in most states it is something like less than two percent of education. fund education by any means. according to the census bureau, and 2011 -- into the 11 the delaware river state local governments regional time i have the report related to the 11th. we are out of time. we appreciate both of you all giving a short time today. ♪

12:15,up on 1215 -- at the health insurance exchanges alliance for health reform. we will have that discussion for you live from capitol hill. today comeite house of the president has a number of before hiss schedule nine-day summer vacation to martha's vineyard. there is a new bill that passed

att sets most student loans a cap of 8.5%. p.m., the president holds a that will range from the terror alerts that have closed over 20 can't -- 20 allssies and consulates, the way to the decision to cancel the summit with vladimir putin. coming upt will be here on c-span, and then we will take your phone calls and questions via facebook and footer. on the issue of u.s./russian set to gettalks are underway between secretary of state john kerry thomas -- kerry, and the secretary of to issues with

russia. we'll keep our eyes on that might bring you more of that later today. some people say that if we cut the military, we do not have that information to fight as much. -- temptation to fight as much. if we have a smaller inventory will stay out of it. that is not true. i do not see a higher correlation to even the defense budget and the worldwide need. the world wars happened to my we the vietnam war happen, and we run prepared.

the reagan years are seen by many people as the golden years, because we don't of the budget and we did not use the military. it was a wonderful outcome. some happy was coincidences, but it shows that if you increase the budget, it does not nest early mean you will have more complex. eccesarily mean you will have more conflict. theater, a look at internment of japanese americans in world war ii. journalists from buzzfeed,

toic --ll lose , and others met to talk about the takeover of washington post. >> welcome, thank you for joining us this afternoon. welcome also to our c-span audience. i'm dr. jane singer, vice chair of the aj stanley committee on professional freedom and responsibility. our chair is also here with us. board member maria harden, and others are also with us. we are sponsoring this panel, so it is a special session. a quick plug that more politics

are on tap tomorrow. we are also giving our first amendment award this year to the first amendment center based in nashville area that's going to be a great program tomorrow during the plenary time spot. if you have nothing else to do, please come to that. we're going to do this very informally and just ask some questions and bounce around some answers and panelists are going to share their thoughts and we will open it up and i hope we have a great discussion. i know you have some good questions. i'm going to go in the order in which they are seated. first to my right is bill adair, the new professor of the practice of journalism and public policy at duke university. you probably know him better as the founder of politfact, the fact checking site you know.

a pulitzer prize winner for national reporting from a couple of years ago. next is rachel smolkin, the current deputy manager at "politico." she has overseen the stories of ,he killing of osama bin laden of the president's reelection campaign and you may know her from her great work with the politics team at usa today and the managing editor of the american journalism review. next to rachel is jen pendry and who is not on your program. originally we were going to have an al jazeera reporter here but she has gone over to the mainstream and is now working for cnn, making her ineligible for the panel. so jen kindly agreed to step in and we appreciate that. she is the white house reporter for the huffington post and covers leadership on capitol hill. she joined huffington post a

couple of years ago and spent years covering the legislative and executive branches of government for "rollcall." probably a walk in the park for her because she started covering the texas state legislature. again, stepping in for camille, so thank you for that. next to jen is john stanton who also has "rollcall" roots. he is the chair of buzz feed here in washington. smith, the editor described him as a reporter's reporter with being in his veins. he's a third-generation news man and it probably doesn't hurt he's a former bouncer as well. at the end of the table is alex mueller, currently with "rollcall." he is currently the design editor, so he gives us a graphic perspective.

he has a background graphics, graphic design and journalism and web design and production. his current career niche is making our legislatures look at least interesting online and in print. not sure we envy him that one. that's a great group and we are happy to have them here. i would ask you not to make any kind of hesitation. mercifully, none of them brought power points. i thought we just throw out some questions and jump in, panelists, jumped in with each other and we will talk about whatever you want to talk about. we want to hear your views on the washington post and the transitional state it is in now. but we want to say a little bit about how you do things differently. what do you do that different from the way you cover politics and how do you define your role and how do you make it work in communicating to the public?

>> i would be happy to go first and say we threw out the mold in terms of story form when we created politfact. the traditional news story, the pyramid, was not going to be the way we inform people about politics. we were going to do it through a different form of journalism and where the information was communicated both through an individual fact check article and also through the collective. go to michele bachmann's politfact page and you can see she has been checked sixtysomething times and 50 of those she has been rated false or pants-on fire. so you learn something about

michele bachmann to learn the collective about her tells something as well as the individual articles. as we set up contact for our obameter, which tracks the president's record, we decided we would create something new. >> we will go in order here. i work for politico, and all politics of location, now politics and policies we have expanded little bit in the past couple of years and continue to expand. we are very much directed at being fast and smart and trying to think of the story that the post and the times might do the next day and we do it quicker and sooner. we have a traffic team of reporters and editors who work to make us look smart and we were directed very much at influence makers inside the

beltway and out. it has been a big shift for me because before i worked at politico, i was at usa today, which is a mass publication. including people who might not be familiar to politics. it has been a shift to the inside perspective and we want to be interesting and accessible, written in a way that is punchy and so we think a lot about tone and style and how to tell a compelling story. >> i work at the huffington post post trade you probably all know what that is. if you go to the front page website, it's a screen of all kinds of issues all thrown up there together. to me, covering politics is great because we can take an issue that is in the daily grind of news and do it a little differently. we have the ability to run a wire story to get the daily, this is what is happening today, and we can put that up and separately go do something

related to it which is not probably the way someone else would report on it. for example, we've been focused on sequestration and the issue seems to have lost a lot of its wow factor and power in this town. it's not something you hear that much about anymore except for side comments. something we have done that has been fun for me and unique to what we can do is we have focused on the subject and try to write on it all the time. we focus on janitors and we talk to families in tennessee who are struggling because their kids are cut out and they don't know how they are going to get by everyday. it's related to the daily news grind, but i like to think of it as you kind of inject that into broader policy

issues all the time in this town. for me, that's one of the things i feel makes huffington different from political reporting. >> buzz feed is aimed at the 18 to 40 or so, a pretty broad range of people. coming from rollcall, the thing i found interesting is we have two things -- we focus on telling the stories in a way that will be viral. we consider twitter to be our front page or facebook, we consider our readers to be our front page. that requires us to find ways to explain stories inside the beltway, congressional stories that your average person may not understand or have any real reason to care. we have to find ways to tell them those stories and it's been interesting.

we don't write stories about commodity news kinds of stuff. we try to find ways to explicate those stories in a different matter. interesting things people are saying or doing as a way to tell these stories. it's a general news and entertainment site which is very different than politico or rollcall. it's sort of the opposite way of going big to small and now you are finding a way to tell people who eric cantor is and why you should care about the fact that he and john boehner are having a fight today. that has been the interesting thing, but we are sort of trying to use social media as a way to broaden people's awareness of politics.

>> our bread and butter at rollcall has been focusing on the stories that affect capitol hill and the community in general. we been doing that since 1955, so we build relationships on the hill. we look at broader issues like piggybacking off sequestration, but we also narrow it down to focus on how it affects the capitol hill community and things like wait times to get into the visitor center and things like that. we are broadening our web presence right now and doing a good job of that. we are always focusing on the stories that most affect the people who live and work in capitol hill. >> you talk about the audience and we have done that as we go along. do you find you're using

different kinds of sources than you use in traditional media? how do you bridge that gap you are referring to of we are inside the beltway, but we need to help people who are not inside the beltway understand why this matters to them. does that affect your sourcing? >> we are very conscious of what people are talking about on twitter, facebook, reddit, and sites like that. if we see something pop up, we will report on it. after the trayvon martin verdict came out, for intsance, there was an acknowledgment among white people that there was a thing that got termed black

twitter. we did a story on black twitter and the power the black communities found in using twitter as a way to communicate things to each other and the broader national audience. those kinds of things happen in other areas. we used it to look at things like the election and people talked about a particular story or video someone put on youtube of a townhall, let's say or or something like that. we definitely use it as a source, but we are still trying to have these very traditional notions of being a reporter in this new world. we are talking to staff, members, the interest groups and people outside of the beltway it is a new tool to find out what people are interested in in a way to investigate the things they might already have. >> not just the use of social media

sites, but since moving to politico from usa today, getting people who are in the room, making the policy, if there is a leadership fight, some of these are not abstract examples that actually happened, and we want to talk to lawmakers in the room and we want as much detail as we can possibly give. we did that at usa today but we were more likely to rely on a professor who could tell you about the dynamics and overview, we want to get to the action as close as we can as consistently as possible. >> in the case of politfact, our rule is when reporters have defined original sources, it's not enough to renew a story that says so and so voted for this bill, we require the reporters

to actually go to the rollcall vote and look at the original rollcall vote. we put a heavy emphasis on original reporting, unlike some of the other panelists. our metabolism isn't quite as feverish. we do a thorough fact check. sometimes it takes a day, sometimes it takes a little longer. our goal is to take a political claim and check it and be as thorough about it as we can and doing so to rely on original sources more than secondhand sources. >> i feel like we have a lot of flexibility to decide on the way we want to do our coverage. what is fun for me is we can walk into the senate press area, i can walk up to marco rubio and ask how we are supporting the immigration bill and how this is upsetting people on the far right.

this is like our tried and true sources, but i can walk outside and there's a huge rally outside with the tea party happening outside the capital and a colleague and i spent the afternoon talking about what we think about marco rubio's role in the debate. do they hate him now? by and large they were unhappy. you probably can imagine what the responses were. those were separate stories that addressed the fight from a different perspective and from a sourcing standpoint, some of my favorite stories are talking to people struggling with the kinds of people that get talked up in this town and feel like they lose meaning, but when you talk

about people not in the bubble here, you can get some great stories. they are real people and i think huffington has been really good for our sourcing, not just people in the bubble, but they've got millions of sources. why not talk about them? >> i wouldn't let too much time go by without asking what's happening this week at the "washington post" and how you might think they will change. being bought by jeff bezos and someone who is very much into audiences and engaging audiences and serving audiences, will they

change or will it be a different kind of competition for you or player in washington? will it continue the role? >> i think it is inevitable they will change. i think bezos has shown as jim brady put it, head of the digital first media, that he was able to see the future and build amazon before people knew they wanted to order things online. that is what has been needed in journalism, somebody who can envision the ways people are going to want information a few years down the road. i think it is a great thing for the post and i know there are a lot of people who are apprehensive about it some but i think he said all the right things. the letter to the employees of the post was pitch perfect in terms of the balance between his commitment to the great journalism the post has always

done, but plenty of clues for futurists who wanted to see what he is going to do. he invented almost internet commerce. so much of internet commerce has been affected by what amazon did and i think he could have the same role at the post. i think it's a very positive thing. >> one of our editors made the joke that a free washington post --bscription with every candle kindle sold. it's a lame joke but if you think about it, you wonder how that is going to affect others and how that's going to affect local news coverage because the local news has been incredible at covering the d.c. region and you have to wonder how they are

going to evolve in the upcoming years with the new mindset of digital first. >> as a local growing up reading the post, i'm a little apprehensive. i think the post for a very long time seemed their core audience was not people in the city but sort of an upper economic group. they have started to change and have a great columnist who is a fantastic writer. i'm a little concerned that move toward a more focused within the city, focused on a younger demographic may or may not be helped or hurt by that. but i think there is a utility for families who live in those cities. having somebody who lives in california or wherever he lives and whose mind is not about local at all. i do have some reservations

about what it will mean for coverage of crime and life in washington and even sports in washington. do they continue to be to go to place to read about the redskins or the nationals? does it become a bigger focus? these are questions that are not going to be answered for months, if not years as a result of this sale. on the same end, i do believe the post has been struggling a little bit. all the big newspapers have been struggling and having somebody with such a creative online commerce can help create a new renaissance for the post and all of the old guard newspapers, which is very important. i don't think they should die. i think they play a very important role in our society. they are the institutes that hold what journalism should be

on all levels and the beats of journalism. if someone can come in and find a way for them to come in and find a place within the new digital environment, that will be great. >> i don't have much to add. i also grew up around here and i have friends who worked there and my sense is people are kind of excited. people have to change. we don't know how long it will take to show what's going to happen, but something had to give. we will see what happens. >> i think it's hard to say how seismic this feels in the industry and the graham family has been such a wonderful store of journalism and their names are synonymous with watergate and the pentagon papers and the

kind of journalism that inspired a generation to come. it really feels like a dramatic turn in the industry representative of the time we live in. the panel is built around what our publications do differently than traditional journalism and this is a sign there is no more traditional journalism in the sense we are used to thinking about. there is not web versus print anymore because we live in a digital age and you have to think about good journalism delivered to people in a way they can absorb it and get excited about it in a way that they wanted. for big metropolitan papers like the "washington post" and the "boston globe" and others that have been in the newspaper facing circulation decline and pressures, on profitability,

they have to find a way to thrive in the new space if they are going to remain viable. we all watch the post and want to see it produce the excellent journalism they have for so many years but at the same time, there is a need to transform for them to succeed in the new world. the question i will have watching them move forward is sometimes it's easier to come into a wholly new space and create something from scratch that is to take a existing institution with proud

traditions and an entrenched beaurocracy and figure out how to make that move into a new space. that will be an interesting process for them. >> it will be interesting. they are coming from a very different place and dealing with a long-standing institution. something you have all mentioned going along the line here is getting people outside the beltway to care and see how sequestration matters to them. what if we could go deeper than that and offer some examples of things you have done that have worked really well in engaging your audience. how do you do that and what do you do with that feedback and how do you use it moving forward? >> we wrestled with this because there had been some fact checking before.

