the next fiscal year. if that number is not achieved, we will fall back to 900 $67 billion at the end of year. my personal preference would be to stay they are right when they say the level push us back. reaction to your the talks? our live look here at the u.s. capitol. the light indicates at least one house of congress is in session. early wednesday morning, 1 a.m. eastern, it is the senate texas senator cruise came to the floor the floorcruz came to to talk about defunding the health care law.

he has been joined by other senators. we see here that you talk republican mike lee. we will look in on this for a few minutes. >> i hope that we will reflect from time to time on that we have all taken an oath to uphold this document, this do hundred nt written byume wise men -- 200-something document written by wise men. did extent that we respect the knowledge of this document, we follow it. to the extent that we defend it. to the extent that we consider it not just the responsibility of the judiciary, but all of the branches of government, including our own branch. we will return to those

practices. we will benefit directly as a result. , i have to askz lawyer,a constitutional as of our nations preeminent litigators, as one who has argued many times before that , and now as aourt u.s. senator, how do you see this? -- what role it as in this body? what role does the constitution play in the u.s. senate? doesn't have a place? or is that something that is supposed to be left -- does it have a place? or is that something that is

supposed to be left to the nine black robes? thank my friend from utah for his very fine, learned question. it is a privilege to serve this body alongside the constitutional scholar, alongside a senator who takes his fidelity to the constitution so seriously, so appropriately seriously. his question is exactly right. how serious do the men and women take the constitution? how serious do we take the obligation? each of us swears to uphold the constitution. easyt it ease -- yet it is in an era where the supreme for members of congress, members of the executive branch to say that is their problem.

we passed the loss and the court figures it out if it is constitutional. ws and theed the la court figures it out if it is constitutional. said he wouldz talk as long as he was able to stand. he was done by several other senators, both republicans and democrats. the senator will have to stop talking before a procedural vote tomorrow morning on whether to .ove ahead on the bill the bill is a continuing resolution. senator cruz demanding that it ,efund the affordable care act obamacare. live coverage of the u.s. senate continues on c-span 2. we will show you an earlier exchange between senator cruz durbin.crat divck >> will you yield for a

question? >> i'm happy to yield. >> is my understanding the senator's position is if we do hasdefund obamacare as he characterized it as a health karma format, he believes we should shut down the government on october the first. is that the senator's position? >> thank you for that question. is not myassuredly position. thank you for the opportunity to clarify. let me be very clear -- i do not believe we should shut down the federal government. the only reason we might shut down the federal government is because president obama and harry reid decided want to force a government shutdown. i believe we should do what the house courageously did, which is last friday, they voted to fund every aspect of the federal government, even the parts he

disagreed with, except for obamacare. hurtingican people are under obamacare. >> with the senator yield? >> i'm happy the yield. sender has spoken many times, including his education. i respect it. he has gone to very famous schools. certainly the senator understands that it takes 60 votes to achieve the goals that he is trying to achieve, and which means the senator believes he has at least all the votes on his side of the aisle and another 14 votes on the democratic side to repeal obamacare. does the senator have that belief? >> thank you for that question. thank you for the comments made schools inoting the have attended. maybe i have learned to count up to 60. [laughter]

i'm quite familiar with what is necessary to defund obamacare. what i have said for months is that this is a long process. ish.not remotely pollyanna- this will not be a short, quick process and suddenly obama will be defunded. it is a detailed answer. if you forgive me, i will take a few moments to lay it out. , this process was never going to work unless the american people could get engaged in historic numbers. i spent much of the month of august and september during a recess traveling to the state of texas and around the country, everything i could to go to the american people. to the entrenched interest and go straight to the american people. the entrance -- the response was incredible.

