better than that. it was true. whether it was teen pregnancy, family violence, obesity, the epidemic of obesity, what ever is going on in the community got children getting injured on playgrounds, no one knows that

better than the people who live there. that is the role that these community board members serve. to be grounded in the community is critical. the second thing is, they occupy the most opportune place in the health-care system, right at the entry point where quality health care can yield enormous improvements in health and save billions of dollars to taxpayers. the care that is provided -- help centers are not only far above their peers in private medicine but also well ahead of the healthy people 2010 goals for people who received mammograms and pap smears3 . one out of a pregnant women in america received treatment from health care.

mother and child are cared for at the health center as well. one out of eddie -- every eight pregnancies in america comes to the community centers, the help of the baby is better and the wait is better. it is that preventive and primary health care that helps. for those who have a chronic condition like diabetes or high blood pressure, health centers have shown they do a better job of controlling that through group visit, planned visits, literally putting the individual in charge of their health condition and saying you can do it. all that matters. those are some of the major things that help center's focus on. they have been shown -- there are no health disparities within

the four walls of the health center. if they need a specialty, salt or need to be hospitalized, they run into barriers but within those four walls, there are no disparities. not by race, not by ethnicity, not by income -- income, not by insurance eligibility. >> that is a gray segue to rebecca. you worked in the health center in new york city for a long time. your center is known for its innovative outreach program for the community. can you tell us about that? >> we have been around for over 30-something years. i want to echo what dan was. we are community-health driven.

everything we do is focused on the community's needs. we constantly do not want to do the same thing status quo. we accept what the community needs are based on the board's suggestions and based on the community use it. we have done surveys on an ongoing basis to see what the community is asking from us. recently, with the stimulus fund and the change in the economy, we have seen many, many changes. one of the local community health centers was closed down after almost 50-100 years. [unintelligible] we help the same persons in the community. we try to recruit some of the staff who had a job in that center to work for us. we tried to create similar system to recruit and bring help

to the patients into our system. that is what we have been doing. we worked endlessly with the state, with the city, with the federal government to be a pioneer and a testing site to make quality care better and bring it to a higher level and make the system more efficient . recently, we work with the new york department of health prin. usually, your primary-care read -- refers you for a colonoscopy they probably refer you to gi specialist. in new york city, we try to break the disparity. they use us to try to create space similar system. if they pcp refers the customer,

what is the percentage of compliance? 100% is the answer. by doing that, they will bring this usage as the example and bring it to the community to go and create a similar and more efficient system for the community. we are located near wall street. for many years, we have never seen any wall street bankers. [laughter] for the past year, things changed. i have actually seen more wall street bankers lost their jobs and lost their insurance and then they came to an area -- they never thought bay would use our service parian -- they never thought they would use our service.

i told them that if they use our service, they will move on and have a job that fits their needs. with the stimulus money, we want to better serve the community. in order to have an efficient system, you have to make sure that your staff are really capable and knowledgeable and ready to meet the challenge. for the past two-three years, we have had the opportunity to increase the capacity and the knowledge of our staff at different levels, not the ceo, coo, but everybody. the front lines that are the ones that receive the patient at

the door and they are the ones that have to do the job. do they know what they are doing to the best of their knowledge? do they know the change to the health-care system? we seek opportunities to bring them to a level to advance their knowledge and skills and better serve the community. that is what we have been doing at the community health center. >> you mentioned there was a clinic that closed that was close by? what percentage of the patients did you taken? >> we worked with managed care to create a similar system. we took on about 40%-60% of their population and some of the staff. we did this in a proactive approach and make sure all the medical records came to us. that is very, very, important.

>> your example about the bankers -- we don't have bankers but stephanie m. loudoun county,, with many jobs blanc, you have only been in existence for two years. you can when the recession was starting. what has been your experience in loudoun county? >> we are one of the new kids on the block. we have been in existence for three years but two of those three years, we were not funded with federal funding. we were really struggling. about 10 years ago, the community leaders came together and decided to solve the problems that we were having in terms of health care in our community. there were many things going on. loudoun county is and what was

the fastest growing county in the united states. we have a population of about 300,000 people now. it has probably tripled in the last five years alone. we are also now one of the top- 10 fastest-growing minority populations in the country. we have many things going on. while we were growing that rapidly, many people were attracted to jobs in the housing industry. we had home builders, realtors, we had landscapers, we have all sorts of people related to the big housing boom that we were saying. in terms of being a high-tech capital for the east coast, we had, but is likeaol based there andci. aol recently moved from loudoun county to new york for their headquarters. when the economy fell into decline, there was suddenly this

ush of joblessness that ghit what used to be a cooking community. we have many people who are out of work and houses are no longer worth the same. the realtors are out of business. people who had been employed by companies like america online no longer are working there but they have started their own businesses. entrepreneurs decided to stay in our community. typically, of entrepreneurs and small-business others cannot import -- afford insurance. we have a large uninsured population. the hospital gave us a big start a branch. -- a startup grant.