i felt like it was eat your vegetables journalism. if you are in a newsroom, has to be done before an election. somebody do a story on the candidates decision on education and then they write a story and hardly anybody reads it because it's not appealing to people. we came up with the idea of the truthometer. we go out and do in-depth research and get together and have a methodology for this and come up with a rating. we know it is very effective at doing this because it drives people crazy. they go bonkers about our ratings and the wonderful thing is, as they are talking about our ratings, they are having substantive discussions about policy which i guarantee is not happening with the long 20 inch fact check. you may not agree with our rating on any particular claim, but the great saying is that it's giving you a snapshot of

our work and our best judgment of what the relative truth of it is and you can disagree. i think that is what is needed and one of the problems as we made the transition into the digital age is this expectation that the old construct of eat your vegetables will work, and i just don't think they will. >> that's a terrific point great we all spend time thinking of how to make journalism interesting and engaging. we're way past the world where this can involve today and how we can expect anybody to care about it. we've talked a lot about how to punch through. you probably all heard driving

the phrase that politico drives so much. we talk about ways to measure if you are reaching your audience and what we do look at, is it being talked about by lawmakers and policymakers and hopefully in a respectful manner but we do use that as a measure. sometimes it's a committee meeting, the publication, all of those measures we look at on topics inside the fiscal debate to the talks we do so many of and do them very well and we cover all aspects that there will be delays or employers on the obamacare mandate trade we did that for many topics and as we expand into more policy areas, are we looking at the best way to meld them with the

core mission of politico as well. >> the huffington post has always prized itself on engaging with the communities. we have people with blogs on the site and have very engaging comment sections for most of the stories. engaging is a euphemism for something else. there is a lot of interaction with the non-bubble community. one thing that's a real success, when the senate voted down the background checks bill, there was an outcry and a lot of people couldn't believe it who don't live in dc and don't follow politics day by day. why can't we pass a background

checks bill? one of our projects was we clicked something on the site that said if you have a personal story about being affected by gun violence, send it in. here is a phone number. call and leave a message. leave your name and number and we will call you back if we want to use your story. we've got hundreds of people who called. so many people have stories, all personal stories of losing a husband, friend, son, daughter, people killed in gun violence. we got hundreds of people who called. so many people had stories that were horrible. all personal stories of losing a friend, son, daughter -- people that were killed and gun violence. a bigger response than i would have expected. one of my colleagues went through and found a dozen of the stories that were project really compelling. they give us their names and where they lived. we had this huge splash on the front page. it was like 10 images on the front of the page that were just people. it was just people who have been

affected by gun violence and really sad ways. when you hovered your cursor over one of their faces, it would take you directly to their story. you could hear it. you could hear the audio. you could hear their voices shake. and when they would get more worked up as they were talking. that was one of our proudest moments, because it is directly engaging the public on the issue that infuriated some of the people and letting the people tell the story that resonates much more broadly than the failed bill in the senate. that is the kind of thing that huffington has been very good at doing, telling people to tell stories that in return d.c. has to read about.

it connects the two worlds in a way. >> in mid-december during the fiscal cliff fight, i originally read a story about how members were not feeling that much pressure, which is a very traditional notion. that interest in politics drops off after the election. we went in and looked at the data from the web sites. i compared the point in the fight with that with the debt ceiling fight in 2011. the thing we found is more people were reading stories about the fiscal cliff at that exact point in that debate than they were in 2011, despite the fact that they had just gone through grueling election where no one wanted to talk about politics. it was right before christmas. we were surprised that there

were that many people. i think it is indicative of a shift that is going on in the public. i do think people are more engaged in politics than they have been in a few years. probably because they're frustrated. partly because they are increasing able to see the people they agree with and that keeps them more engaged. the fights right now become these life-and-death sort of deals. that gives me a lot of hope that we're finding a way, even if we do not understand how we're doing, it, people and keep them engaged with what is going on. i think one of the things that we try to do that helps with

that is to try to find ways to make things a little bit more personal. i did a story that has had a lot of traffic to illustrate this. a friend of mine that was working for the defense department as a contractor and the sequester started, and he was your average american, lots of credit card debt, the house, divorced and had kids. he took a new job here thinking it would help him get ahead and get a handle on the finances and then the sequester hits. it sounds like a 2 percent cut, but it can be 20 percent of your pay in some cases. that reality forced him to reenlist in the military. they go year without having to pay taxes and they get all these benefits by putting yourself in danger of dying. we did this story and a lot of people read this, an average american being forced into this

terrible decision because of sequester. the other one that i think that very well that illustrates this is we did a story about the chief justice for fisa court. one of the highest-ranking black judges in the united states. we found this great essay he had done about being racially profiled and what that meant for a justice and how he viewed the legal system. we just wrote this thing that this is a guy in charge of one of the most powerful courts in the world. a lot of people read it. an interesting way to look at

the debate. i think it puts a human face on this otherwise impenetrable government bureaucracy. no one understands exactly. >> i agree with john when he says people have been more plugged into politics than they ever have been here yet that is in part due to media analyst scovering politics on capitol hill. sort of what you see is people are only going places that reinforce their already held opinions. it is important to provide an independent look at what is going on. that is simplified enough for

the common person but still nuanced enough that you are not boiling it down to something where we're not getting anything out of it. i was talking about roll-call does the 50 richest list which looks at lawmaker wealth on capitol hill. we just revamped its this year to create this fantastic online database. when you talk about the fat cats in washington, now you can see easily just how fat those cats are. conversely, we also read about the least rich lawmakers. some people who are not worth anything actually owe money. it is an interesting snapshot of who is making the decisions that affect you every day. you can look and see a lot of the people who have been on

capitol hill the longest are the richest, research what committee they sat on and how well changes from year to year. what sort of assets their money is wrapped up in. you are providing this fantastic resources for people to look at their own lawmakers and see exactly how much money this person has and whether you can make your own call on whether that affects the decision making. purely as a resource to learn information about the lawmaker. that is the sort of resources and reporting that we pride ourselves on. >> i remember joe biden always came in dead last. least rich on capitol hill. he made $200 on his book last year.

[laughter] >> i know everyone has questions. each team has worked somewhere else. some of you have worked in more traditional places compared to where you are now. can you tell us how that is different for you personally, what you feel has been a change for you perhaps in moving into the work you are doing now. we're also interested in how you help students prepare for this environment where there are all of these opportunities. what do they need to know to take advantage of opportunities that are out there? >> i think they need to learn how to code. as someone who has worked for a newspaper for 24 years, the last six of that running politifact. i am struck by the tremendous

opportunity for students that can understand the fundamental of journalism and understand computer science, understand html and want to take the curiosity of a journalist and put it to work on the web. >> i will push back a little bit on that from my own interest and say i do not care if they know how to code. i want to find students who are smart and curious. i was on a panel and talking to

students that i think curiosity is the most important factor. i want to see the wheels in their mind turning all the time. we finish a moderator says are there any questions? a whole group just sits there and look at us. finally someone asked us a question. i think we get so focused on social media and the bag of tricks we forget that journalism in the most fundamental way has not changed. you still have to be able to ask the smart questions and do this more reporting and be able to write a story that it's interesting, coherent and draws people in. i see young journalist be too reliant on the new tools.

i could email my source or send them direct message. i want you to get out of office and have coffee with them and look in their eyes. many new tricks of the trade, that is wonderful, but not at the expense of the most important things that we do. >> i have to completely agree. i asked for questions and it is silent. one of the first questions i have gotten is is it worth it to get into journalism? they will tick off all of the hits the industry has taken and it is depressing. you do not make a lot of money. other than that, it is great. it is a great job. the teachers to organize the class suggested they should not go into it. i am like what are you doing? no names. are you interested? are you curious?

do you see something happening in your community that does not seem fair or right? someone disempowered that seems stomped all over by people of power? basic questions like that that need to be told because that is how it works. i have a friend who told me once that he loves his job so much because the only job in the world where your actual job is to tell the truth. at the end of the day you are supposedly here to tell the truth. you cut through all and you tell the truth. put it up for everyone to see. when it is a good story, that it's like the best feeling in the world. there are friends leaving jobs

because of newspapers holdings and things like that, but it is the initial excitement of these that are wrong and telling people about it. that is our job. we look for people who are not necessarily i believe frederick to want to come to huffington and get into this world. we look for people that are curious and want of different ideas because they are curious. that is the most important thing i would say. >> i would agree with all of you. to learn the coding and things like that is very important and you have of the course set of values.

i would say if you could teach them how to run a lead is awesome. i think my view of this is increasingly a lot of the kids i see sometimes, you read the other stuff, everyone is a quasi- columnist blogger. active voice is something that seems completely foreign to the millennial generation. we all had the idea of what was a movie. did not understand that they built that movie off over originally very boring stuff. a local crime story no one wanted to cover.

they built the story that way. now it is more and more like a notion of understanding. it is a weird thing. i think that is the thing i have noticed with younger reporters sometimes, they get frustrated reporting because they feel like they're not getting ahead as fast as they feel they should. that is a shame because a lot of them are very talented and maybe

they have tempered their notion about what they will learn on the job, they would be better off for it. at the same time, i think because of the 24 hour news cycle, because of twitter and facebook and the ability to push things out, they have an ability that i do not know that we had when i was 22 or 23 and wanted to work all day long, all night long and never complained about it. they just do not. that is an amazing thing. every reporter i know is more than willing to drop what they're doing on a sunday afternoon and spend three hours working on a story. that is a credit to them. >> i think it is a born for young journalists to look for ways to evolve their storytelling, whether that is increasing the media or looking for ways, working with other people in the news from to create resources to complement your story.

i think you should have an idea of what coding is and you can work with someone else in the newsroom to create a package that shines and i hesitate to use the term -- go viral. you could be writing the best story, most important story, but no one sees it -- there is a so much competition out there right now. it is always important to be looking at ways to make your product unique. >> as editors we oftentimes need to learn how to learn from them.

they have a world that is foreign to me. i remember when pages for a new thing. kids come up and they have had laptops with wifi for much their entire life. they do not know world without e-mail or all these things we did not know. i am constantly amazed, the reporters we work with that have a different way of seeing the world. different ideas about how to tell people what is going on in the world. things that i look at and i am like that is crazy. it has been an eye opener to work with the folks and my outlet because i have embraced twitter. i thought it was this silly thing. i really have learned it is a valuable way to talk to people. if you can write a good, solid lead on 140 characters, i think you are doing something very bright. it takes me refer to figure out

how to write a tweet that is not terribly misspelled and books right. they do it everywhere easily. >> i would make one more point to piggyback on one of these comments. we've been talking about building a brand and the younger journalists seem to know instinctively. they are born with that in their dna. they note to do all of that, but i think there is a little bit that has been lost. paying your dues is still viable. there are some opportunities now for young journalist to cover congress, even the president before they have covered a zoning meeting in chester county, which is where i started out. i think that is something that is important to emphasize. get ahead and take all the opportunities but did not miss the thing that you were when you covered with it when you cover the school board hearing and the

county planning meeting. you learn how to deal with people, not be afraid of sources when they're yelling at you and how to tell sources at top story is coming and things that will ultimately make you successful journalist. >> i feel like we're in the "those kids today" stage of the panel. kids today. >> i have more questions but we have such a nice audience. i will ask if your questions and also at the panelists at questions of each other. let me ask the panelists, is there anything others have said that you would like to follow up on? >> when you work creating politifact what was the conversation around dealing with the fear that maybe you were watering things down or simplifying it enough that it was easy for the layperson to

understand but not losing any of the details of the overall conversation and discussion? >> it started on a word document. from the beginning it was a meter. that gave us confidence this was not going to be seen too much. there was a willingness that this thing was a going to evolve. there was a willingness to

invent over time. i have said this and other speeches in panels, the willingness of the management to stick with it. to stick with this and let us to invent it, recognizing there would be mistakes along the way and what ever. i think it is a really cool story of creation. and also a cool story of team work. i was the guy who did the word doc sketch but the staff filled in the blanks and made it work.

>> talking about writing today. i have to teach writing to these kids. i know how to do it, but i have notions that were created in 1973. has there been a definite change in how the writing style should be? >> the rise of blogs cause the softening of writing. it caused a little bit of softening for a time where people that went from being bloggers to reporters. the notion that you do not to talk to a bunch of people. what he does is great, but not

exactly hard news and reporting. he has some opinions and read about it. a lot of people thought that was being a reporter, and it is not. there is a difference. now there is a shift back. it is tough to tell. when i was a kid, when i was a dumb reporter, i could not write my way out of a paperback. i spent hours being screamed at by my editor about how much of an idiot i was. i learned and got beat up said the head about how to follow a lead. a little bit of it is the speed of journalism, a lot less of that.

editors often times say they will not spend the time to browbeat the reporter and explain why this is wrong, which does not do the reporter a whole lot of good. the need someone to say this is how you do it right and wrong. we get caught up in the speed of it and it does have an effect. as a reporter is incumbent upon them and on us to be much more careful with our riding, at least the top of the story. >> the matter of the medium, the pyramid is timeless. you are not dealing with linked issues, space issues, but dealing with people leading the way.

so if you have the attention span issues now. still important to get your best information at the top of the story. i have noticed the trend, mainly that some of them are pretty good writers and also pretty good reporters. we throw them in the capitol building like here is congress, a figure it out. you have to start somewhere and get screened out -- his grain at a lot. one thing i have notice from the here and there stories i take a look at that the interns are doing, of some of them are great writers and really good reporters, but it is the lead. they seemed to vary the lead.

you are like what? he said what? one thing i think maybe can help with that is for whenever my advice is worth, just talking through a story before you write it. i think what sometimes there is a pressure to write everything you have and try to make something up tops down created by you are missing the content. where is the nagging that is the news? .- content that is the news? you can put story?

all the other news into it. >> i absolutely agree with that. i do not want to hear any throat clearing at the start of the story. tell it quickly so i do not have to wade through to figure it out. i would much rather see someone who can write a good, strong news lead. we're talking here a lot about the style of writing, but the other thing i would say is accuracy is more important than ever. yes, you could fix your mistakes quickly but a lot easier to make a mistake because it is not let me write this story and go up and eat lunch and have a talk with people and come back and fix it. you want it as accurate as possible the first time around.