we have seen over 1.6 million american sign a national petition to defund obamacare. that was the first up. it was the critical first step. the second step is what happened last week. the house of representatives voted to defund obamacare. the senator from illinois is well aware as recently as a couple of weeks ago that every learned observer, every pundit said it was impossible the house would pass a continuing resolution that would defund obamacare. it will not happen. yet to come on friday, it happened. the house of representatives listen -- yet, on friday, it happened. that house of republicans -- the house of representatives listen to the american people. i would like to finish answering your last question. let me finish. where we arep is now. it is the u.s. senate. to u.s. senate, we will have

do two things. unify republicans. bring together all 46 reidlicans opposing harry being able to fund obamacare on a partisan vote. i believe every republican should be unified in that. right now, we are not. there are divisions in the republican caucus. listenrepublicans will to the constituents. i cannot convince my colleagues. on this side of the aisle or that side of the and able to unify republicans, you ask me, how do we ultimately get to 60? i assume that predicate of that -- the firsthat

thing we have to do is get up to 51. 46 republicans and five democrats. how do we get five democrats? if the senator from -- as a aware, from illinois is there are many were of four election in red states. red states.ction in if they hear from the constituents in overwhelming numbers, that would change things. let me readily admit as long as republicans are divided, as long as we are shooting each other, -- if we can unify republicans, i believe we will start with red state democrats will potentially lose their jobs if they continue not listening to their people. >> question. >> sure. voted order tos

times to abolish obamacare. times to abolish obamacare. one of the reasons i voted for health care reform was industry by woman i met in southern illinois. of hard-or spoke working people. this woman's name is judy. she's a housekeeper at a motel that i often go to. she has worked her whole life in manual labor. ands been a cook housekeeper, all of these things. she is 62. she told me she had never had life insurance -- health insurance went in her life. she worked every day eric could that she could, but never had health insurance. -- she worked every day she could, but never had health insurance. we had an announcement in illinois that is going to be officially released tomorrow at

about what this new health insurance marketplace in illinois means for people like judy. it means that we will offer 165 different health insurance plans in illinois by a different insurers. the premiums at the lowest level of health insurance for those who are not under medicaid will ,e in the range of $84 a month but the good news for duty is that her income is so low is that she met it -- qualifies for medicaid for the first time in her life. the first time in her life, judi, who had been turned down because of the existing conditions of diabetes, will have the peace of mind of health insurance. you and i are blessed to have the best health insurance in america as members of the u.s. senate. when you say you want to disband and stop obamacare, do you want to deny the opportunity for judy

and millions more just like her for the first time in their lives will have the protection of health care they can afford? >> thank you for that question. i will say that i respect his sincerity and passion in believing that government solutions from washington can fix this problem. i do not know if the senator shares the view that majority leader reid expressed. single paymove to a our government -- health care. i do not want to put words in your mouth. i do not know one way or another what you're viewing the. -- you told the story of judy. the best way for judy for anyone who has health insurance is to have an economy that is booming where people can get jobs and have opportunity. let me respond with two things. number one, before the senator

from illinois came to the florida senate, and i read a number of letters that have come from people all over the country -- i will read the stack. "since the passage of obamacare, and insurance premiums have gone up there times. that doesn't count the increasing use -- other increases. certain retirees from another group would see their insurance terminated after 2013. my support wl terminate after 2018. in the meantime, i have lost two family doctors who have left the practice. i must settle for nurse practitioners and assistance. i'm fortunate to have would coverage in which i have paid dearly which is excepted everywhere cap i fear the day i can no longer afford it. i am paying for obama's train wreck ever since the bill was passed.

surely there must be a way to defund or repeal the bill. please help." i would note to the senator for help are coming from all over the country. i think you answered a judy is that she needs a better job. after 62 years of hard work, the best you could do i think your answer was, judy, get a better job. let me ask you another question. when i voted for obama care, one of the things that motivated me was the fact that health insurance companies would no longer be able to discriminate against americans with pre- existing conditions. i had a situation in my family, a child had a serious, physical problem. .ould not have qualified it was available to me as a member of congress. if i had gone on the open market to buy policy, i'm not sure if i

could've bought one to cover my child. when you say you want to abolish abolishe, do want to that part of obamacare that says you cannot discriminate against people for pre-existing conditions when it comes to health insurance at those people are the dems of asthma or diabetes or mental illness? -- of asthma or diabetes or mental image? >> thank you for that question. let me answer this in two different ways. let me talk only about what the senator talked about about his health insurance and mine as members of the senate. make ist point i will that the senator from illinois is passionate and has been quite eloquent describing what he perceives to be the benefit from obamacare. that theeak volumes senator from illinois and i in