we were struggling to make ends meet. before we got the stamp -- federal stimulus funding, we were seriously considering layoffs. we started out with only five employees and we grew a little bit but we are not a big help center. and the time we have received the funding to continue, we now have 30 employees. we are growing rapidly. we have seen about 6000 patients in three years but the demand is still really high and we have a wait list of about 600 people waiting to establish care with us. we just don't have the room or enough staff. in the future, this is what we hope to do and we hope to open facilities and hired new staff to meet the demand. it is out raises that there are 600 people that we cannot find appointments for. >> what do you think are some of the challenges that you will

continue facing? other than the money coming from the health care reform, how will that help you and what are the challenges? >> space is our biggest challenge. with more space, we can see more patients. that means we have to hire more people. that means we have to bring on more computer equipment and all the things that you were talking about earlier. growth is our biggest challenge in being able to meet the demand. in northern virginia, we particularly have to face the challenge of transportation. out tot have metro loudoun county. there is limited public bus routes. it does not go regulate like in an urban setting. we don't have taxis that you can hail on the street corner. transportation is a base problem in northern virginia. what we hope to be able to do --

we have a situation where we can tap in and get taxicab rides for our patients who do not have cars. we will have a taxicab pick them up and bring them to their medical of women and bring them back, dan. -- and bring them back home again. we will pay for a taxicab to drive our patience two hours to uva for specialist upon as the transportation will continue to be a problem. trying to keep up with demand and growing and building new health centers where they are most needed will be the thing we are looking to the future for. >> there was an article today in"the washington post about s.taining talent sprin

can you tell us about that, especially in rural areas? >> the single biggest challenge i see is that health centers, especially with the new funding that is coming to them in the health reform act is the work force, finding the health professional, the positioners -- the physicians, the nurse practitioners and others who will be needed to staff additional center sites answer the additional population. fortunately, other parts of the health care bill contains a very good signs. the national health service corps and a young woman who is the subject of the story in the article in ""the washington post" this morning is a member.

in return for the services she offers in an underserved or in the area, the national health service corps has received a big boost in funding both as a result of the recovery act when health centers receive some of the new funding that they could put to use. the unemployed wall street bankers and aol started coming to your centers looking for care, the recovery act included funding to expand by about 7500 health professionals. many of them have gone to help centers already and are working there. the young woman of the article today is one of them. the health reform act contains additional funds that would triple the size of the national

health service corps allowing them to place 16,000 health professionals. every one of them will be primary care. medical care, dental care, mental health care, we're not talking thoracic surgeons. we are talking family practitioners, pediatricians,obgyn's. those of a kind of folks that the national health service corps will help wet. that is not enough. a young lady who grew up in the northern virginia area, the maryland suburbs, feels out of her element in our rural southwest virginia. we need to grow our own. we are partners with an osteopathic medical school years ago and we are now producing 100

osteopathic medical students per year for primary-care going into residents say, many of home were actually sponsored by local health centers called operation home town. that school is now brazil -- producing about 100 dentists per year for primary care. that is good but it is not enough. we are seeking partnerships with the country's medical, nursing, and dental schools to find a way we can replicate this program and find more people from the community. the woman who runs my old health center today is a pediatrician. she was a patient there when i was a director. the family brought her into receive care and to receive care at the help center for a number of years. it helped her to see. she was a student intern during

a a couple of summers when she was in high school. this was enough to instill in her a real desire to learn a health profession and come back and give back to the community. that is exactly what we need more of. that will be the crucial difference. >> ellen-marie, do you have any reactions to what has been discussed? >> one thing we wanted to with this panel is to see the difference of community health centers. there are 8000 of them around the nation. when you have seen one health center, you have seen one. they are run by community boards and these are very different centers. the ancillary services that we live up to the community board to choose, you can imagine that the translation services at one

site, the dialects are changing. another service is transportation which is more important in loudoun county but not so much in new york city. the other thing is to highlight how we see the difference in the late economy. -- in this economy. loudoun county can't continue and expand but there is a difference in services that they wang center in new york city, it is interesting to see how different they have become. you talked about going into the garment district and other places. they do out reach. you can't do it now because of your waiting lists. hopefully with the new bonds. i want to make sure that we

highlight that there is a big fear and concern if there would be enough people served under the affordable care act. i think we can see how we have this at hand and have the capability in the foresight that n.e policy makers put in paren with the 8000, you can look at the other folks who are out there who look very different. >> the point i was going to make was that back in 2000-2001, one of the things we are proudest of his bad health centers have enjoyed strong bipartisan support from republicans and democrats and independents over the years. 10 years ago, president george

bush as part of his campaign claimed that he would grow the help center program and doubled in size in his term in office. he succeeded he pressed, chris to provide additional funding for health centers. congress responded and did. everybody worried if there was going to be enough primary-care practitioners to staff these new health centers? 10 years later, there are twice as many physicians, 2.5 times as many of nurse practitioners, four times as many dentists because the health centers has six -- has expanded to accommodate dental services. they served twice as many people. with funding, they will double that number in five years. 40 million people by 2015.

after 35 years of work in and with and on and about health centers, i am absolutely confident that they will succeed. >> that is a good point. people are concerned about the money doing what it is set out to do. we saw the money going from the recovery act and we saw things come from that. hopefully, they will do the not the same thing in the next five years. -- they will do the same thing in the next five years. >> just last week, we learned that when the recovery act funding was first provided to help centers across the country and stephanie's was one of 125 new ones that were funded, in march of last year, the federal

program managers projected that help centers would add services to serve an additional 2.9 million people over the two- year period of the funding. they were already at 2.1 million people last year and last week, dr. mary wakefiled announced that help centers had served an additional 2.7 million people in 15 months. they will blow past the 2.9 million target. their original target was the 1.1 million would be uninsured. they are already at 1.5 million. these folks are social entrepreneurs. they are not in it to make money but they are making lemonade every day. they are doing great work.