>> you did long form journalism. takeover politico is now launching a long-form journalism. i think the future of that is fantastic. i think the future is less great for journalism in the middle. i think long-form, more and more than ever. we're all talking about journalism that can really tell us something that we do not know. i think there is a lot of exciting experimentation in the industry with how you translate it to the web. do you put it on a continuous green? how do you tell it best with video and promote -- formed journalism on twitter and facebook and the other places you might do it. i think the future is extremely bright because we're looking for ways to set journalism apart

from others and make a difference with our stores in think that is the best way to do it. >> i agree. we started long reads of speed and has done extremely well. -- buzz feed. we did a long story about david lee roth's a couple months ago. it was fantastic. a lot of people read it. he reminded you of the old days sitting down with a magazine. part of that was there was this push on the internet to make everything fast, get it out first. i think consumers of news are starting to shift back a little bit. they are saying there is 5000 of you and all of you are posting the exact same for sentences of a democrat at the same time.

as editors we are saying i want more than that. i think the content over speed is driving this resurgence of long read journalism. i think it is very good. >> i agree with that. we are also launching a long form initiative. we have an app for long form pieces. they are specifically who want to read it on their candles or whatever. to me, it is repackaging the way you present it. i feel very excited and hopeful for it. we do the really fast stuff all the time, but it is encouraging if we have ideas about long form

pieces to go with it. we can work with the design team on certain pieces. we can have video that goes with it. not to distract you, but to put it all together that works where you are engaged with it. a field there is a lot of potential that has not been fully tapped. to go before we go on, i want to mention design. are there things you do that and engage people with that kind of journalism? >> getting back to video or audio, not to accent the story itself, but you read a piece and you can click to watch the interview with the individual or they have just set up a camera during the interview and you can watch that as an addendum to the store you just read. that provides a different aspect

of what you're looking for. you can see reaction to the questions and get a real feel for what the actual conversation was like. it is important to provide images. whether you are reading the newspapers or journalism or person writing it, a lot of gray can be very daunting. it is interesting to see you are all launching -- read products that are in a specialized location. you want people to know there is a place where they can go that they can read along the peace about something they might be

interested in. whether they can sit down with a have a long commute and plan ahead because they see something interesting bit like instead of accepting a clicking on it, putting it away and saving it for later and forgetting about it. it is interesting to see how that has evolved. here, and then behind you. this lady here. >> could you talk a little bit more about how marketplace pressures affect the work your organization does? years ago there was a camel news hour. today there is more instances of advertising masquerading as journalism. >> trying to get us in trouble. take a like sponsor contents --

>> likes bonds are content, that sort of thing? >> what challenges your organization has faced, and either keeping that at bay or trying to do something with it. >> we are a little bit different than a lot of organizations because we do not have advertisement. we did not have banner advertisements, pop up advertisements, things like that. the advertisement done on our website is sponsored content. it is very much in line with how we do things. mostly because we do viral marketing. i do not know whole lot about

it. and could be they are in a different part of the universe. i did not know if anyone does any advertising. that is how it is. i do not know. that is how we do it. >> i feel pretty separate from the people that make those decisions. i know when i see the pages, the story, there is an advertisement here or video advertisements here. i did not even notice them honestly. >> i think there is a very strong desire to keep advertising separate from the work they do.

every news room i have bitten is focused on the separation. that remains critical to the success of the business. having said that, i think there is a little bit less. there is the fear of i cannot think about business because i am on the editorial side. i do not think there is a greater level of comfort. i think editors and general crop across the business, papers probably interact more with the business side than they used to, and as long as that does not come up the expense or integrity of the journalism, it is necessary to keep it healthy.

>> we would never elect the roll-call influence what we're reporting. we do have a web site run by a boeing. it is set off to the side and very of front about it not being at -- roll-call is not writing this story. it is material. they pay us to advertise on the web site. it has been well received in industry and a testament to the industry -- to the editor. the outlet saw this opportunity and ran with it. i think we will probably start more blocks like that. it was a new way to build revenue for the product.

the unfortunate reality is you have to do it somehow. >> it is decent content. >> in our case politico is an interesting aspect. they also provide content as the political side. i do not think any standalone site is making enough advertisement to pay for the bill for reporters. the news organizations do it because it is great content. fortunately, i think politifacts is viewed as a public service. we have gotten money from foundations.

i think that is another avenue. public-service journalism is to get revenue from additional foundations. >> a lot of people have questions. i think will -- we will ask the panelist one or two people to respond unless you really feel you need to respond. i have a question about legitimacy and this may go more to huffington post. first of all, michael hastings

death. this delegitimized him in the journalism he did and what has been done. and then also, questioning of bread -- glenn greenwald and the david gregory questioning whether he is a journalist or not. i feel like it is strange today we're still fighting the battles of who is a journalist and who is not and we are questioning people that are doing really good journalism. how do you go against these areas of going against what she wants to say that day.

>> people say that? decode well, on the topic of -- >> well, on the topic of "the new york times" it is an example of what is not journalism and was terrible. so there is that. on the broader question, people saying it is the content, i always point back to the 1930's and this trial of the silent movie star accused of murdering and having sex with an underage girl. it was on the front page of every single newspaper in the united states for like a year and a half. it was the biggest story. during the depression. during the worst economic time in this country's history, this

was a top story. we have created this motion in my mind that for some reason, journalism, there was a decade- long time of very serious news and kim kardashian's back end was not something anybody read about and suddenly in the past decade it is all right about, and that is wrong. the history of the profession is both of those things -- both of those savings are talked about. they want to know what is going on with tim kerr-jan. if they want to know what is going on with sports teams, but they also want to know when a general is acting like a crazy person answering bad things about the commander in chief. i have never understood the notion that those things cannot coexist together perfectly well, or the idea that there are serious journalist that do this other stuff.

i have tried to write a story several times and very difficult to do. takes a lot of time and skill. you have to have an eye for what will make people want to read it and continue to read it. take out i read the top 20 things about growing up in the 1980's that was awesome. loved it. >> requires you to have a depth of knowledge and understanding of how to relate information to your reader. those are exactly what made a good journalist in any part of the business. so that is my take on it. >> i have thought about this, and there is a difference

between being between journalism and people -- things people want to talk about. to me, they are both valid. we have what is maile cyrus doing to her hair? she is almost all now. those things are there now. i am not sure you would call it journalism, but they are there. people want to talk about all kinds of stuff. to me, that is fair. it is the way it works. then there are stories that are next to the stories that are well reported pieces of journalism. it is the way it works of huffington. the maile cyrus storey and kitcat pictures are like catnip. they come to the site of like clicking on them, but hopefully while they are they're clicking on the fun things and our board

at work and do not want to work anymore, they will notice this story next to a about the latest fight over closing abortion clinics in texas or something, a real substantive issue to be reported on. people who have left their house and wrote a really good piece. that is journalism. to me, it comes down to pretty basic stuff. then there is journalism. does that mean they're not worth reading about? i think they're fine. i like those things. i read heavy stories and i like to look at the cutis cats born in 2012 but i also want to know what is going on in texas. if it is a well-reported peace, it is journalism. and it is a fun read. it is not that hard to differentiate. i think it is great because this together. in the end, it is human

interest. >> if you like those, 20 reasons why john stanton should be in the 20 most beautiful people in washington. >> i have a question about the archiving of your content. a lot of you are born digital and only think about digital. as someone who thinks about capturing content for the future, what, if anything, could you go back and get from years ago or that is continuing on in the next 10 years is someone going to be able to get content from today 10 years from now? >> that is a great and important question. as someone who is moving on to academia, i cannot tell you how many broken links i have found in the past two-three weeks. it is so frustrating.

when we created this, we said it was going to be as important for people to be able to look things up as it is for people to see the latest fact checks. there has been a commitment from the start to archiving. the commitment was that we would also give the content to nexis. it is preserved in both places. you just want someone to put some energy at every news organization to go put energy into fixing the link. some of these will time out.

a news organization will say this could only be used for two weeks. is a really big issue. take a more and more organizations are posting their news library. what used to be the place responsible for collecting and archiving is gone and those functions have not been absorbed by other people in the news organizations. especially troubling for the born digital publications. >> that is a great question. theoretically it should be on the internet. we update stories over and over. as the news story developed throughout the day, we call it more times, depending on what the news dictates and then switching to the analysis piece. i find myself more often telling editors let's start and won because i want to preserve the original story for the people

looking for it -- start at new link. >> there is no protocol for that at news organizations. i am putting things on the newtown shooting and trying to find the early news stories and they have all been written through. there is no protocol in journalism for how you do that? how to use signal to a reader that this is an old story. if you want to correct one, go to this. we have not sorted it out yet. >> it is something that is new, we will put up data of the top. the original version is not there anymore.

that is definitely something we are very actively thinking through a minister right now. >> how much do you discuss the finding your role and defining the presidential field for 2016? we hear about man -- grand paul and mark rubio. >> we just wrote about this today. this is actually it -- we have a debate about it all the time, almost every story. i feel like our reporters are very reluctant to become part of the cottage industry of the next presidential election the day after the last one.

>> we will stay with that. but, the reality is we all do it. i sank right now, i have been trying to not get too far ahead of ourselves end allowing us to interview the players. paul ryan is not doing anything to make it look like he is really running for president. i feel like he probably is, but he is keeping a lower profile than save and paul is. pretty good about keeping it to the limited. >> we start off early in the discussion talking about implications for the buyout of the washington post. one of the things we've been able to do is whistle-blowers. let's say a word snowed and best

friend comes forward. he believed he wants to blow the whistle on government mismanagement. how does your organization handle that if they want to come to you because you are not the washington post? >> we would handle it the same way. i think they have done a very good job of being good stewards of information. there are tons and tons of information. way more than anybody realizes. said we're not want to use this for whatever reason, it will put someone in danger or whatever. i think they have done a much better job than some of the legacy u.s. papers. the new york times has erred too much on the side of caution in some cases.

i think there is a model of how to handle that frankly. >> in an era of citizen journalism, he chose to go through traditional journalists. he could have very easily posted that of the website somewhere, and he did that need journalists, but he did. it would be fascinating to talk about this because i've -- because i would presume if he posted on the website it would be shut down but if he could and list -- enlist if journalists

that they would give credibility and protection to him. so it has been a fascinating episode, and yet, he really did not have to have them and probably had he put it up, wikileaks would have taken a snapshot of it. >> an organization that could go to bat for you. especially some of the smaller small citizen blockers would back away from that in a heartbeat. >> we had a series on ecuador. the government enlisted the outfit in spain to put the screws to us and get the documents we have gone taken down from file-sharing sites. a few of them agreed. there was never a question. there was never a question from the top-down that we would

protect not only rosy but the story and make sure the website put the information back up. we pushed back hard and they did. i have worked roll-call and work here and i know both of them and i feel like all of us come from that same place. >> i think we have all work that organizations were the top leaders are very respected journalist and what not back down from a fight if they felt it was the right one to be having. >> we would handle it similar to greenwald said approach of handling this. >> time for one more question. one more question? anyone? final thoughts. tell us one thing that has been the most fun for you in this new endeavor. give us a lead.