every other member of congress has been exempted by president obama. it was and certainly -- it was inserted that we should be subject to the rules. we should put in the exchanges like millions of americans -- you just talked about the wonderful exchange. the text of obama care providers that we should be in those exchanges. that employerss cannot subsidize it once we get into those changes. law, theed into democratic caucus met with president obama. i was not in that meeting. i read the public reports. everett the press accounts. it'll indicated that the majority leader, members of the senate, asked president obama and to get us out of this. we do not want to be in these exchanges. i see my friend from illinois shaking his head.

all the press reports say that is what occurred. regardless, that is what happened. that message was heard by the president because shortly thereafter, the administration issued a ruling that exempted numbers of congress and exempted our staff. i'm curious if the senator from illinois is such a fan of the exchange, such a fan of the health care that has been provided to judy, with the senator from illinois support the amendment to provide every member of congress, every one of our staff, every political appointee in the obama administration, and every federal employee under the exchanges so we will make the that we be subject to those same rules, those same plan so when we go on television and say, exchanges are really aboutwe are not talking

something someone else is experiencing. we talk about our own health care. >> i would like to respond to his question. >> i'm happy to yield to a question without yielding the floor. what he just stated is just plain wrong. here is the state of the situation. the health insurance that we enjoy is the federal employees health benefit program. it covers 8 million federal employees and their families, including members of congress and our staff. there are primus that we pay and choose, the federal government as our employer pays 72% of the premium. this is not an unusual situation. but hundred 50 americans, half our population, employer sponsored an employer education

to the health care of their employees. but the president did is to say, you, myself, and others will now have to buy our health insurance through the insurance exchanges that we created. with a, we will get employer contribution as we do now as you they now and i enjoy for purchase of health insurance. my wife and i will be choosing a policy from the health insurance marketplace in the state of illinois. we will have a different insurance companies and 160 five choices. that is our insurance. about is the employer's contribution to health insurance. that is your position and the republican party that it is a federal subsidy that should be stopped, you are affecting the health insurance not just as a member of congress, but 150 million americans.

better think twice about this. if you want to stop employer -- that is the headline for tomorrow morning. i do not support that. do you? thank you to the senator for his certainly genuine political advice and counsel. note that the experience of obamacare facing the prospect of losing health insurance, being forced into the exchanges, health insurance that the clerk provided, and being forced into is axchanges, it disconcerting experience. it is an experience no one likes. it is an experience that is lousy. there's a reason why democratic senators were upset. there is a reason why congressional staffer so upset.

just a few weeks ago, ups and a some 50,000 employees. we are dropping spousal health insurance because of obamacare. is 15,000 ups employees who had insurance for the husbands and wives and suddenly those husbands and wives are left without health insurance. they are being told to go on an exchange but no employer subsidy. senator durbin made a passionate case by that is a terrible thing to tell people. i agree. is not toed outcome subject members of congress and congressional staff and political appointees of the administration and their employees to the exchanges and obamacare. my preference is to subject nobody to that. senator grassley

asserted the amendment is because we have a problem with a ruling class in washington in both parties. this is a bipartisan affliction that believes that the rules of that govern american -- working americans are not govern us. if obamacare is going to force americans all over this country theose their employee -- men and women who serve in this body should feel the pain the same so when we go on television and say this is great, we should know of which we speak because we have skin in the game and we are not being treated better. under no circumstance should congress, embers of congress be treated better than hard-working americans. that is what president obama did. the request of democratic senators in this body. >> on the next "washington journal" we discussed the

possibility of a government shutdown. we speak with a representative rob wouldall. we will also -- rob woodall. we also hear from representative john delaney. our spotlight on magazines a --est will be "washington journal" live on c- span every day at 7 a.m. eastern. c-span, we bring public affairs from washington directly to you, putting it in the room of congressional hearings, white house events, and offer complete gavel to gavel coverage of the u.s. house, all as a public service of private industry. c-span, rated by the tv industry and funded the by a local cable or satellite provider.