>> ellen-marie, in your report, you outlined the economy in the communities. what were some of the highlights of that report? >> is important that we see employees coming to the health field -- to is important that we see employees coming to the health field -- it is important that we see employees coming to the health field. we want to see how much the community is growing. in some of the rural areas, the community health center is the engine. they are the core in that

community and the anchor of helping the community survive. when you see the jobs being created -- we talk about sustaining, as well. these are not jobs that were created necessarily because of the closing of st. vincent's but you could keep your center opened so it was not necessarily a loss. some folks lost jobs will get employed by bell local state polls -- employed by the local staples because you are using the local staples. >> i think we are ready for questions. we have a microphone right here. let's go to the gentleman back there. >> thanks. i want to thank you for the great work you are doing.

about 36 -- about 30% of school age health care is sponsored by chc. houses research apply to a school based setting? >> one thing that health centers do and what i studied in west philadelphia was a satellite. it was maintaining these jobs within the health care jobs community. what is important is that one thing is that what you describe as a perfect example of the ability to offer service in another place that does co- located and coordinated with the site that is available 24-7. as a satellite, you can provide care where it is more accessible. the services can continue in a

comprehensive way when you were court made it with something like a community center. the things you do predated the minutes clinics. you did not want to create two different isolated ways of delivering care. we would like to see more of the nursing centers, school based centers become incorporated into things like the community center and as we leave more toward electronic medical records, either by the the spoke from this of and the ability -- from the us hub and the ability to be that important in the community. >> over here? >> i am with the institute of social medicine and community health. the discussion has primarily

been the induced a fax -- e fax on the community -- effects on the community. as a model for health care delivery within the system, within the community and geographical area it serves, to what extent can some of the lessons of the effectiveness be translated into improving the efficiency of health care delivery at the geographical level of the community and the region? >> that is a great question. thank you for raising it. the major purpose of health centers from day one was to bring health care to communities with too little. they were agents of care but also needed to be agents of change. to change the way health care is

organized is the point. that is a lesson they can bring. in small but significant ways, it has had an impact on the rest of the health-care system. most health centers have gone through the health disparities situation. this was created about 10-12 years ago before. clinician tames, health professional teams, not just positions or the dentist but a team of physician, nurse practitioner's, pharmacist would an environment ma using the chronic care model that term health care from a

reactive system to a proactive health delivery care system. when i talk with my colleagues, i have found that not only did it fundamentally change the way that health care is organized and delivered to the absolute benefit of the people who receive that care, it also put those individuals in charge of their own health and their own destiny in many ways. instead of feeling like a victim of diabetes or a victim of hypertension or a victim of asthma, people would learn and could learn to take control of their health condition and learn what they could do to improve and maintain their health. i cannot tell you the number of times i have heard clinicians' tell me about an individual who called them ecstatic because their hemoglobin blood sugar level for diabetes was now the

lowest ever. they were thrilled and they were doing it. they were testing their blood sugar every single day. in many ways, this has allowed clinician's to be cared rivers but also to be cheerleaders, cheering the individual and a group of patients because the user group patients with diabetic and hypertension. that is life altering for a person on the receiving end of the care. this is also fundamentally life altering for the clinician's to give care. this health disparities collaborative have been the biggest boosters for clinician's

that felt like they were at the bottom of the cycle. all they could do was reactive to respond and not be overwhelmed. instead now, it is pro-active and is what our health care system should always have been about but it -- but it is not. we need to turn from success care to health care. that opalescent that: -- that is the lesson that health care professionals need it has contributed to different reports and studies that the care in health centers is superior in many cases to that offered in other settings. >> a couple of years ago, we worked with the community to have a healthy heart coalition.

we had commercial partners. we established the manual. at a restaurant they have a separate menu for the low calories. this is what is healthy for your heart. we worked with bakeries. they have a list of low, healthy, diet bakery pastry less. iat. they gave the community a choice. that is what we have been doing. >> i think we will have a high cadre of people exposed to this kind of care.

a wall street banker will not settle for different things. loudoun county people will want that from their health providers. there is a big discussion of moving to the medical home. i think of this as good primary care and coroneted and comprehensive. with the health centers, because they move beyond the care that is delivered in the health-care system but realize the importance of the translation is this moving towards the place that helps you to negotiate the proper health care system. as we had more and more models of the new models of care and characterization's of medical homes, can have health center care is the model of how we move into the future and what we would like this and possibly at some point of health,.