>> in this panel or in life? >> i think the new media world creates great opportunities for invention, and in my previous job, i loved working with people to invent. it was great fun sitting in meetings coming up with stuff. in my to reject new job i am looking forward to a new and different things. i sank invention is a time of invention. i think there is a great spirit of journalism to do that. >> i agree with that. i think the creativity and the adrenalin of the new media world are incredibly exciting.

i think there is a time where practically everything we are covering feels like a first. the debt ceiling, brinksmanship or anything else. i feel like we're living in historic times and have a new way of covering this to get the news out. so it is of very exciting time to be a journalist in washington >> i have fun every day. it is fun. it is fun to be a journalist right now. this frees me up to take all kinds of different approaches to stories that previously i probably would not have been able to write. really quickly, i am thinking of one now. i ended up in a twitter exchange with republican congressman about gay marriage.

we went back and forth back and forth. in the end he said he did not think we should have the defense of marriage act. this is a republican congressman >> leans libertarian. broader emphasis we have been it has been the most interesting and fun part for me. it has been something that since i came on last year that has been a major focus for the site. we are now dealing with the russian olympics and that kind of stuff. i find it to be gratifying. it news organization that is focused on that on this very

important civil rights issue, this is that moment where you get to say yes in 30 years we were working on this and we were paying attention to it. for me that has been the best thing. >> i agree with everybody. it is interesting to see the role social media is playing, whether it creates the story or you can mind social media for story ideas or sources. a is an exciting time to be journalist, especially in the sea. it is incredible. it is an important time to be paying attention to politics. it is exciting to try to get those stories out there that as many people as possible. >> at perfect notes and on. thank you so much.

i don't want to volunteer their time but if anyone wants --

>> a busy day before the president gets away on vacation for nine days. today the president will be signing the student loan bill at 2 p.m. eastern, which passed the house recently on a 392 -- 31 vote. after that the president holds a news conference. he's expected to answer questions on a wide range of topics, on the terror alert that closed in number of embassies last weekend, to the state of u.s.-russia relations. that is coming up live at 3 p.m. eastern here on c-span.

we will follow that up with your phone calls, your facebook comments, and your tweet. on the issue of u.s.-russia relations among a meeting going on at the state department between secretary of state john kerry and his russian counterpart, as well as chuck hagel. secretary kerry saying the relations have been marred by challenging moments. we are going to show you the opening statement of today's gathering, which is underway at the state department. >> good morning, everybody. we are delighted to welcome .inisters laparoscopy

i particularly want to welcome my old friend, chuck hagel am a from the defense department. the relationship between the united states and russia is, needless to say, a very brief -- a very important relationship. it is marked by both shared interests and, at times, colliding and can looking interests. i think we are all very clear i about that. surrogate lab are often i are .ld hockey players we both know that diplomacy like hockey can result in the case no collision. in there very candid areas in which we agree and the areas in which we disagree. we have secret that experienced some challenging moments. obviously not just over the

snowden case. we will discuss these differences today, for certain. remains important, the collisionsd and moments of disagreement. ways toportant to find make progress and a missile defense on other strategic issues, including afghanistan, korea, and syria. and the one thing i would emphasize is in syria, while not agree i do completely on the responsibility of the bloodshed or some of the way forward, both of us and our countries agree that to avoid institutional claps and dissent into chaos the ultimate answer is in a negotiated political solution. stepa to conference is a

toward that solution. i look forward to a very honest and robust discussion on all of these issues. we welcome the delegation from russia here's a day. we look forward to a very productive and full conversation. >> thank you, ladies and gentlemen. hospitalityr the extended to myself and my colleagues. [indiscernible] they one day decided to resume,

and thus we meet here today in washington. we are preparing a number of documents for approval at the meeting between the two presidents. i am referring to the statement on the comprehensive development , the context of the 18th anniversary of russian diplomatic relationships between our two companies. i am also referring to the statement aimed at giving momentum to the economic operations of our two countries. design, our presidents were inposed to adopt a statement the presence of captains of business of the two country. the us a prepared a number of statements on combat threats.

agreement on protocol eyes asian --that particle his age and agreement on research in the nuclear sector. havet to highlight that we laid very solid foundation for our future work. once we start building on the foundation, once these instruments are approved, we will be able to enhance our operations significantly. internationals issues, global security in particular. since we started discussions of the new strategy we always spoke about missile defense.

thatte with satisfaction in his letter to president putin, president obama take into the need to account all factors that affect the stability when talking about productions. discussedesidents -- to increase transparency. the two countries were given instructions with that respect. we and russia were prepared to take our proposals to the two presidents. we will do so once the summit meeting takes place. agenda.the top of our

they need to start political process. we need to state at geneva numeral dose -- 2 -- geneva 2 conference. i am not convinced in the current day reality, especially in light of what we have been hearing lately, this is indeed our top priority. the rainy nuclear program is also important. -- the iranian nuclear program is also important. many other topics will be discussed today. we are united by shared responsibility. we must prevent that the slab laser nation -- must prevent the

stabilization. we need to ensure peaceful settlements of all communities and avoid attempts -- examples in the past that we have seen are not working. we want to see national reconciliation in egypt. we appreciate the efforts made by u.s. colleagues. we have disagreements and we will continue to discuss measures in which we disagree. i recall when i first met john in his presidential capacity and we were having this initial conversation, he told me that our countries have special responsibilities.

we need to work as grown-ups. this is what we do. we hope that this will be a recipe for help. >> thank you very much. i appreciate that. secretary hagel? >> thank you. you and your colleagues here at the state department, y for hosting today's meeting. to our guests from the russian federation, welcome. we are very grateful for this opportunity to spend some time yourthe minister colleagues, who have accompanied you come onto a dress some of the most pressing and important country andg our the world.

almost in every case noted, and --e, our mutual interests the world is complicated, it is combustible. to find solutions to critical time in the world are not easy. andster labrocv secretary kerry have noted, to address these clearly and directly with each other, honestly, and to find a common denominator's where we can ill high ground to move forward to help resolve these great issues over time and we live in a very defining time in the world. just as the minister had noted in his first conversation with secretary kerry, our countries have some responsibility to each other, obviously.

and to the world, in many respects. and weleading nations must work with alliances and others as to how we find these solutions to these great challenges. some of the issues we will do it today have been noted. i particularly appreciated the opportunity to spend an hour with minister shaikh you this morning. we addressed some of the more specific issues related to our defense ministries. meeting was a very positive meeting, which set the standard. i look for to this next meeting and i think ministers labrov and shake you. and i think you secretary kerry

for hosting. >> thank you. today i had an hour-long meeting with my colleague, secretary hagel, who spoke about military to military operations, and military technical operations. i like to thank my colleagues for the wonderful arrangement of meetings here in washington. it was again i would like to -- in our view very efficient and important. we will discuss issues that is important to our colleagues today.

first one in 2014. we first spoke with syria. we also stopped about corporations between deputy ministers of the two countries, which is no less important. giveoke about how we can incentive to radical corporations, such as exercise, military exercise. special forces exercise? but also spoke about the need for more transparency. -- we also spoke about the need for more transparency.

thatuld like to make sure major events in the federal federation, would lead to fight u.s. colleagues and that timely. to inviteike delegations from the u.s. capitol, from washington, to -- -- to attend we started talking about missile defense, but that should probably be discussed. i would like again to thank my youth colleagues for organizing the meeting. i hope it is going to be atticus constructive as my meeting with secretary hagel was. >> thank you very much, mr. minister.

again we emphasize the importance of this conversation, and in order to do it pop early we credibly need to ask our friends in the press if they would now leave us so we can have an opportunity to talk. thank you very much. i appreciate it. >> that meeting continuing now at the state department. the associated press reports the father of national security agency, edward snowden, has applied for a travel visa to russia. u.s.-russianof the relations, it will certainly come up as a question for president obama and today's news conference. that is coming up at 3 p.m. eastern. with yourllow-up phone call comments, facebook upts, and tweets and coming 20 minutes from now, we will take you to a discussion at the

hot alliance for health reform. they are looking at insurance exchanges, which began on october 1 as part of the 2010 health care lobby of officials from the health and human services panel are part of that discussion, live at 12:15. on today's washington journal, a discussion on the hurricane season. host: now joining us on the "washington journal" is dr. gerry bell, the lead hurricane forecaster for the national oceanic and atmospheric administration. dr. bell, how do you get a job like that? guest: it is a pleasure to be here. my specialty is studying climate patterns that affect seasonal weather, winter weather, summer weather, and hurricanes. since the late 1990's, i have been very involved with southern climate patterns and predicting the patterns that really control the hurricane activity for the season of a whole. based on that, we started making be seasonal hurricane outlooks back in 1998.

host: how can you predict the next four months of hurricanes? guest: there are a couple of patterns that show the way. by predicting the climate patterns come even often make a confident production about what the hurricane season will bring as a whole. that is a scientific basis behind the hurricane outlook. host: can you tell us in layman's terms what is the scientific basis? guest: the fundamental scientific basis is monitoring, understanding, and predicting the climate pattern that really controlled conditions over the atlantic that in turn control whether you are going to have more or fewer hurricanes. host: so then you look at hurricane season -- i mean, are you looking at what is happening in the south atlantic, are you looking at what is happening in africa? what are you measuring? guest: we are looking into core

regions, one over the entire north atlantic nathan in africa. one climate pattern that controls the hurricane activity for decades at a time is really centered in the atlantic and africa. that is related to changes in atlantic ocean temperatures, rainfall over western africa. and really how the winds come off of africa that are key in determining whether you have a lot of hurricane activity or not. a completely different climate pattern is in the pacific ocean. that affects year-to-year changes in hurricane activity. so really predicting the hurricanes is reading a global monitoring and predicting types of scenarios. host: the el nino, la nina, that is a new concept, isn't it? guest: it has been around for a while. we think of el nino as producing the stormy winters and california and wet and stormy

weather across the south. it turns out that el nino and its counterpart la nina are also very important factors in year- to-year creations in hurricane activity really across the pacific basin and the atlantic. host: gerry bell is our guest from noaa. dr. bell, you recently came out with your hurricane season outlook. what if the season going to be? guest: we updated the 2013 hurricane season outlook just yesterday. it is really reiterating what we had predicted in may. we still expect an active season with the possibility the season to be very active. for the season as a whole, we are predicting 13 to 19 main storms, six to nine to be hurricanes, and three to five to be major storms. that is a lot of activity still to come. that is by far were the major

hurricanes occur. we so have a lot of way to go with this hurricane season. host: what is the peak? guest: august, september, october. you might say mid august to mid- october. throughout this entire three- month period is when by far the bulk of the major hurricanes occur. host: the "hartford courant" this morning -- weather service packs off a bit from production. what are they talking about here? guest: we lowered our upward bound of major hurricane slightly for the northeast. this is for the entire atlantic basin, for the season as a whole. we don't think the season could potentially be one of the strongest on record or close to that. it is still going to be an active season, but we just don't think it will be as strong as we had indicated in may. make no bones about it -- what we are predicting is a lot of activity, and those numbers are way above the seasonal averages.

so don't be fooled into thinking we are somehow predicting a less than strong season because we are not. host: the phone lines are on the screen divided by region. if you live in the east and central time zones, (202) 585- 3880 is number for you dial. (202) 585-3881 if you live in the western time zone. what is a normal season?r guest. the average is six hurricanes and three of those being major hurricanes. today we predicted 69 hurricanes, 325 nature hurricanes, well -- protected 5x to 9 hurricanes, 3 to major hurricanes. host: do you predict where they

will hit? is predictings the strength of the hurricane season. it is not a landfall prediction. we cannot predict where they may strike. those types of things are really dependent on the weather pattern that are focused on the hurricanes approaching. that was what the national hurricane center does. they make the reduction for the strength, types of vanished and so on. expected majority are for the august through november period? yes. we usually do not see hurricanes in july. if we see hurricanes in july, the that is owing to be one of the strongest years ever. so june-july weing

only see one or two storms, one or two fall storms. that sometimes gives people a false sense of, well, we have not seen much activity. in june and july we typically see very little because the system is not conducive to producing that activity. a call from and in florida. hi, and. apologize for that. we begin with kevin in new york. kevin? you are on "washington journal." caller: i have two questions i would like to have mr. bell comments on. the first is hurricane sandy. mademe up the east coast, landfall, managed to go through the jetstream, something that is quite unusual. the second thing

i would ask them to comment on is the current system in the arctic and what effect is the super heating of the arctic having on the weakness or strength of the jetstream? host: is it a hobby for you to follow this? itler: i am interested in because the current weakening of the jetstream has massive impact on global weather patterns, and is melting of the arctic potentially something that could sever the movement of the gulfstream, which would be near catastrophic. host host: thank you, sir. sandy,with regard to basically, hurricanes do not like a jet

stream. as the storms moved westward along the tropical atlantic of the united states, they become progressively more interfered with by the jet stream. a lot of storms weakened as they approached the atlantic coast. we can purchase them out to sea. it is not comment to have a hurricane retain its strength as it is interacting with the jet stream as sandy did. it shifted into being energized it the jet stream. transitioned from the tropical structure and being energized and shifting into being energized by the jetstream. that is a rare event. a lot of times we will see over the open atlantic storms that become embedded over the jet stream.

the storms have now become post- tropical or extra-tropical if you read the weather center reports. i am a specialist with hurricanes. hurricanes do not like a streams jetstreams. they will eventually be join -- they will eventually destroy them. a little bit of the follow-up -- host: little bit of a follow-up to these questions -- due to climate change, atmosphere now holds 4% more water than it did 40 years ago. is that true? guest: it brings up an important issue, understanding what potential impact global warming

could have won hurricanes. it is a more complicated issue than we first thought. initially, we thought global warming want to be ocean. what we are seeing globally is fewer hurricanes except for the afflicted.-- the atlantic. what the global warming is doing is increasing the atmosphere's ability, making it harder for thunderstorms to a rise and harder for moisture to contends. the thunderstorms provide the energy for the -- making it harder for thunderstorms to arise and harder for them to condense.one part of the puzzle is not sufficient to understanding how global warming is impacting hurricanes. host: anne in florida, you are on the "washington journal." caller: i am in central florida.

i would like to ask two questions, if you do not mind. i am into gardening. we have had no hurricanes for several years in central florida. i am on the west coast north of tampa. the gulf temperatures have been around 90 degrees. we are so happy we are not having any hurricanes. we are always planning for hurricanes regardless. this relates to the cost of insurance and living in florida. it is very political. what i would like to ask you is, do you work with the space station? how does that work? nasa, no -- how does that work in a hand in hand partnership to work with these -- look at these

factors in contour space? we will not have a hurricane in november -- look at these factors in outer space? we will not have a hurricane in november. i promise you. guest: i cannot tell you how nasa and no work together. that is not my expertise. one area they were together is through the satellites and monitoring global conditions. without this ability to monitor inland daily and what is calling on globally, there is no wind -- monitor daily, there is no way we could put out detailed hurricane forecast many days in advance. these are way out over the atlantic ocean where 50 years

ago we would not have known they were there. all of these agencies are critical in the mission of the environmental and oceanic monitoring. he made an excellent point that you prepare every year for hurricane season. i commend you highly for that. atlantic and gulf coast residents should be doing this regardless of the seasonal i'll look. it only takes one hurricane to make -- regardless of the seasonal outlook. if you are a coastal residents, make sure you have your preparedness plan being finished our completed so that you know what to do if a hurricane threatens. host: dr. gerry bell, are you based here or in miami?