now you can watch us in hd. >> several offense to tell you about tomorrow. cybersecurity commander and nsa director general keith alexander speaks at the billington cybersecurity summit at 8 a.m. eastern. investments.cture later, the long-term financial outlook for retirees. that is at 2:15 p.m. eastern. and we will be live at 7 p.m. eastern for a debate between that candidates for the governor position in virginia. >> president obama told members of the united nations on tuesday that they should adopt a strong resolution to hold syria

accountable if they fail to turn over the chemical weapons. he welcomes the statement by the iranian a president on his country's nuclear program. this is 25 minutes. the assembly will here and adjust by his excellency, barack obama, president of the united states of america. calm to escorto his ex -- protocol to escort his excellency. [applause] i have the honor to welcome to the united nations, his

excellency, barack obama, president of america. i invite him to address the assembly. mr. president. >> mr. president, mr.secretary general, fellow delegates, ladies and gentlemen, each year, we come together to reaffirm the founding vision of this institution. for most of recorded history, individual aspirations were subject to the whims of tyrants and empires and divisions of race, religion and tribe were settled through the sword and clash of armies. the idea that nations and peoples could come together in peace to solve their dispute and advance a common prosperity seemed unimaginable.

it took the awful carnage of two world wars to shift our thinking. the leaders who built the united nations were not naive and did not think this body could eradicate all worse, but in the wake of millions of dead and with the development of nuclear weapons that could i nile ate a -- annihilate humanity could not survive the course it was on, so they gave us this institution, allowing us to resolve conflicts and force rules of behavior and build habits of cooperation that would grow stronger over time. for decades, the united nations has, in fact, made a difference, from helping to eradicate disease, to helping children, to brokering peace. but like every generation of leaders, we face new and profound challenges and this

body continues to be tested. the question is whether we possess the wisdom and the courage as nation states and members of an international community to squarely meet those challenges. whether united nations can meet the test of our time. and for much of my tenure as president, most of our urgent challenges have revolved around an increasingly integrated global economy and to recover from the worst economic crisis of our lifetime. now five years after the global economy collapsed and thanks to coordinated efforts by the countries here today, jobs are being created, global financial systems have stabilized, and

people are once again being lifted out of poverty. but e still have work to do together to assure that our citizens can access the opportunits need to thrive in the 21st century. we have also worked to end a decade of war. five years ago, nearly 180,000 americans were serving in harm's way and the war in iraq was the dominant issue in our relationship with the rest of the world. today, all of our troops have left iraq. next year, an international coalition will end its war in afghanistan, having achieved its mission of dismantling the core of al qaeda that attacked us on 9/11. for the united states, these new circumstances have all meant shifting away from a perpetual war footing. we have limited the use of drones so they target only those who pose a continuing imminent threat to the united states where capture is not feasible and near certainty of no civilian casualties and transferring detainees to other

countries and trying them in courts of law while trying to close the prison at guantanamo bay. and just as we reviewed how we deploy our extraordinary military capabilities in a way that lives up to our ideals, we have begun to review the way we gather intelligence so we balance the legitimate concerns of our citizens and allies with the privacy concerns that all people share. as a result of this work and cooperation with allies and partners, the world is more stable than it was five years ago. but even at a glance of today's headlines indicate the dangers remain.

in kenya, we have seen terrorists target innocent civilians in a crowded shopping mall and our hearts go out to the families of those who have been affected. in pakistan, nearly 100 people were recently killed by suicide bombers outside ap church. in iraq, killings and car bombs continue to be a terrible part of life. meanwhile, al qaeda has splintered into regional networks and militias, which doesn't give them the capacity at this point to carry out attacks like 9/11, but does pose serious threats to governments, diplomats, businesses and civilians all across the globe. just as significantly, in the middle east and north africa, have laid bare deep divisions within societies. as an old order is offended and people grapple with what comes next. peaceful movements have been answered by violence.

from those resisting change and from extremists trying to hijack change. sectarian conflict has re- emerged and the potential spread of weapons of mass destruction continues to cast a shadow over the pursuit of peace. no where have we seen these trends converge more powerfully than in syria. there are peaceful protests were met with threat and slaughter. in the face of this, many retreated to their sectarian identities, sunni and kurds and the situation spiraled into civil war.