>> we bring this back to the last person? >> good morning. the metrics used to determine the medically underserved areas have not been updated since, i think, 1978. how is them reflect the actual need in under reserve populations underserved populations? >> first of all, the metrics are proportions. it is the rate of poverty, the population over 65, injured mortality, low birth rate, and primary care room physicians to population. even though the demographic 7. have changed, and there are areas that have lost their

status because of gentrification or something like that i am a believer, and by the way, let me say that because they are now 30 years old that the methodology, the criteria being used, even as they have been updated with new data from the census and from other sources, they are still -- so much has changed in america but they need to be updated. that is why last year we supported legislation that ended up in the health reform act that calls for a negotiated rulemaking process to specifically update both the health profession shortage area in the process. i am pleased that it became law. it is now about to be implemented. i am pleased to note that i was appointed to lead negotiating room making committee. we strongly support meeting to

update the process. having said that, one thing i believe in is that once the center is funded there's only one set of data that matters, okay? this determines whether it is needed in that community and that is the demographics of the very people it serves. fairfax county today does not have a community health center because the party in that community, and there is poverty, is washed away by the great wealth. it is almost impossible to get a designation even though you and i both know that there are pockets of people who desperately need this in fairfax county. the sale loudon county will come back, it will be strong, what would happen? if the demographics were to lie about the designation that you have today? here is what i maintain. let's look at the stephanie

health center data. what percentage are uninsured? what percentage are for? what percentage rely on public support like medicaid or the children got to health insurance program? what proportion are people of color? what proportion of people are at risk for for held comes and poor health status? to me, the measure of her success in her house hunter success will not be a demographic process. and now to be in the numbers she produces the their meeting a continuing need in this community regardless of what happens to the demographic of the larger community. that is what really need. that is what i hope to be able to accomplish the negotiated rulemaking, -- process. once we fund a health center in the community, let's look carefully at the demographics of who that health care -- health

center serves in making the termination of continuing to put resources in there and invest in the community in the future. >> off of what you just said, we have identified a tremendous need in loudon county for a pediatric center. there is one frequented in the county that only cares for adults. there is really not anywhere else for children to go. because of a 600 person waiting list, we cannot would return with children certainly. we are on target opening in a pediatric center for specifically low-income and children on september 1. this is without federal funding because we cannot wait. the demand is there now. help in the future to get funding for the center, but we just cannot wait. we looked at the demographics and we know the demand is there. we are moving forward regardless of federal funding to meet our community's needs for a

pediatric center. >> live up by wall street, yet your committee is one of great needs also. >> do is list of additional funding, right? how do think that money will be used for the community center? >> i will lead rebecca and stephanie tell you how they hope it will be used. here is a reno. the formal care act provided $11 million in new funding for health centers of the next five years. that is above and beyond the current $2.2 billion annually fund -- annual funding that will continue to receive, we have, from the congress of the next five years. the 11 billion is in the bank already. was directly appropriated, guaranteed funding it will be

released in growing amounts on october 1. of the $11 billion, or $1.5 billion is for facilities. other than work force, the next greatest challenge that health centers face is based. when i ran a health center, i had a mantra. always have something, it is either not enough money, not enough space, or not enough people. sometimes all three. typically all three. those are the challenges that health centers face. with the health reform act, the money problem is not totally solved, but it is a good way down the road toward being resolved. the space challenge will be a great one. the $1.5 billion is about 10% of what is needed. for health centers now and in the future, to grow and serve those 40 million people. the other 90% will have to come from private sector, state

funding, philanthropic support. it probably will not provide everything she needs. she will have to leverage other resources locally. that is a big point. the other 9 $5 billion will be released to support operational support. it will give stephanie and rebecca the resources they need to hire new staff, perhaps read some new space, buy supplies and other things they need to actually begin providing care. it is that $9.5 billion that will be the capacity to serve 20 million more people on top of the 20 million served today with the $2.5 billion annually. already, last friday, the secretary of hhs, catherine civilians -- sibellius,

announced they will have applications for the new access point. i believe it is $250 million of that $1 billion in fiscal year 2011 of new funding that will be available. applications of the accepted some time in the fall. hopefully, those new health centers will be funded sometime in the winter and can begin providing care. it will go that way each year for the next five years. >> how would you use the new money that would come? >> welcome and we know right off the bat. [laughter] we've are out of space. we cannot higher support staff because we do not have any place to put them. the facility we are in is very nice, but it is a very limiting. the very first thing we would do

would be to build a brand new building. we have an architect in the community that helped us design a plan for the building that would include 18 exam rooms, 10 dental offices, exams base for our mental health workers, prenatal care, you name it. it just depends on the other services we might identify in the community. we already have a really good base and a real good feel for what we would do with that funding and we have a space fixed out. >> that is great. >> for us, we tried to offset the needs of the community. lots of patients want to be seen on the weekend. we have been opening on five days initially and then we increase it to six days. then we increased to seven days. in the community do they have

ob/gyn services on sunday? for us, we are maintaining the level of service on sunday. with the capacity building, hopefully we will be able to expand service on the weekend, as well. just like we talked about by train the front line staff it will be on going. you want them to be quite ready for any changes in the future. >> if i could make one other point. healthcare is about the only industry that do not work and banker's hours anymore. only the health-care industry works and 9-5. every single one of these has evening were weekend hours like this. this is what we need. the reason that they started a revolution health is because he

had to sit in an emergency room one hour -- one weekend afternoon when his daughter was injured in a soccer match. he thought his time was worth more than that. it was a clear market. it points to the failure of the health-care system. it is not responsive to the people who needed care. help centers are trying. they are far from perfect and have a long way to go, but they are moving down that road. the rest of the health care needs to follow. back to your point, what can the rest of the system run from health centers? it is we need to stop working banker's hours. >> we will go to the back, the needy in the back. >> i work for refugee works. i work for on workforce issues related to refugee and immigrant health professionals. they are already in the united states and trained abroad. they want to requalify to practice in this country.