guest: i am based here in d.c., in college park, maryland. miami is the national hurricane center. they are part of my team in making the seasonal outlook. the primary mission is predicting the individual tropical storm and hurricane throughout the season. all of the hurricane watches and warnings come from the national hurricane center. i am more of a climate specialist. i look at the moment -- global climate patterns have and make predictions about the strength of the season as a whole and the dominant factors that are influencing hurricane season. host: have we had in her cage yet this year? guest: -- host: have we had any hurricanes yet this year?guest:

fortunately, we have not had any hurricanes. we have everything in place for a very active season. as i mentioned before, this is going to be active. at host: for the people who want a prediction three or four weeks out, can you or did something, say you a bunch of clouds? guest: we will see the potential as a cloud system or a low pressure area movie was to her moving westward from tropical area -- tropical africa. we start monitoring and it is full go on all of the systems three to fournt on.

weeks those incipient disturbances would be in there, yes. host: do you provide your services to some of the island nations in the caribbean as well? guest: yes. in an active season like we are expecting, they will typically see even more hurricanes striking. there is a strong interest throughout that entire region as to what the hurricane season might bring. they interact with the national hurricane center as to what an individual storm will do. host: katie is in new york. were you hit by sandy? caller: fortunately not. i know people who lost everything. what role has development plays

in these large levels of sustainment in the coastal areas. after world war ii, they used a the of silt to create land. flooding experience during sandy they g island -- almost came near those old land boundaries.that had the effect of going back where it was over hundreds of years. guest: both coastline have built up tremendously over the last 15 years.-- 60 to 60 years -- 5- to florida for example.

that is of extreme concern. every time a tropical storm threatens, there are millions of people potentially at risk.>> watch all of this online at www.c-span.org. we now take you live to the alliance for health reform and a discussion on health insurance. among the panelists, officials from the health and human services department. they will be talking about the funding of the healthcare law, the deadline thestates to begin hosting insurance exchanges on october 1. that is the all of the discussion. live coverage here on c-span.

>> if you want to find your seats, we will try to get started on time. good afternoon. my name is ed howard from the alliance for health care. i want to welcome you. today's program is on the current status of efforts to stand up these help insurance exchanges or marketplaces in any state. come october 1, just over seven weeks from now, these entities

are scheduled to begin enrolling individuals and small businesses in the health lands -- health asns beginning as early january 1. with the context it is important whoote that most americans do have coverage will probably not be dealing directly with the exchanges. if you get your coverage through your employer, and that is a substantial enterprise, you will continue to get your coverage through your job. perhaps there will be a change in what is covered and what you have to date. -- to pay. for those who have jobs that do not bring interests with them, the exchange or marketplace in your state will be ready to go and there will be at least one in every state. as we tried to convey in the -- that this briefing

is different strokes for different states -- none of these exchanges will be the same. they will share common standards , but they will differ in many and many important ways. in recent months, we have had a lot of predictions about on-time metaphoricd other outcome predictions related to the exchanges. we are not going to try to validate one or another of those sets of addictions this afternoon. -- of predictions this afternoon. but we do think it is time to take stock of where the exchanges are, what kind of choices are being made, how insurance companies are coping with those changes, and what ordinary folks might encounter when they start trying to sign up. as ae pleased to have partner in today's program the commonwealth fund, a centuries- to philanthropy established

promote the commonweal, the common good. we are pleased to have as co- or today sarah. sarah and her colleagues have produced some of the best analyses of the exchanges getting up and running. you have a couple of those in your packet. sara, welcome back. we are pleased to have you help frame this issue for us. >> thank you. commonwealththe center, i want to extend a warm welcome to everyone on this very warm day in washington. the congressional budget office -- this is not.

>> pointed right at that. >> [laughter] >> or not. >> or not. thank you. the congressional budget office has advised by 201820 5 million people are expected to enroll in the newth plans through health insurance marketplaces, also known as exchanges. obviously this will not happen all in one year. predicts about 7 million people will enroll in the marketplaces next year, in 2014. i 2015.ll be 13 million medicaid expects an increase in enrollment, about 9 million folks by 2015. certainly the home mark of the reform is the agreed

implementation is taking place at the state level and how local politics will influence both state and national outcomes like enrollment, reduction, and the number of people in short, premiums. i will give you a sense of the temperance for variation in these outcomes. these are active tools. these are on the website. states and the district of columbia will operate their own marketplaces next year. theirstate will operate marketplaces in partnership with the federal government. seven others will have federal workplaces but will play an active role in plan management. the shadow government will run its individual exchange. fledgedes will have full-

federal exchanges. on the right, these are decisions be states have made as to whether to expand the medicaid plan. 20 states are so far expanding. have joeally lucky to thompson here today to help explain this to us. at about 25 states are undecided or have decided not to expand. where the most exciting developments of the summer has been watching the slowly released 314 premium plans that will be sold through the marketplace next year. the individual market -- it is difficult to predict now what they will be in 2014. the benefit packages very enormously across people, across regions. people are charged based on their help and gender. it is really hard to make apples to apples analysis.

in this analysis, hhs compared with the projected premiums next year. in 11 states the premiums for these plans are on average 10% than the cbo projections. it is also important to keep in mind the core subsidies. the marketplace will be paying substantially less space on the -- less a stun their income. next slide. looking at the rates in the small group market, the proposed rates for the lowest cost silver plan or about 18% lower. so far at least we see in newly regulated market insurance charging premiums based on the risk profile of the applicants. two really important pieces of this puzzle -- we see the market

is being quite competitive on being meaningful to consumers, principally on value. next slide. in addition to questions about premiums, there are so many that cross one's mind as we look forward to october 1. enrollment beginning in less than two months. how areery near term, the markets shaping up? what are the key differences across states? how is the dissipation by carriers crore -- carried across -- how is participation by carriers carried across states? experience ofhe people bringing plans to the marketplaces? available role? why or why not? in the short to longer-term, will different workplace designs

affect outcomes like enrollment, premiums, innovation? how will the state and federal medicaid expansion affect the changes in the program, the marketplaces? how are state and federal governments coordinating the changes? with that, i turn this back over to you, ed. i will be happy to take your questions. thank you. >> let's see what we've got. there we go. sorry. a couple of housekeeping items before we get to our panelists. , youu are in twitter mode can use the hashtag @hhrexchanges. @aarexchanges.

there will be a recording followed by a transcript on our website. backgroundnd information. not only the ones that you have hard copies of in your packet, but additional materials you can use. if you are watching on c-span, you might take note that if you have access to a computer you allforhealth.org right now and have access to those back round materials right now. i would ask those in the room, if you want to ask a question of our panelists, there will be question cards then you can use -- that you can use. there are also microphones so you can ask your question in person. and at the briefing we would love for you to fill out

evaluation forms so we can improve these programs and get the topics and speakers you would like. now, to get to be programmed, we have a terrific group of panelists. we always have a lot of them. we will ask you to give a brief presentation and we will save a bunch of time at the end for your questions. we are shifting the order of speakers around from the one you see on your agenda, in order to accommodate our first speaker, who has to cut out from this meeting to get to another meeting. she tells us she is busy. i do not know if that is really the case. she is the deputy director for policy and administration at the cms center for consumer information and insurance oversight. it is her shop that is theonsible for developing

many regulations and other guidance that is needed to get exchanges and insurance reforms in the aca up and running. alongk she is not taking vacation this month. some of you may know her from her days on the professional a fewof the committee years ago. we are very pleased that you carved us out to talk to our audience. >> thank you for the invitation. it is a pleasure to be here with you and i'm sorry i will not be able to stay very long, but i assure you, i am very busy. i am going to start by briefly talking about what we are doing with the federally located marketplace. mentioned there are 24 states that we have conditionally approved to fully or partially run their

marketplaces. 24 states and the sea. -- and d.c. the federal government has a role in even if they are not running the marketplace to make sure that health care is available in october. part of theincipal changes that come in 2014 -- things like the health benefits, modified age rating, etc. we are working with the states across the nation as they review as part of their normal regulatory process to make sure that all of the policies and health problems -- health lands are meeting the reform. plannedion, they have management functions. as sara mentioned, they are doing the work to certify the qualified help plan -- health

plan for the federal government. we are working with many state -s we stand up the federally facilitated marketplaces. i'm just going to talk for a few minutes about the work we're doing with each community. veryve been watching closely with issuers to make sure they have the information available they need and order to offer products for 2014. we have, as you know, and putting out a tremendous amount of guidance over the past couple of years. we are very close to the final. does one more regulation that affects the marketplace that we plan on finalizing very same. as you know, this year we will offer additional rulemaking for issuers that outlined many of the rules of the road for the issuers interested in application any qhp

process. acceptinge started applications for health plans to be offered in the marketplace. these numbers may change as they are not finalized until september. thewe are very pleased with participation. the announced earlier this year we received over 120 issuer applications. we have been very pleased about participation in the marketplace. states have been in the process of reviewing applications to ensure everything meets the benchmarks for health benefits, satisfying network standards, etc. later in the summer we are in the process of working through any technical questions in the application that may be needed

as well as looking at rate outliers. issuers the summer, will hear from us about the final certification determinations and they will sign the qualified health plan agreement. the states will have started to release information on rates. there are some states that have rules about when the disclosures occur. what we have said and our intention is only to publish rates related to the federally- facilitated marketplace. that is an activity that will take place in september. after that we will be releasing information about the states. i will say again in states where there is a great deal of competition, the results of and very promising. verye results have been

promising. i want to speak briefly about the available assistance for the federal or- facilitated marketplace. there is an application, as you , an application for enrolling in a variety of grams. it certainly enrolling in a health plan. if you are enrolling just for coverage, you only have two throughout the information related to searching for qualified health plan. if someone is interested in applying for one of the insurance portability programs -- insurance affordability programs, they have to provide more information about their income, etc., in order to determine if they are eligible for the payment of the tax credits for one of these programs.

constructing a federal hub, which is a way to make sure the states are able to interface with the federal , different queries, different databases. that effort began in october of last year and continues to be ongoing with the states and other partner federal agencies that we have worked with. and finally, as we start connecting with consumers, we have relaunched the call center at heathcare.gov. also beenenter has launched. we just opened up the shop call center. both all centers are starting to get calls and information in communities. we have worked on revamping

healthcare.gov to prepare for all the new enrollment will begin and of course you will see changes as we finalize these and start we authored providing information for people to enroll in coverage. ofare also in the process training. robo training has begun. we have had quite a robust process, the last week and a half of people getting trained. as we have said, we will soon be announcing the navigator awards and shortly after that, we will find certified application counselors. people will have a variety of federally-oll in the facilitated marketplace, whether they want to buy online, in on the telephone, or a combination of those approaches. i want toinally, mention of course there is a

great deal of information on our marketplace.cms.gov, healthcare.gov, cio.gov. again, thank you for having me. and to me with the great work that you do. this is very encouraging on our end to see the great work the partner states are doing and it has been quite a partnership, i would say, working with aca, both with the state issuers and others in the community to make this a reality. thank you. .> thanks very much, chiquita godspeed to the next one. have foury, we

panelists who have volunteered to answer all the questions that chiquita was not around -- [laughter] and we're going to start with sara dash. sara is on the faculty at the georgetown policy center for reform. her work focuses on the implementation of health insurance exchanges around the country. she is the author of two major documents in your packet. full disclosure, before joining the center, sara was the senior policy aide for senator jay rockefeller and the alliance liaison. sara is going to give us some detail on what is going on in the one fourth of these states

that have decided to run their own exchanges as chiquita has described. thank you for being with us. much.nk you so thank you to ed and the alliance. i will be talking about some of the key design changes states have made as they work on their exchanges. and there have been a lot of them. they have had to do a lot of work in a short time. they have had a lot of flexibility. the key thing here is going to how to dofiguring out the differences in the design decision as far as they play out in the sustainability of exchange, the competitiveness of the marketplace, and key outcomes. themes we havey found as we have gone through and look at these design decisions. states really took it seriously

theirms of customizing plans to the needs of their states and stakeholders and consumers. in some states they actually moved much arthur ahead than they were required to in the law -- much farther ahead than they were required to in the law. in other areas where they had flexibility such as expanding the pfizer for small businesses that goodbye on the exchange, fisa fore -- teh fi small businesses that could buy on the exchange, they chose not to expand it. move into some of the design decisions states have made. next slide please.