the international community recognized the stakes early on, but our response has not matched the scale of the challenge. aid cannot keep peace with the suffering of the wounded and displaced, a peace process is stillborn. america and others have worked to bolster the moderate opposition, but extremist groups have taken root to exploit the crisis. assad's traditional allies vice president propped him up citing principles of sovereignty to shield his regime and on august 21, the regime used chemical weapons in an attack that killed more than 1,000 people, including hundreds of children. now the crisis in syria and the destabilization of the region goes to the heart of broader challenges that the international community must now confront.

how should we respond to conflicts in the middle east and north africa? conflicts between countries but also conflicts within them? how do we address the choice of standing callously by while children are subjected to nerve gas while we are embroiling ourselves in someone else's civil war? what is the war of force of a region that threatens and undermine conduct and what's the role of the united nations and international law in meeting cries for justice? today, i want to outline where the united states of america stands on these issues. with respect to syria, we believe that as a starting point, the international community must enforce the ban on chemical weapons. when i stated my willingness to order a limited strike against the assad regime in response to

the use of chemical weapons, i did not do so lightly. i did so because i believe it is in the national security interest of the united states and in the interest of the world to meaningfully enforce the prohibitions that are older than the united nations itself. the ban against the use of chemical weapons, even in war, has been agreed to by 98% of humanity. it is strengthened by the memories of soldiers suffocating in the trenches. jews slaughtered in gas chambers. iranians poisonned in the many tens of thousands. the evidence is overwhelming that the assad regime used such weapons on august 21. u.n. inspectors gave an accounting rockets fired large quantities of sarin gas at civilians.

these rockets were fired from a regime-controlled neighborhood and landed in opposition neighborhoods. it's an insult to human reason and to the legitimacy of this institution to suggest that anyone other than the regime carried out this attack. now, i know in the immediate aftermath of the attack, there were those who questioned the legitimacy of a strike from a clear mandate from the security council. without a credible military threat, the security council had no inclination to act at all. however, as i have discussed with president putin for over a year, most recently in st. petersburg, my preference has always been a diplomatic resolution to this issue, and in the past several weeks, the united states, russia and our allies have reached an agreement to place syria's

chemical weapons under international control and then to destroy them. the syrian government took a first step by giving an accounting of its stockpiles. now, there must be a strong security council resolution to verify that the assad regime is keeping its commitments and there must be consequences if they fail to do so. if we cannot agree even on this, then it will show that the united nations is incapable of enforcing the most basic of international laws. on the other hand, if we succeed, it will send a powerful message that the use of chemical weapons has no place in the 21st century and that this body means what it says.

now, agreements on chemical weapons should energize a larger diplomatic effort, to reach a political settlement within syria. i do not believe that military action by those within syria or by external powers can achieve lasting peace. nor do i believe that america or any nation should determine who will lead syria. that is for the syrian people to decide. nevertheless, a leader who slaughtered his citizens and gassed children to death cannot regain the legitimacy to lead a badly fractured country. the notion that syria can somehow return to a pre-war status quo is a fantasy. it's time for russia and iran to realize that insisting on assad's world wealth will go to the outcome they fear, difficult for extremists to operate.

in turn, those of us who continue to support the moderate opposition must persuade them that the syrian people cannot afford a collapse of state institutions and that a political settlement cannot be reached without addressing the legitimate fears and concerns of minorities. we are committed to working this political track and as we pursue a settlement, this is not a zero-sum endeavor. we are no longer in a cold war. there's no great game to be won, nor does america have any interest in syria beyond the well-being of its people, the stability of its neighbors, the elimination of chemical weapons

and ensuring it does not become a safe haven for terrorists. i welcome the influence of all nations that can help bring about a peaceful resolution of syria's civil war. and as we move the geneva process forward, i urge all nations here to step up to meet humanitarian needs in syria and neighboring countries. america has committed over $1 billion to this effort and we will be providing an additional $340 million. no aid can take the place of a political resolution that gives the syrian people a chance to rebuild their country, but it can help desperate people to survive. what broader conclusions can be drawn from america's policy towards syria? i know there are those who have been frustrated by our willingness to use our military