for the m.d.'s is the lack of residencies. hospitals have a lock on that. the want to recruit people who will become specialists. is there a possibility that in the future community health centers can have residency's available or in addition to hospitals said that you can provide the next generation of primary-care providers? >> that is a very good question. i think that is one that, back to the point of needing to grow our range, it is not only finding people from the community who can pursue a health professional boxing career and a fleet combat to the community to give back and care for the community. it is really running an

operating room and then tries to educate physicians, nurse practitioners, and others. in fact come in the health-care reform matting, that much maligned health reform, which has much wonderful stuff in there are a whole host of programs for improving training. one of them is called teaching health centers. it calls for funding to develop and operate residency programs. this with the four physicians. listen to programs that are based in health centers, not just in health centers but in ambulatory sites where the vast majority of health care is provided today. it is not in an inpatient care institution. as you have pointed out, virtually all of the residency training in america today is run

out of hospitals. we need to move much of that into the community, and to ambulatory health care centers, hospital-based residency programs are doing some of that of we need more. we know of at least one dozen health-care centers across the country that offering, managed come and run primary care residency training programs. we think that number could triple or quadruple easily. we know more than 300 health centers actually of residents who rotate through today. they might be there for 90 days or six months. they might be there on a residency rotation, but there is some much more to be done. then there is funding for expanded nurse practitioner training. rebecca is sitting right here next to me, i want her to be my best friend of what her and her

colleagues to be my best friend. i believe some of the most productive members of health care staff are certified nurse min -- nurse midwives. they do a wonderful job. we need to train more of them as well. it is the same with extended the due care practitioners. we need hygienists, dental educators. we need clinical social workers, marriage and family therapists from other mental health professionals to health -- to help with this stuff. they should be trained in community-based settings. my hope is that more health centers will step up to service the training sites for them going forward. >> two other quick points. one of them is that theme health care reform and cuts the some requirements that had a lot of

physicians in training in hospitals and has allowed them to prison. in the more community-based sites. the second is allowing the reallocation of some unused primary care slots. there are some places that do a great job in primary care and they are full. there are other spots not being used. we tried to move them and has some of the unused slots good place is going a good job providing primary care. that will be two chairs -- two ways. >> the match again, that will come back to the front. we have time. >> i am with the committee transportation association of america. we thought we would hear what you would have to say about transportation. when the training and jobs happen to know we want to be a support of transportation does not become the barrier.

is the same with patients coming in. the community transportation association is listening. if you have any questions for me, please do not hesitate. >> i want to thank you for making that point. i want to make another point. we talked about how in rural america, my health center was in rural america with the public service bustlines. forget a macro or in some way. it had nothing. someone did not have a pickup truck, they could not get where they needed to go whether it was to buy groceries or get health care. we had to operate efficient fans, literally running around the two county area where i worked in order to bring in patients. right here in washington d.c., transportation is an issue. yes we have the metro. if you are a mother with four kids in southeast d.c. and the need come to gw or howard, it is

a one hour or more in writing, four bus transfers, blossoms dollars with the kids in tow to get to a place where you can get care. thank god unity healthcare has sites in southeast. even in an urban area like washington, d.c., or new york city there are places where people can i get to where they need to go. this is in suburban and urban america as well that access includes access to transportation. [no audio] >> we have worked with the children's health fund not only to bring their staff and our staff together to grow services, but also to do one-on-one transportation planning. there are two components we

would work on the with which to be planning and the one-on-one delivery so you can empower people to find their own transportation. i think of us as community-based as well. >> i can give you one example. there was a young mother bringing her two small children in for an appointment. she lived in 87 miles away from where we're located in a town called sterling. we are based in leesburg. it is not that far, but the bus service is not local would and did it. she had to take the kids on to the bus, walk to the bus station, wait for the next bus to come through which was not in an urban area where they come to every two minutes. it occurred two hours to go 7 miles. >> it is a real challenge. we go right there for the next question go ahead.

you are the lucky one. >> i am from senior service america. we are labor department funded national organization that works with low-income seniors, many of whom i am sure our patients in health centers around the country. my question is to the two practitioner's asking when they have any current connection with the senior service employment community program in your areas and the possibility and if you do not of making those connections. the broader question would be to dance to do that in a broader relationship. we are in 16 states and in multi-county areas. the potential is there for the placement of low-income seniors in 20-hour per week community service assignments to do lots of different interesting things they could do that our community-based in their own backyard. >> we work with our local agency on aging to reach out to our

senior population. just like i described with the children, our local free clinic does not care for seniors as well. usually they would be going on to medicare. our local free clinic does not take insurance of any kind. the other problem in our community and many other is that a lot of private practitioners are not taking medicare. they are turning the patients away. we welcome them. we want them. there are an awful lot of key -- opportunities in our senior community, we have a lot of retirees moving too loud in county. we would love to have helped to have us -- to other seniors. we have a large retired military population we would certainly welcome those partnerships. we try hard to reach out, but with a limited staff with volunteers or other outreach people to help us to that in a

better way. >> we have a long history in terms of working with the seniors. when we did was a couple of seniors were our patience. then they register and work 20 hours. we gave them training. after they proved themselves and physically they were able to handle it, they become subsidized half of the time. we have someone working more than 20 hours so they can serve as a messenger, making copies, analysts things. they are very helpful. >> ok, great. one more question right here. then you guys can talk afterwards. >> i am a free-lance correspondent.