here is really that there are a lot of issues with sustainability and that means different things to different people. the financing, for instance. basically this is an area where some of the states are still financially to be self-sustaining as of january 1, 2015 when they are required to. will pretty much follow the same model as the federal marketplace. existingates had pre- mechanisms for revenue that they are redirecting, at least in part, to the exchange. i'm going to move onto the next slide. there is a lot to cover. we can catch some of this in the q&a.e and a -- to be a mored

transparent, competitive marketplace. in order to do that, you need plans to participate. the plan participation numbers are coming out. states took a variety of approaches to encourage insurers to participate. some have a very hands-off approach and it said the less, the better. others have said, we will require insurers to participate, either from an opt out requirements, or couple of revisions in terms of closing the long exchange market, which -- a deof a tobacco facto way of moving insurers into the exchange market. want across the board -- the sort -- the so-called clearinghouse approach. that means preventing any plan

that does not meet the criteria for qualified health plans. a smaller numbers were selector contractors, also known as active participants. and then in the middle category, we have the market organized, which is placing some structure around the plants that could be offered, such as limiting the number of lands that could be offered -- of plans that could be offered and not creating an additional layer of review once the lands were submitted. next slide please. this is a really big value for the exchange. this really showed up especially in the exchange with regard to the employee choice option. every state has its own exchange with a couple of exceptions, it will be offering what is known

as employee coverage. businesses, the employees do not have a lot of change -- lot of choice and plans. the employer picks it for them. the next couple of points are that states took a lot of steps make it easier for consumers to choose a plan. i will talk about that in the next couple of slides. reporte not required to the quality matrix for plans before 2015. many states chose to do so for 2014 that is an indication that states are feeling consumers should know more of the value proposition of the exchanges. the next slide for you to look at will show one example where

states have gone beyond what they needed to. they required insurers to offer more than the amount required in the law. be 13 states and the district of columbia. the next one i am going to gloss over a little bit. it is interesting because the three things that are here on this slide, again, the state did not have to do this. it makes it easier for consumers to choose a plant. the idea is be when there are to exchange,es on the consumers might freeze up and not be able to make a choice or not make a choice that is the best value for them. so, the states have try to streamline that. for example they may limit the number of plans that given insurer can offer or require additional standardization and benefits than what is required in the aca.

this is the last slide. we looked at some of the steps that states took on their programs. really think about what you need to get in exchange to be successful. you need a plan. you need a competitive marketplace. you need people to come to the marketplace. and so, you know, the outreach component of this is going to be really, really critical. exchange, consumersthis is part of the und effort. most states do have a required navigator program as well as an optional insurance assistance program. in 2014, some of them were still figuring out the funding for the navigator programs. see some ofing to

the broker on boarding, training . states also had decisions to make in terms of the training hours they were going to require , the compensation they were going to require. they varied on the details. general, they did this as part of a unified program. statestion, they had creating initiatives to increase the affordability and certain programs. slide, the exchanges are really a means to an end. that is what states are focused on, getting exchange 1.0 up and running. out,ings continue to roll or are some state that really see this as a driver for things like system reform and quality. couldtates have felt they

take more on in that regard this year. i think that is something we will continue to see as this rules out. my time is up. i will turn it over to you, ed. >> great. thank you. sara gave you an overview of what is going on in a bunch of it from places. now we will hear a little bit closer to the ground what is going on into very specific laces, and specifically were talking about the state of arkansas and maryland. maryland withwith the executive director of the maryland health center exchange. it has been almost three years, which is pretty remarkable when you think of the length of existence of the affordable care act itself. for that, she held a number of senior national positions with kaiser permanente.

maryland is one of those states that is opting to run its own exchange. she is here to give a report on how things are shaping up in baltimore. right. thank you. i appreciate the opportunity to be here. i want to start with a couple asics about maryland. about maryland. early oned very because the governor signed an executive law in maryland. governor o'malley put a commission together to see how states would go forward with health care reform. we have had three sets of legislation so far to make sure the marketplace we put in place is right for all marylanders. for population, we have about

5.9 million people in the state. about 590 thousand who are eligible for medicaid or in the exchange. the institute out of the university of maryland did an impact study for us. they estimated that the affordable care act would create 19,000 new jobs. we very much believe this is a source, not only for health, but down the path. this is very important to us. -- what thehows hell care at the moment is. if you focus on -- what the health care at the moment is. if you focus on 2014 -- we

475,000, 2020 to have you can see. that will cut the uninsured rate by half by 2020. again, we think this will make a real difference in the uninsured numbers. the number at the bottom is a little difficult to see. both what we really want to drive home is the importance. the affordable care act act allowed us the opportunity to replace a 20-year-old eligibility system for medicaid. once all of the redetermination's are made for all of the people currently on medicaid into the new system, it should be 1.2 million people on the new combined system. again, very important to us. talking about our plan availability -- we have 79 medical plans.

recently we received notification that we were expecting insurers on the open market. that leaves 79 medical plans available. even though we did not require a catastrophic plan, we did require gold silver -- gold, silver, and bronze. we do have five plans. we do have plans at every single level. we really feel strongly that anybody searching will find a plan that is right for them. a were just released very recently. we did some analysis and determined in that analysis that 12the other plans, of the

states that were approved, we were among the lowest. so, the baltimore metropolitan area, the average rate for a 25- 170-old non-smoker is $6,000. -- $176,000. numberwe feel like the and the rates that we have on our market are really going to be competitive. how do we get people to come? we have been building this for the past couple of years. how do you get people to purchase? our last estimate is that we have over 5000 people who will be supporting us. our connector entities are separated by region and we will have over 200 navigators. these are the people who will be willnocking on doors. we

utilize the department of health and social services. we will indicate eligibility for the states. people in the000 market who intend to work with us. we havethem signed up for training that starts in mid august. that is about 5000 people. this does not count the call center. we know there are going to be a lot of people who want to talk to somebody. just to be able to really talk to somebody who can explain things to them. so, this is how we split up the state from a regional connector. it was really important for us. it was very important to us to

understand the connector entities within the environment to work with the community-based organization to reach these populations. when they submit to us, they had to prove to us -- there are six connector entities working with 50 smaller organizations within the states that have expertise within the population. we do have several online resources. we have marylandhealthconnection.gov. this is up. this is where everyone will go to enroll. this is where everybody will go to enroll. we currently have a stakeholder people canis where sign up for a weekly newsletter we send out.

this is really important for the information we do now. we just launched our social networking last week. you can follow us on his book and twitter. we are also on youtube. this is the beginning of looking at a very comprehensive marketing and outreach campaign. we are beginning to educate people about the value of health issuing thed we are call to action a little bit and thatn october 1. is really where my presentation ends. >> and quite a good win. we will turn out to joe thompson.

forthompson has the title the surgeon general of the state of arkansas. that is a pretty good title, but it belies a wide-ranging portfolio of responsibilities. arkansas was faced with the choice of expanding medicaid under the aca or not. dr. thompson worked with the governor, the legislature, and hms to come up with a third way ans with arkansas incomes of two 138% of the federal poverty level to be enrolled in the private exchange rather than directly and medicaid. joe? -- thank you,ed.

ed. arkansas is a little bit more politically diversified in maryland -- [laughter] we have a republican house, a republican senate. the advisor for democrats and republicans. workforce toth a teach the planning process. of multi-phased public and private transformation effort. along came the affordable care act, which i described as disruptive. it can be good or bad. it is what you do with it to the terms what the outcome is. originally we were not going to participate at all and have a federally-facilitated exchange.

the political wind made the exchange that we wanted to have some control. we will have the state maintaining the responsibility for consumer outreach and engagement and plan management. and we have robust system with our navigators, our applicant support. we have reached out to two-year colleges to train these people across the state. they will be working to help enroll people. they will have community annections. this is just placeholder. we have about 3 million people in the state of arkansas at a 25% uninsured rate. several of our counties have a 40% uninsured rate. we are not the most attractive state in the nation for insurance carriers to, and offer their services.

we see the affordable care act as opportunities -- as an opportunity to help those, but also an opportunity to manage the expansion opportunity under medicaid to help individuals who did not have insurance. our state has now be lowest and most restrictive eligibility criteria for medicaid. in my stateicaid you have to make less than $4000 a year and have less than $2000 in assets and be apparent. so so, we have a huge hole in our coverage area. is a politically challenging solution for us. in the last legislative session in january, there was a strong impetus not to take advantage of the medicaid expansion after a very tumultuous process. the

republican leadership challenge the democratic administration to use the commercial sector to strengthen the competitiveness of our market and explicitly not expand medicaid. they came along with a plan. we took the challenge and put it together. slide, weto the next passed what is called the health care independence program. and havehis program funds to spend, it took 75% of the house and senate. there was no low bar. we had the 75% requirement. will go into the private insurance market -- for students above -- for people above 130% of the federal poverty level. it is not what states have traditionally used in bidding out and contracting directly with the carrier or medicaid.

what we have always done which is to contract with providers directly. it is using a payment assistance mechanism in a new way to use premiums to buy individual the proposal to the federal government is that we will reduce access barriers to medicaid ben fishes, we will increase the quality of their are. that are achieved through traditional approaches. individuals will be able to stay in the same plan as they go up and down the income ladder as they reduce what has been predicted and historical experience. and the size of the marketplace, our private individual health insurance exchange almost doubles with the medicaid program buying in, which will

increase the competitiveness of the market and attract new carriers into the market statewide. and finally as the enrollment of the private option role will help continue to support our ayment improvement effort. if were suddenly trying to put medicaid eligibles through the exchange, into private plans, for which we're in a federal state partnership, we just doubled down on the complexity of trying to implement the affordable care act. we are close to figuring out, essentially at the top, as individuals come in and come to what i call the magic box in the sky that will determine if they are a citizen, and if they do have income, and that it's at

this level and therefore they are eligible for a tax credit or not. if they are eligible for a tax credit, they will proceed across the horizontal to a, the arkansas federal choice, and choose between plans that are offered on our federally facilitated state partnership exchange. if they're found to be less than 138% and therefore ineligible for medicaid, they drop down or transit over to the state-based portal, where we are obligated and want to screen out those individuals that are medically frail or very complex for which the private sector would not be the best place to try to have them seek care and financial support from. so if they screen out as medically frail, we will retain them in the traditional medicaid program. however, if they screen not medically frail, i would call these individuals the working poor, which we have some experience with. we transit them over to a

shopping experience that our goal is to look and feel exactly the same as those individuals who are above the 138% line and using federal tax credits. so, the goal that we have in collaboration between our democratic executive branch and our republican-led house and senate, is that we want everyone to have a private experience. we do not want to grow state government through the medicaid program. we have required that all plans that operate on the exchange to offer a high silver value plan and to be willing to have medicaid enroll lees buy in. we think for the market place by putting a quarter million guaranteed covered into essentially an individual insurance market, we will provide some significant stabletity to the carriers in that insurance market. potentially reduce the premium cost of that market, and increase the carrier into that

market. with a state that currently has 25% of its uninsured, those are bold goals. but it is a unique opportunity and trying to take every advantage of it going forward. where we are now, if i could have the last slide, these are uninsured his is rate that they chose to divide the state by and the number are the number of carriers that are currently under review by the state and the federal government, for competition in each of those market areas. you can see in all but one of the market areas we had more than two plans. so we think we have already reached at least one of the early goals private tiesing medicaid through premium assistance into the private market place. we submitted our waiver of tuesday this week to the secretary, the governor did, we look forward hopefully to a response by the first of the

year. hopefully in times that we can guarantee people as we start to enroll them in october that there's federal support for the plan. >> thank you very much, dr. thompson. now, our final speaker is karen, she's the president and c.e.o. of america's health insurance plans, which is the trade association for america's health insurance plans. she's been working with the plans for, i can't believe this, 20 years or so. before that, she directed the a.f.l. work on employee benefits. on the professional staff of what is now the senate health committee. karen's here to share a bit of what her members are encountering as they prepare for the full scale implementation of the major a.c.a. provisions, including ex changes. both the federally facilitated exchanges and the state-based ex changes over the coming months, or weeks as the case may be.

>> karen thank you so much for being with us. >> good afternoon everyone, it's terrific to participate on this wonderful panel. i look forward to questions as well. i have four slides after this one, and what i tried to do is anticipate all the great information that would be imparted already, if i knew i was batting clean-up here. what i thought i would do is to give you a birds eye perspective from the through the prison m of the health care community. what are we addressing, what with we working on, what are we . iority and how do you think about, how do they think about pricing premiums across the country and why do prices area across the country. so i anticipated some of your questions and i tried to build that into the presentation with the idea of imparting helpful information to kick off the discussion.

can i have the next slide please? so many times over the last couple of years, a number of individuals would say, something like the following. our health plans repairing for health care reform. after i gave them a look, it just occurred to me that for many of the stake holders health care reform begins on october 1 of this year. and that's what people have been thinking about, and so on. if you have health plan, health care reform in 2010. i just wanted to flag just a couple of things that have happened, but in 2010, in september, we had to change our benefit packages in the individual and small market. that was changed very substantially. e've overhauled internal appeals and grieve vance processes. but with all of the information that is relevantia in the individual and small group markets on the portal, that's already there.

it's easy to say not a small thing to do. it has also changed the way benefits are displayed. it's standardized now across the country. we've gone through an entirely new process for rate review and for submitting information to states, an entirely new process for submitting information to the federal government. and in addition to all of this, a massive readiness effort on the part of our community to make sure that we were ready to do what is expected starting october 1. in addition, to make sure that we are ready to offer affordable products on october 1, a number of the plans in partnership with providers, hospitals and doctors have launched new payment arrangements which i'm going to talk about because that explains what you're seeing in some of the premiums across the country.

so, this is a handy dandy chart, but from the prism of the health plans you can see the entire shaded area has been done. what is next is not shaded, which is above the line there. next slide please. in terms of understanding rate variation, just one rule. there's no average. number of people expect that there is an average premium and we have a very good study that was done for us which actually from a rly explains specific, m a very how they area across the country. they also conclude, there's no possibility of determining an average for the following reason. how you price a health insurance product depends on the age of individuals buying, number one, where people live and i'll explain why in a moment.