might to dispose assad and our failure to do so is weakening in the region. others have suggested to direct limit the military strikes to deter chemical weapons shows we have not learned anything from iraq and america seeks control over the middle east for our own purposes. in this way, the situation in syria mirrors the contradiction of what has persisted. the united states is chastised for meddling in the region, accusing of having a hand in all matter of conspiracy and at the same time, the united states is blamed for failing to do enough to solve the region's suffering. i realize some of this is inevitable given america's role in the world, but these contradictory attitudes have an

impact on the america's people support of our involvement in the region and allow leaders in the region to avoid addressing difficult problems themselves. so let me take this opportunity to outline what has been u.s. policy towards the middle east and north africa and what will be my policy during the remainder of my presidency. the united states of america is prepared to use all elements of our power, including military force, to secure our core interests in the region. we will confront external aggression against our allies and partners as we did in the gulf war. we will ensure the free flow of energy from the region to the world, although america is steadily reducing its importance on foreign oil, the severe disruption could destabilize the entire global economy. we will dismantle terrorist

networks that are threaten our people. wherever possible, we will build the capacity of our partners and respect the sovereignty of nations and work to address the root causes of terror, but when it's necessary to defend the united states against terrorist attacks, we will take direct action. and finally, we will not tolerate the development or use of weapons of mass destruction. just as we consider the use of chemical weapons in syria to be a threat to our own national security, we develop chemicals weapons that could undermine the we reject chemicals weapons that could undermine the global nonproliferation regime. now to say that these are america's core interests is not to say these are our only interests. we deeply believe it is in our interests to see a middle east and north africa that is peaceful and prosperous. and we'll continue to promote democracy and human rights in

open markets because we believe these practices achieve peace and prosperity. but i also believe we can rarely achieve these objectives through unilateral american action, particularly through military action. iraq shows us that democracy cannot simply be imposed by force. rather these objectives are achieved when we partner with the international community and with the countries and peoples of the region. so what does this mean going forward? in the near term, america's diplomatic efforts will focus on two particular issues. iran's pursuit of nuclear weapons and the arab-israeli conflict. while these issues are not the cause of all the region's problems, they have been a major source of instability for far too long and resolving them can help serve as a greater

foundation for broader peace. the united states and iran have been isolated from one another since the islamic revolution since 1979. this mistrust has deep roots. iranians have long complained of a history of u.s. interference in her affairs and of america's role in overthrowing the iranian government during the cold war. on the other hand, americans see an iranian government that declares the united states an enemy and taken american hostages, killed u.s. troops and civilians and threatened our ally israel with destruction. i don't believe this difficult

history can be overcome overnight. the suspicions run too deep. but i do believe that if we can resolve the issue of iran's nuclear program that can serve as a major step down a long road towards a different relationship, one based on mutual interests and mutual respect. since i took office, i made it clear in letters to the supreme leader in iran and more recently to president rouhani, that america prefers to resolve our concerns over iran's nuclear program peacefully, although we are determined to prevent iran from developing a nuclear weapon. we are not seeking regime change and we respect the right of the iranian people tore access peaceful nuclear energy.

instead, we insist that the iranian government meet its responsibility under the nuclear nonproliferation treaty and u.n. national security resolution. the supreme leader has issued a against the development of nuclear weapons and president rouhani has recently reiterated that the islamic republic will never develop a nuclear weapon. so these statements made by our respective governments should offer the basis for a meaningful agreement.

we should be able to achieve a resolution that respects the rights of the iranian people while gisk the world confidence that the iranian program is peaceful. but to succeed, words will have to be matched by actions that are transparent and verifiable. after all, it's the iranian government's choices that have led to the comprehensive sanctions that are currently in place, and this is not simply an issue between the united states and iraq. iran has evaded its responsibilities in the past and iran needs to meet its obligations in the future. but, i want to be clear, we are encouraged that president rouhani receive a mandate to pursue a more moderate course and given his statement, i'm directing john kerry to pursue this in close cooperation with the european union, the united kingdom, france, germany, russia and china. the roadblocks paved may prove to be too great but i believe that the diplomatic path must be tested, for while the status quo will only deepen iran's isolation, for them to go down a