this paper -- i think this is probably more relevant. how many centers are involved? how many of the population is served? what is the money put in there? for the center in wall street, if you notice in the last couple of years the increase of environmental related diseases, particularly respiratory diseases? if they have not been pace anemometers, i think they are numerous health conditions the should remind should. -- conditions should be

monitored. for the future, i do not with the year is, but there was a 60 dozen dollars center. where will they come in from. taken the lead from the primary care. we are sure nine primary-care patients -- positions. -- we are short on primary care physicians. for the current center, how do you recruit staff? how much are they paid? do you have a problem the turnover rate? thank you. >> in the four minutes? [laughter] one of the most poignant

questions about the aftermath of 9/11. >> we are 10 minutes walk from ground zero. for the past so many years, after ground zero, we have been seen was respiratory definitely come and the children. we are lucky to have and as much initiative in our center, especially for pediatrics. we work closely with the city hospitals and the city department of health. educate,re to screen, and teach the parents help the child maintain a healthy lifestyle and how to use the breather appropriately, but definitely you are right that we have been seeing an increase. >> let me see if i can answer couple of your other questions on this. in terms of the members of on the screen, in the year 2015,

and this is all related to the year 2015, not a five-year time, but the total federal funding of the $5.8 billion. $2.2 billion, the regular funding, and 3.6 billion in new funding from the health center fund in the health reform act. that will be roughly $6 billion. the remainder of the $31 billion there and you're to come from medicare, medicaid, private insurance, state and local government sources, a private philanthropic support, and from the patients themselves who are always asked to pay a little something although no one is ever denied care for the inability to pay. $6 billion of the $31 billion of the federal grant fund. that 6 billion leverage is. the other 25 billion in other

revenues that will unable to serve the allow you to the c 40 million people in one year. that is twice what reserve today. we anticipate they will be served at twice the number of locations from 16,000, as compared 8000 today go what will it take to somewhere in the range of six-and 8000 physicians. 40005000 dentists. i know. these numbers are huge. a dental hygienists and others? among some of the confident, however, that health centers will find them. they found them over the last 10 years when the shortage was only getting worse. they went from 4000 to 8000 physicians between two dozen to and 2010. they followed. in some cases, they were recruited. the fund for writers who were

just tired of working for they had been working. they wanted something new, exciting, and challenging, so they were able to recruit them that way. i'm convinced we're turning the corner in the primary care. we have begun the process of revitalizing primary care. some of this is in a market phenomenon with respect to salaries. you mentioned what they're paid. if you work at a health center, you are paid a market which, a fair compensation compared to what is going on in the private sector in your community. that does not mean we have many former thousand dollar surges -- $400,000 surgeons. that is because the health center needs to offer in order to recruit and retain them. i do not know what the turnover rate is. i will tell the the longer a

health center has been in the community, the longer people work their stay. i'm sure rebecca can speak to that, and the stephanie may have experienced something. the first three or four years, it was like the whole staff turnover. by the time left, there were people who had been there for, 5, even six years and were committed to staying. >> with potentially have no turnover. >> good for you. >> we have no turnover. we just hired a new general practitioner. he is a rather young man. he read -- he retired after 20 years in the navy. he was a doctor in the navy for the entire time he was there. is looking forward to come to work with us as of september 1. >> that is wonderful. >> and still young enough to provide many years of care.

>> i want to thank our events team. thank you so much. thank you for taking your monday morning to come to this. [applause] >> president obama is on his way to taxes.

he was in washington this morning. -- president obama is on his way histexas. the president will attend two democratic party fund-raisers in austin and dallas. he will also discuss higher education and the economy at the university of texas in austin. that will be about 6:00 p.m. eastern on c-span. u.s. house members are cutting their summer break short. speaker nancy pelosi is calling numbers in the session tomorrow to vote on a jobs bill passed by the senate last week. the $26 billion bill is designed to prevent teacher reduction and the layoff of state workers. live coverage when the house gavels in tomorrow at 10:00 a.m.

eastern here on c-span. "washington journal" this week is looking into energy issues. energy issues all this week on "washington journal" at 9:59 p.m. eastern. >> tonight, what to watch for in emerging technology trends. industry insiders from washington on cyber security, web accessibility for the disabled, and how young people use the web on "the communicators" on c-span2. >> of the next few weeks, all of the tv on primetime. >> at the edge of the process," "with the wings like eagles," and they have both picked up "to

big to fail." this week in prime time on c- span2. >> conduct has a tradition of kicking off the fall political campaign with the fancy farm picnic in the small town of a fancy farm in grades can. it took place this past weekend. attending this year were senate candidates rand paul and jack conway. other speakers included senate republican leader mitch mcconnell and the state governor. here is a one hour portion. this is its 130th year. >> i appreciate the opportunity to serve here. are you having a good time so far? again, i want to welcome you to the 130th fancy farm picnic here

in st. jerome. we will have a good time this afternoon. is anyone hot? the need to get comfortable, because it will get hotter in the next few minutes. we have some great speakers lined up. as a good for our program this afternoon, remember that these men and women are in the public service, a respected them for what they do and for the jobs that they do even when you disagree with them. we live in the greatest country in the world when we can gather here today. we can think our god for giving us the freedom and the liberty to be here and think our men and women -- and thank our men and women serving in the armed forces all over the world so we have the opportunity to come here this afternoon. [applause]