number two, and other factors that i'm going to talk about in a moment. now obviously in the interest of time, so ed doesn't have to get oversimplifying but i want to give you a top line. what coverage do people have today. so if you are in your 20's, for example, generally what you buy is catastrophic coverage to protect yourself and prevent medical bankruptity. not that we don't try and want to sell broader coverage, but generally, folks in their 20's, and many times in their early 30's, are, sometimes later 30's are just interested in having that baseline protection. so obviously, if you're starting there you're going to categories of coverage, that is a buy up situation. what health insurance also a reform does, but if you're on the older end of the spectrum, and you have a number of health conditions, then health reform

probably means that you are going to be spending less. so where you stand is where you depend on where it starts. so, there's no average. the second thing is where the premarket regulations in the state. so a number of you also heard us talking about us and compression. this is an important area because folks who are over 50 are expecting reductions and people who are under 45 and healthy need to be part of the pool, so we can make sure that the expectations are fulfilled on the end of people ho are older rather than younger. that's why some of the issues within the legislation compressing premiums, to the point that they are compressed, has put pressure on folks who are younger. at the same time, plans have tried to recognizing the dynamics here to do whatever they can to make sure that they re turning in affordable rates

for individuals who will be purchasing to have a healthy insurance pool you have to have that mixture of older, younger, and healthier and sick. so, we've worked very hard to make sure that we are doing our jobs to provide affordable coverage. state mandate does play a role. where you are located in terms of high cost, low cost areas, and certainly that differs state to state, also plays a role. and finally, the ability to do payment invasion to the extent that you can do it as a health plan, then you're stretching health care dollars for individuals. that's why we've worked very hard to do that. there's some issues that overhang here that i think more policy leaders are paying attention to. if you look at california's rates that are now posted, same health plans operating in northern versus southern california, you can see a

palpable difference between the pricing, higher in northern california, because the extent of hospital consolidation in that market, versus southern california. that's a primary feature and it's a very distinct difference in the pricing of the product. so i use that example, a number of other examples. there's a health insurance premium tax in the legislation, that's the concern because it adds on average first year $300 to the cost of family coverage, and anything that's adding in our view is a problem in terms of adding to cost while we're trying to make sure we're turning into affordable products here. states, joe and i were talking about this, have many states around the country still have restrictions on our ability to actually provide high performing networks for individuals to be able to access high performing doctors and hospitals to make

sure again we're stretching those dollars. so that will have to be looked at. scope of practice, this community is very familiar with that. to make sure that nurses can play a broader role, and other professionals, as part of teams, so that we can try to cust mize health care and make it very patient centered, and again stretch those dollars. finally the issue of defensive medicine, i'm not talking about tort reform here, but from the perspective of if we want to have high quality practice, then we have to be able to reward physicians that are practicing according to the latest professional society standards. i think there's a potentially an area to look at there, as a way to improve quality. the final slide, i'll just say a couple of things about this. as i said, the planned community is focused on being ready, doing the job that we are expected to

do. i can talk, if you're interested, from the standpoint of what that means for getting our call centers ready, our agents and brokers trained, outreach and education. all of the technical infrastructure support on the i.t. side making sure that we're ready to do our job, making sure we're meeting the standard of federal exchanges as well as state exchanges and making sure and we are doing our job working closely on the testing of the various websites and aspects of the websites. we're very focused on affordability, focused on work ability and making sure that the experience is a positive one for individuals, whether they call our health care plans, whether they're using the health plan services or whether they're inquiring about the network of hospitals and doctors. so, a significant amount of

activity going on, and i hope add that helpful in terms of rounding out the panel, but i look forward to answering questions. >> that's terrific, thank you very much karen. and it does help, i think a great deal. we've put a lot of issues on the table here. and put a lot of pressure on our panelists to not be too detailed. so we now have a chance to sketch out some of those details, as i mentioned there are microphones that you can use to ask your question. if you do that, i would ask that you identify yourself and keep your exes as brief as you can so you can get through them. we also have the green question cards in your packets. if you want to write your question out and hold it up, someone will come by and bring it forward and get to those as we possibly can.

and i believe you were first. >> thank you, i'm a primary care physician. i'm curious about planned areaability. it is possible to design, well, let me go back -- it's possible to design plans that are more attractive to young healthy people with a gym membership, france. and plans that are less attractive to older people where maybe there aren't so many specialists, not a lot of physical therapy. nobody said anything about risk adjustment on this panel. how are you, are there any controls on making plans more attractive to young people and less attractive to older people. > good question. >> i think first and foremost the essential health benefits address that a little bit. everybody's required to cover the essential health benefits

and physical therapy for example needs to be covered. also, from a risk adjustment perspective, the rates are pooled inside and outside the market, inside and outside the exchange, so i think that as you address your entire market, you're looking at the entire market you've got a look both inside and outside. so while you may try and attract certain people within the exchange or outside the exchange you've still got to pull it off the board. i think that helps to address that. >> i think rebecca did a great job and that's exactly right. i also think that the competition now, the way it's designed, everything is very transparent. one plan bidding against the other with very clear disclosure on all of the benefits, network adequecy and very specific standards in all of those areas. so the plans are very, very focused on, and that's why i

wanted to spend time on making sure that they're engaging in the partnerships that they need to engage with, with providers, to provide the affordable coverage options that we are seeing now, as the rates are being exposed across the country. >> ok, thank you. >> thank you, sir. i work with the american college of nurse midwives, and i have a question that i think primarily for mr. thompson, but there's a difference between the benefit package that is defined in the law, and the essential health benefits package. and to the extent that somebody qualifies for medicaid and under the program, they're required to get their colorado radge through an exchange base plan. they may have a package that's different than what they would qualify. i'll give you an example. for ffordable care act medicaid, and it's not, that

level of coverage is not specified and is going to be variable depending on what states plan to do with that package. so it may be they get into an exchange plan and a pregnant woman does not have coverage if she wants to go to a freestanding birth center. how is he going to know that she can get colorado radge for that kind of service under the fifa service program. are you making any provisions? >> many of the requirements of medicaid plans have been to assure access that approached but didn't equal what individuals in the private sector were achieving. you give an example about nurse midwives, rirmes for access. in our private option, explicitly in arkansas statute, we are trying to have medicaid program utilize the same benefit that private individuals have, and therefore to eliminate the

supplement requirements for medicaid access to approach equity. we will have equity. the same people on the private -- the individuals in the q.h.p.'s, it's the same, whether on private insurance on edicaid, we think the q.p.p.'s some will for both private and medicaid, but it is explicitly not having medicaid reach across and tell them who they have to contract with or what they have to pay. it's to actually get them newly covered under the affordable care act, the same coverage that privately covered individuals have in the tax subsidized insurance under the affordable care act. it neutrals the access difference by us using the same plans that private individuals will pay. in our approach, if you're not medically frail, you will not have the option to go on traditional medicaid. you will be able to select between one of the q.h.p.'s on

the private exchange, as do those who come through the federally facilitated exchange nd have that same choice also. >> people who were eligible for medkead and then getting coverage. >> that was one of the things over the last 60 days we've spent a fair bit of effort on. the afford cable care act, on the private exchange, there's a people 5% -- for the 128%-158%. it's 5% of family income under new guidance. so it's essentially and through the insurance commissioners planned guidance to use the same high value cost sharing so that

an individual who is medicaid funded at 100 or tax subsidized at 149, we required the plans to have the same cautionary arrangesments. >> on premium? >> individuals will not have premiums because medicaid will be buying the premium on their behalf. >> yes, go ahead. >> i'm with the h.i.v. medicine association. i have a question about the state of essential community providers, and the federal exchanges, i think the partnership ex changes, anyone who participates in the 340 b program is an essential community provider. but state run exchanges that's not the case, and that's still influx. so who and how are we going to monitor the inclusion providers in these health planet works? especially because of the

organizations care for underserved and poor populations. >> that's a great question, that is definitely something that we're going to be tracking, going forward, as the state approaches to both network adequecy and to essential community providers. >> i can tell you what we're doing in maryland. do you care about what we're doing in maryland? >> yeah. >> so in maryland, the network adequecy standards today are actually defined by the carriers. in your one, we didn't want to modify that just because we didn't want to disrupt the -- but we also created mixers between the essential community providers and the carriers, so we met around the state, introduced them to the carriers, and helped the essential community providers understand what it means to work with a carrier,

and the fact that they may be getting grants today to help them change their business model for them to understand that their funding is not necessarily going to come through grants anymore. it will actually be coming through the carriers and networking with the carriers. so helping them to understand what those differences are, and to make sure that they participate with the carriers. >> could i add to that? >> please. >> just coming right behind rebecca, there's a great deal of work going on with the plans and providers across the country, on both getting to know one another, but the number of the plans have actually been long-standing colleagues with central community providers. and i think you said it very correctly. i see these relationships growing. one of the issues that the plans have put on the table, i'm not sure it's surfaced in maryland yet, but across the country is we want to make sure that essential community providers are able to meet quality parentcy. and tran

so we're in the process of alking that through. >> yes, go ahead. >> i'm with duke university of public policy and my question is primarily for doctor thompson. i'm wondering, first, how arkansas defines medically frail, and about what percentage isthat population under 138% medically frail. and second, i'm also wondering about the budge tear impacts for the state of arkansas after 2017 when the federal share drops below 100% to pay for medicaid, whatow the state justified it's doing with the 1115 waiver given that private plans are typically more expensive than medicaid. >> starting with the last first, given our political diversity we

have authority to do this for three years while the federal government is paying 100% from our general assembly. so, we have three years to actually assess, and i think that's why it is a demonstration waiver to the federal government, of what the system impact is. not only for the medicaid program, but also for the broader health care system. and i think that will be an important part of the evaluation component that i'm confident will be required of the federal government and we desire on the state side. coming back to your first question, which was related, i'm blanking -- >> what is frail? >> what is frail. every plan, and i think one of the challenges that we have, again that we've worked through in the last 60 days are these people have no claims, they have no past record, except for the individual providers practices. so when somebody's coming in to enroll, how do you identify someone who may not be best served for someone in a private plan? we have developed a screener set of questions, relatively limited with the university of michigan

and some limited validation steps with the agency for health care research and quality that we will launch in line of the path of the individual coming through. we estimate that the number that are medically frail will be less than 10%. we're going to try to pull 10% of everyone throughout. the important caveat, if you're already disabled, then you're already on medicaid and you're not coming in through this portal. so all the disabled individuals stay on medicaid. it's 10% of the uninsured individuals and we have some experience with individuals that were in this working poor arrangement. so we're going to start off, we believe it's less than 10%, we're going to overshoot and pull 10% out. as we get experience with the individuals on their use of services, the claims information required from the health plans, particularly the wraparound services that people will be able to avail themselves of, try

to refine them overtime. >> i have a question about the essential health benefit. the essential health benefit requires that mental health and substance use benefits be a parity with medical surgical benefits. i guess my question is, what is the experience thus far? how well is that working as we've set up the qualified health plans, as the states are getting ready to go out and begin enrollment and so on? >> in maryland, we chose an essential health benefit package, our bench mark plan was actually in our small group market, which was not compliant at the time. the insurance commissioner as she and her team reviewed the plans took a very close look to make sure that the plans were compliant. just as she has been doing for a large group for several years. and so, as they've come through,

we are lucky enough to have a very strong advocacy group in the state of maryland for mental health care, and they are taking a look at the plans to make sure hey meet the requirements. >> in our federal state relationship, federal state partners, the state determine what the essential benefit plan is too, and we picked one of our small group plans as the base and had to supplement, obviously on both substance abuse and the mental health side. i would actually say it's almost easier on substance abuse and mental health than it is on other care so i think we've got it on substance abuse and mental health. i think it's still a little bit squishy on what we'll end up with because the private health care world has never had experience with that. i would say my concern is less about the financial parity of hose two, than it is about the

work force available because the lack of parity overtime has not built up the work force being able to provide the services even if the financial barriers are relieved. > thank you very much. >> i'm clark ross and i wanted to go back to dr. thompson on the medically frail issue. we're working with several disability coalitions trying to figure out the determination of medically frail and the timeline, how quickly this will be done. so i understand using university of michigan in our questionnaire, who actually will make the determination. and is there a timeline for whoever that person entity is to make that determination, to make the determination? >> so, it's an operational challenge but let me take you through it. we are using the best supported

screener tool that we can find. we believe the number of medically frail is, again, significantly less than 10%, but to err on the side of safety, we're setting in at 10%. so the individuals come through the process and it will be a self assessment, they fill out the questionnaire with a predetermined calculation. and those 10% will be routed if they will, maintained in the traditional medicaid program and not allowed to go forward into the private health insurance plan selection. those who do go forward into the private, we hope there are very few, they are medically frail that get rooted into a plan. from our discussions with the federal government, we believe we want the individual to essentially raise their hand and say i think i need to take that screener again because i'm not being best served. or we retain the option for the medicaid program to say the

service looks like they may not be best served. what we do not want to have happen is we don't want the health plan to say oh, this is a costly patient and we want them to go back into the program because they are "medically frail." we're restricting the plans from being able to do that. and every 12 months the medicaid eligible individuals will retake the screener and be considered whether or not they are best served in the private sector or best retained in the medicaid program. o that's our current approach. you can do a detailed self assessment on the front end and end up guaranteeing they end up in the right place. the approach we've taken is try to minimize the number of, if you will, false negatives, people ho are medically frail and that end up into the private sector. but with two different safety net routs to be pulled out after the fact. >> if i can ask folks at the

microphone to be patient for a moment, i'd like to get at one or two of these questions that have come in on cards and that we have had submitted in advance. there's been a lot of interest expressed and lot of attention on our panels part to question what the premiums are. questionnaire asks how much ability did states have to negotiate or do states have to negotiate lower premiums for exchange plans, and is there a lot of variation on how aggressive the states have been in this area? >> i can try to answer that one. the state choose to negotiate premiums or to kind of follow the standard process. generally you have a few states premiums, california

is an example, rhode island. these are typically your active purchaser, selective contractor tates where the rates came in. the notion that they could not be certified if the rates were chosen t what they have to do, the insurance commissioner is the one who's typically responsible for the rate review process that karen mentioned that was instituted already. and tip clir they're kind of following that. in a couple of cases in d.c., they may be augmenting it with some of their own independent to take an additional look at the rates. karen, you might have perspective from the planned

perspective. >> may i? >> go ahead. >> i think everyone in the audience knows well, this is a very different dynamic. the market is changing very substantially in terms that we are going to be in a situation where consumers now can compare plan to plan. consumers are very price sensitive. the plans have, are very significantly motivated to do what they can, which is why i wanted to stress what they're doing in terms of payment reforms to make sure that you are competitive on price. competitive on quality, as individuals look at the quality pectrum as well. in addition, the third factor to keep in mind is there are caps now on administrative costs for

plans. if you are a health insurance plan, your mission is to provide health insurance coverage. so you are going to do everything you can to provide affordable, high quality options to individuals because you want people to buy your products. so as you think about pricing, you think about what will motivate people to buy products, so the pressure is to be as cost effective as possible. which is why all of the work on the payment side is so important here to leverage those tools. care coordination, disease management, arrange of things we haven't had a chance to talk about. but go into how you think about building your premium. when you're up against consolidation, where it's difficult on the hospital side, to actually negotiate the kind of affordable premiums you would like, that's the problem, the reason you want to point that out is because you can see that

as a very striking example. i think the policy community is only beginning to internalize that as a major issue and as the issue it is. >> there's a post on the website on thursday that's really worth looking at and i guess that's the question the variation. what that did, the range of premiums that have been published so far propose so far in states. looking althe variation between the second highest silver premium and second low, and there's a tremendous amount of variation in those rates in different states in baltimore, that there's a tremendous amount in new york city. there was a great deal of ariation, and in california. what sara just mentioned at the selective negotiation that california, there's far less variation, at least in san francisco and san diego. so the author also provides, the explanation of why they think

we're seeing this broad variation in certain cities and maybe not so much. a lot of it comes down too, what karen is arguing, that we don't have a lot of experience yet with this market. and so, so some are very conservative others are less conservative. we'll see a lot of variation. but the question is overtime will these different approaches to market organization that we're seeing in states, will that really make a difference in the kinds of premiums people are seeing? i guess, maybe i'm posing that question to karen, but overtime, how are these markets, how are these markets going to converge? will there be less variation as more plans come in, et cetera? >> well, i think so, because you have in some cases new entrants offering insurance products that have never been in the insurance industry before.

so it will be interesting to see if they're able to make it as insurance carriers so that's number one. number two, i think that as you approach this year one, and as an insurance plan, you think well do i have a network that i can build out from in a particular area? that informs your pricing. and then the third area is the large unknown, sara talked a little bit about this as well, and i think very ablely, you don't know who is actually going to come to buy your product. so you have to make a hypothesis about percent of young, percent of old. if we don't have that ideal blend, then it doesn't work out so well. so, you try to do whatever you can in pricing to make sure that you're offering affordable products to as many people as possible that balance in the risk pool. so, all of those factors as sara said come into play as you build

your network and then overtime, we see people have more experience, they know year one, what the experience is. and so it's very different bidding year two. we saw this in part d, in the prescription drug program, and i think we'll see it here as well. and the only other factor to putting on the table, and all of you know that if you look at the experience ram, the there is soberering. we have a number of people, the rules are we can't have insurance coverage for six months before you enroll. it probably gives us a window of who may be coming into the pool. the piece of programs across the country, and they're administered at the state level, but a federal program, i don't know of any that is even with what is being paid in versus

what is being paid out. i know the number of states are paying out eight times what was taken in. some are paying out two times what was taken in and then there are a bunch in between. i think that reflects through. if you're building a risk pro so i'll to consider how to price a product, you have to figure out how many people who are very, very sick are coming into your plan. there's no way to know until you have the first year under your belt. so i think, sara, you've asked a very important question. we're probably going to see some of this the way we did in d. >> you're referring to the federally set up temporary high risk pools that were put in place by the a.c.a. as a way to get people with preexisting conditions to the starting line in 2014? >> right, which is a very important program. it just does give us a window into people who don't have health care coverage. many of them have very

significant health care concerns, obviously it's important for them to get into the system as early as possible so you can coordinate their care, provide the support that they probably haven't had. nd you can do it, i think, far more afford bli than these individuals have, had to rely on going to the emergency room and that was the only way they could get care and coverage to the extent that you call that coverage. it's not much, but now with that program that's allowed folks to be able to go into the system, very important. but if you're sitting at your desk thinking about how to price a product, you have to look at hat as well. the high cost low cost areas, we see that across states. if you look at new york state, much more expensive down state

than upstate in terms of pricing he actual services that people purchased through premiums. >> if i can take 30 seconds for a commercial, the alliance is delve morewebinar to quickly, tuesday 1th, so if you have the occasion and the time, you can find information about it on our website. the folks at the microphones have been very patient. >> please, thank you very much. question on the design models for eligibility for the premium subsidaries and tax credit. what design models have been considered and or adopted already? i understand that with the federal data hub, they've actually chosen the design model that includes utilizing some third party vendors to validate

income and credit scores and things of that nature. i'd like to understand a little bit about what other design model has been used in that big box in the sky. and how effective they are. >> we're using the federal data hub. >> you are? ok. >> as are we too. we did not want that responsibility in the rapid cycle frame that we were going. >> a large number of states are using the federal data hub. >> i guess maybe my cor lair question is then is there any risk associated with just having opposed to some combination? >> i think the obvious answer, it's very, very early. i think from our perspective, what we're focused on will the data be correct. and the individuals are focused on that as well. so we've been working with the

number of advocacy groups and so on, and a number of states as well. and with c.m.s., very actively to help support the design that's being built to make sure, and they're very focused on this, to make sure the information is going to be correct. so what we are going to be getting is a transmission from the federal hub, for example. from the federal exchange, saying, and the hub in this case, for states that are using it, saying that this individual is enrolled, they are eligible for particular subsidary, because that would have been, they would have an interface with the i.r.s., et cetera. so that's generally how it's going to work. >> ok. >> and i would just add, this is not going to be perfect on october 1. >> understood. >> it is going to have a lot of bumps and a lot of potholes going down the path. so, i think it will get refined

overtime. if there is risk in having to consolidate it too much into one entity i'm sure that can be mitigated through competitive purchasing. > ok, thank you all. >> i had a question for dr. thompson. obviously a lot of newly insured people, what difficulties you foresee having with them with access to care, where will they be going? >> i think that's one of the reasons i mentioned, our cross platform, while we started with the work force strategic process, that both came out, both did a kwan tative assessment of where our individuals were and providers were. we found a dramatic consolidation, primary care providers and had low ininsurance rates. people don't like to move out, provokes the essential community i think oviders, and anticipated centers and ores to

meet the newly insured demands between the health plans and the providers. we actually found that if you count nurses and primary care providers, we have a much less of a shortage. i think we still have a shortage. i think the nation has a shortage. but we went farther than that to say what we really need to do is reorganize the practice systems and actually move towards team base care that has a physician in the lead, but does not necessarily have a physician being the touch point for the patient, to use them at the top of license, and to integrate using electronic health records. we've actually come from way in the back of the pack on health information exchange, electronic to where we were the first get approval by the office of national coordinator. i think it's about practicing smarter, using technology and tually using facilitated

techniques. importantly to refer on into the system that we remove the financial barrier, which has been such a devastating issue, and has effected work force access, and candidly we did a story, or a study for us that if we took advantage of the medicaid expansion and the tax credit 2400 lives a year saved in our state. >> to add to that, the question of network adequecy, one of those probably going to continue to evolve as we're watching, watching this go forward. some of the things that karen have been talking about, the new team base model of care, different ways to make sure there's access, open access scheduling and things like that. just the way we think about network adequecy, i think is evolving in terms of what the

standards should be and different states are in different places. some have existing standards like time and distance standards, no more than 30 miles. others might have the ratio of providers, and flexibility in terms of how they apply the twork adequecy standards, so tay take it up to a level, states i think had to really think through and kind of struggle with how to take a standard that might only apply to h.m.o.'s in the state and how to apply it to all of the health care plans in the exchange and then figure out how to apply it and whether to apply it market wide, both inside the exchange and outside the exchange to sort of avoid those adverse issues that could arise. so i think that's something that states are still thinking through and bears close watching

as things move forward. >> we have about 10 minutes left and i'd ask you as we go through our last few questions and answers, if you would fill out the form and give us some feedback and guidance for the future. and the next question actually, we're coming back to you sara. they would like you to take us in ugh the funding streams, 2014 and long term. >> you want to stay after school? so the funding stream, so i mean, to try to simplify it a little bit, when states decided to set up their own exchanges or to enter into a state partnership exchange like arkansas has done, they had access to basically exchange

establishment funding to set up navigator and consumer assistance program. the federal exchanges that aren't running and where the state isn't running a consumer program, they're relying basically on federal grant funding who funds their navigator program, so i think that first wave was 54 million if i'm not mistaken, to fund those navigators and those were the navigator grants. talking about soon to be announced. states, they can't use the funding, the states cannot use exchange establishment grant funding to fund navigator grants. so that's why there's this in person assistance program or sometimes called nonnavigator assistance, which is a program that states can use their exchange establishment grant

funding to fund the actual grants. starting once the states start to get revenue into exchange, then they can use the operational funding to fund the navigator grant. i think that this is all overlaying fights about duties of navigators, and agents and workers that have been ongoing, bit of a struggle, but essentially what we had were states having to put together an assistance program and kind of use different funding streams in order to do it while trying to harmonize the duties and the outreach and making sure they're reaching the populations. i don't know if there's a specific state perspective but hat's my best attempt. >> there definitely are different funding streams. the good and bad of being one of

the first states, i think the third state to get our level two grant, and the funding hadn't been announced yet. so, we had to go back for our supplement to our level two grant to get our sister to sister funding so we insurgently have several different streams. we've already gone and gotten our state funds through the end of 2014. then we have funding from 1311 to fund. so definitely what we're focused on is making sure that the funds are for oing there that only. having that oversight is something we're extremely focused on. >> we have a question again for joe about medicaid approach that arkansas is using and whether he thinks it could work for other

states. i guess that -- if you think back to the map about 25 states not decided if they're going to expand their programs, other states looking at you and potentially looking as an option for a way forward for them. >> you know, i think we are testing several aspects. one is eliminating access barriers by having medicaid individuals be carried for in the same plans, privately insured. on the flip side making sure that they're adequately served n the plans. i think it's important to go back to our state, we had not expanded into care before. states that had already done that may have an easier path to use those paths that they had already had in place. if we find that providers are much more readily willing to accept medicaid patients, if we close the access barer, if we

get the outcomes that we want, then i think this could be a mechanism. and, we are able to maintain a competitive pricing structure so that it is actually equivilent to what medicaid would otherwise have to pay should we use the traditional path. i think this is a path that opens up a potentially new avenue to try to achieve the goals and outcome of high quality efficient affordable care for medicaid programs in other states. one that's here relevant here, do you envision paying providers the same rate for these nonmedicaid medicaid eligible people as they're paying for those over 138%? > important question, i think.

we are buying the health plan, the same health plan that the tax subsidized individuals above 138% are receiving and we are putting in safe guard so the provider doesn't know if they are medicaid eligible or tax subsidized. so we are trying to eliminate the knowledge whether the individual is medicaid funded or tax subsidized and the payment rates clearly have to be the same. >> very good. >> yes, i'm sorry. >> last question here. >> hi, this is just a general question, i'm sorry if this has already been answered and part of that answer that sara gave, but i'm just trying to understand what the difference between the sisters and navigators, because it seems

like they do, it's just a different term for, you know, the same kind of thing. so i'm just trying to understand what the difference is between the what a sisters and avigators actually do. >> long story short, they're doing very similar roles. the states could, na gators have a certain state of prescribed roles in the law, such as outreach and education, facilitating enrollment into the plan. certainly providing services in an appropriate manner, and those are required services. states again designing these programs could very much some themes and variations on that. by in large, they're going to be largely similar duties. but, you know, again, with the different funding streams.

>> how will the consumer know the difference? so the consumer will want to find the navigator, but they'll see an organization that will help them -- >> in my take they don't need to know the difference. >> go to the website and you'll find a list of potential people to help you find. >> and then we have numbers of agents and brokers around the country that are also going to be very actively involved in helping people get enrolled and sort through the coverage options and so on and so forth. they have a lot of experience doing that. >> is there any difference in any of those categories, people, in the extent to which they will get access to the personal information? there's been some privacy concerns raised in this area, so, will nonnavigators be able to get that same information to help people put it into the system as the navigators do?

>> yes. >> well, agents and brokers for example, sort of the kitchen table test will be helping people determine whether or not they have a chance of getting a subsidary and so on and so do.h. how do you compare one plan to another? what kinds of diseases do having your family or my to have the possibility or? rob ability of having how do you look at networks and so on and so forth? so the scars of decisions are being talked about by agents and brokers with their clients. and normally at kitchen tables across the country. but certainly they will be helping people determine whether they are candidates for these subsidies. there's no question.