i want to thank mark canally wilson, the cochairs of the fancy farm picnic and olivine committee for the hard work and the jobs that they did. i know he long appreciate what they do in putting this on. show your appreciation to market, laura, and the entire committee. [applause] the forrey began, there is a lady here i would like to recognize. for many years, someone you saw at fancy farm every year. there were involved in the public service in kentucky. they served in the state house of representatives. he served as a state senator. he was on the kentucky supreme court. anyone that new walter baker knew there was not a finer gentleman and a final public servants than senator walter

baker. but fortunately, we lost walker -- walter a few months ago. making the trip here today in his honor and in his memory is his wife, jane, and his daughter and. please welcome them back to fancy farm. [applause] all right. are you ready for some speaking? our first speaker this afternoon was elected governor in 2007. he is the 61st governor of the commonwealth of kentucky. he previously served as the state rep. he served as attorney general. he served as the tenant governor. he is a native of the dawson springs. yell out, dawson springs.

he received his bachelor's degree and his law degree from the university of kentucky. he has been married 41 years to a wonderful lady named jane. they have two sons, jeff a veterinarian, and the aid attorney, and three grandchildren. please welcome my friend, the governor of the commonwealth of kentucky. [applause] >> thank you. thank you very much. thank you very much. and is great to be back, in west kentucky. it is great to be back here at fancy farm. what a great tradition this is. the barbecue sauce is going to be hot. the weather will be harder. the political talk will be the hottest of all. it is always great fun and this is the season for partisan political talk.

those of us that you have allowed to beat in elected leadership knows something else. partisan political rhetoric has never gotten the first person a job. [applause] it has never put the first piece of food on the table. it has never put a roof over anyone's head or send a kid to school. people, real leadership is the ability to bring people together. these define common ground and move our state and our country forward. that, my friends, is what we have been doing in kentucky for the last three years. we have balanced our budget the last three years eight different times. we have cut over $1 billion in spending out of our budget. we have the smallest executive branch in a generation.

but we also know what priorities are about. we have maintained those priorities that are so dear to kentucky. the first did biggest priority is the education of our children. [applause] we know where to invest our money and it is in the future of our children. public safety has been another priority of ours. as we kept our people sit in their homes in on the street, how did we do that? we did it by bringing a republican senate and a democratic house together and they agreed and it did it. that is what leadership is all about. [applause] we passed a significant pension reform in the state. how? we brought the two sides together, found common ground, and we got the job done. you may have heard that we may get a nascar sprint cup race in

kentucky next year. if we do, it is because i asked the legislation to passed legislation to bring it here. the republican senate and the democratic house got together and they got the job done. [cheers and applause] we have passed the economic incentive reform to create thousands of jobs and millions of dollars in investments in kentucky. if you do not believe it, go down and asked remington. go to paducah back and ask h. b. fuller. go ask briggs and stratton. and is working and that is because we brought the two sides together. that is what leadership is all about. and that is the kind of leadership we need in washington, d.c. jack conway will take it to the united states senate. [cheers and boos]

you are right. jack, knows how to bring people together. on like rand paul could just knows how to divide people. -- on like rand paul. jack, knows how to balance a budget. he has done it eight times. this guy over here talks about balancing a budget that he has never done it. he will not tell us how he is going to do it. we are beginning to hear how. he is going to balance the federal budget on the backs of our school children. he is going to balance the federal budget on the backs of our coal miners. on the backs of our farmers. on the backs of our law enforcement officials. by taking the federal government out of the war against drugs. my friends, jack conway's

political philosophy is in the mainstream of kentucky. rand paul's political philosophy is in the extreme. until the primary was over. he escaped his handlers about three times. when he did, he actually told the people of kentucky where he stood on some issues. it is scared the living -- out of us all. let me tell you something. let me tell you something. it is very appropriate that the november 2 election day is comes just a few days after halloween. there are two groups of people. they ought to be scared to death of these candidates.

the entire commonwealth of kentucky, republicans, democrats, and independents ought to be scared to death about rand paul. there is another group. there is another group that ought to be scared to death about jack conway. that is the wall street fat cats that got us into this mess to start with. it is the same wall street fat cats that rand paul against in the primaries and now they are taking money from them to run in november. my friends, on november the second, there's only one choice. there is only one guy who can lead this state. there is only one guy whose views are in the mainstream of kentucky. that guy is a jack conway. thank you very much. [cheers nad boos] -- [cheers and

boos] >> all i can say is welcome to fancy farm 2010. [applause] we have some very special guests with us here today. if you would give me just a moment to introduce some people. these are some of my colleagues that served in the kentucky house and the state senate. several of these have driven a long way to be here and debate at fancy farm. i want to introduce some of them to you. first of all, the speaker of the kentucky house, the former

attorney general. but -- also my counterpart as the majority floor leader, my good friend rocky adkins. [applause] also here today, someone who made the trip for many, many years, the longest serving speaker of kentucky's history, and jody fisher of bowling green. other legislators here, senator dorsey -- dorothy ridley, mike reynolds bowling green, jerry rhodes, senate president david williams.

[boos] all so here are representatives brent youns, eddie ballard, bob will corsey, mike cherry princeton, kelly meeks louisville. we have some other legislators that will be speaking later on in the program. i think all of you, members of the general assembly, for being here today. -- i thank you. our next speaker is the longest serving united states senator in kentucky's history.

mr. mcconnell was elected senate republican leader in 2008. he is the 15th senate republican leader and in the second from kentucky. the first kentucky said later was albert barkley who led the senate from 1937 until 1949, a native of this area. senator mitch mcconnell was elected in 1984 and was the first republican to win statewide in kentucky since 1968. senator mitch mcconnell is a graduate of the university of louisville. he received his law degree from the university of kentucky. he is married to elaine u.s.

president bush's secretary of labor. ladies and gentlemen, please welcome the longest serving united states senator in kentucky's history, my friend senator mitch mcconnell. [cheers and boos] >> welcome and thank you very much. it is great to be on the stage with the next united center -- u.s. senator from kentucky, rand paul. i see that jack conway is here, too. normally, i detest more

regulation. we are on a seven second delay on jack conway's speech. i hope you will end by barack obama down to kentucky to campaign with you. i know you'll be proud about what obama has done. it did not work when he campaigned for martha copeley. she got run over by scott brown's pickup truck last january. i hear from people from kentucky oliver the state that they wanted to pass along a message to the democrats on the stage, when you stand with obama and nancy pelosi you do not stand

with kentucky. he stood up here and told us he was one tough son of a gun. that is not exactly what he said, but we will keep this rated pg this year. you know what is really tough? tough is what life will be like here in kentucky unless we send rand paul washington and make obama a one-term president. what is really tough is tough for 20,000 more people in kentucky out of work since barack obama to poppa's. it is tough on kentucky's

economy when this president is dead set on an acting cap and trade and national energy tides. -- tithes. at various times during the past year, jack conway said he would be for the national energy tith e. times will be tough for thousands of kentucky seniors to depend on medicare. the president's health-care bill, which we just had a referendum on over in missouri on tuesday, obamacare will cut $500 billion out of medicare over the next 10 years, less money for hospitals, less money for nursing homes, less money for hospice, quality of care will go down, bills will go up. jack conway is for obamacare.

jack conway thinks what barack obama thanks. jack conway thinks what nancy pelosi thanks. that is that washington knows best. i am in washington and i am proud to remind people i am from kentucky on like the rest of the country. in 2008, kentucky did not fall for hope and change. kentucky's knew better. this year, we will know better once again. we know better than to send jack conway to washington to understand the obama-policy agenda. i say if ed whitfield, mitch mcconnell, and rand paul are on one side and on the other is a jack conway, barack obama, and nancy pelosi, our side is the kentucky side. what did this out of control

trillion dollar deficits, we need rand paul to rein in government spending and keep us from burning in a sea of debt. now, look. rand paul has spent his entire professional career helping people out. jack conway spent his entire professional career chasing ambulances. jack conway will not stop out of control spending. he will not vote for a balanced budget amendment. rand paul will vote for a balanced budget amendment. what barack obama in aids policies says is we need to spend more, -- what barack obama and nancy pelosi says is we need to stand more. rand paul will stand up and say, "no."

if you're like most americans, you are appalled at to much spending, washington takeovers, your taxes, too. rand paul will join me in saying "no" to all of the takeovers. rand paul does not know -- he knows we are not undertaxed. we have a spending problem. we spend too much, not that we tax too little. yet the guys on the other side cannot spend enough, cannot borrow enough, cannot take over enough of your life, cannot raise enough taxes. the only way to stop that is to sendrand paul to join me in the united states senate. thank you very much. [boos]

>> i have been asked to announce robert robertson from taylor's bill, a black civic needs to be moved. police are requesting in the moves. a black civic group -- belonging to robert robertson from taylorsville. our next speaker this have june is certainly no stranger to fancy farm. he has been here many times before as an observer and as a candidate. he is currently serving his second term as kentucky's secretary of state. he was elected president of the national association of secretaries of state. he and his wife nancy are the

proud parents of two children. if there is any hint of the truth to the recent rumblings within the past couple of days, i would say we are going to see him on the campaign trail sooner rather than later. secretary of state tray grayson. [applause] >> thank you everybody. thank you everybody. at least i am here, on like your candid it. -- unlike your candidate. it is great to be here at fancy farm, and the that you would not see me after the drubbing they took in may. you're looking at one a tough son of a gun. i stand before you as a proud conservative.

i am a proud conservative from washington, d.c., like mitch mcconnell and ed whitfield who stand up to the anti-jobs agenda of president obama. they know we cannot spend our way to prosperity. i am proud of the conservatives of the frankford. they stood up to the liberals who wanted to raise our taxes and increase our debt. they know we must learn to live within our means. you see, most americans know that reducing our debt is the biggest issue facing our country. it is clear there's only one candidate in the u.s. senate race to understand that. that man is a doctor -- dr. rand paul. [cheers and boos]

>> i have to admit that some kentucky democrats have finally started to talk about that. unfortunately, they were talking about campaign debt. endorsement, is guess that is one that these democrats are willing to erase. when i was busy running for u.s. senate last year, i still kept my eyes on frankford as your secretary of state. we had our best legislative session ever passing several important bills. we cut more red tape for small businesses. we make it easier for members of our military to vote while they are protecting us with their race service overseas. we are doing better with less and i am proud of my record as secretary of state. now, as a lk