different path will be good for the region and the world and help the iranian people meet their potential in commerce, culture, in science and education. we are also determined to resolve a conflict that goes back even further than our differences with iran and that is the conflict between palestinians and israelis. i have made it clear that the united states will never compromise our commitment to israel's security, nor our support for its existence as a jewish state. earlier this year in jerusalem, i was inspired by young israelis who stood up for the belief that peace was necessary, just and possible. and i believe there is a growing recognition within israel that the occupation of the west bank

is tearing at the democratic fabric of the jewish state. but the children of israel have the right to live in a world where the nation assembled in this body fully recognize their country. and where we reject those who fire rockets at their homes or incite others to hate them. likewise, the united states remains committed to the belief that the palestinian people have a right to live with security and dignity in their own sovereign state. on the same trip, i had the opportunity to meet with young palestinians in ramallah whose potential is unmatched by the pain they feel and having no firm place in the community of nations. they are understandably cynical that real progress will ever be

made and they are frustrated by their families enduring the indignity of occupation. but they recognize that two states is the only real path to peace, because just as the palestinian people must not be displaced, the state of israel is here to stay. the time is now right for the entire international community to get behind the pursuit of peace. already israeli and palestinian leaders have demonstrated a willingness to take significant political risks. president abass has put aside efforts to pursue peace and president netanyahu has reafffirmed his commitment to a palestinian state. current talks are focused on borders and security, refugees and jerusalem. so now the rest of us must be willing to take risks as well.

friends of israel, including the united states must recognize that israel's security as a jewish and democratic state depend on the realization of a palestinian state. and we should say so clearly. arab states and those who supported the palestinians must recognize the stability will only be served through a two- state solution and a secure israel. all of us must recognize that peace will be a powerful tool to defeat extremists throughout the region and embolden those who are prepared to build a better future. and moreover, ties of trade and commerce between israelis and arabs could be and engine of growth and opportunity while too many people in the region are without work. so let's emerge from the familiar corners of blame and prejudice, let's support israeli and palestinian leaders who are prepared to walk the difficult

road to peace. real breakthroughs on these two issues, iran's nuclear program, and the israeli-palestinian peace, would have profound impact in the whole region. just as lasting peace cannot be measured only by agreement between nations, it must also be measured by our willingness to resolve conflicts within nations. by that measure, it is clear that all of us have a lot more work to do. when peaceful transitions began in tunisia, the entire world was filled with hope.

although the united states, like others, was struck by the beat of transition, and although we did not, and could not dictate events, we supported those who call for change. we did so based on the belief that these transitions would be hard and take time, but the societies based on democracy and the openness and dignity of the individual what ultimately be more stable, more prosperous, and more peaceful. over the last few years, particularly in egypt, we have seen just how hard this transition would be. mohamed morsi was democratically elected, but proved unwilling or unable to govern in a way that was best for his people. the interim government that

replaced him responded to the heirs of the people who believe that revolution had taken a wrong turn. they made decisions inconsistent with democracy. america has been attacked by all sides of this internal conflict, simultaneously accused of supporting the muslim brotherhood, and engineering the removal of others. the united states has purposely avoided choosing sides. our overriding interests throughout these past few years has been to encourage a government that legitimately reflects the will of the egyptian people. one that has respect for the minority rights and the rule of law, freedom of speech and assembly, and a strong civil society. that remains our interest today. so going forward, the united states will maintain a constructive relationship with

the interim government, and will continue support in education that will benefit the egyptian people. we have not proceeded with the delivery of certain military systems, and our support will depend on egypt's progress. the united states will a time work with governments who do not need, at least in our view, the highest international expectations, but who are working with our core interests. nevertheless come a we will not stop asserting interests and ideals. whether that means supporting the international declaration of rights. we will reject the notions that these ideals are simply western

exports incompatible with the ideals of the east. we believe they are the birthright of every person. although we will be wary of efforts to impose democracy through military force, and though we will be accused of inconsistency, we will engage the upholding of the law. this is the task of our generation. we understand such long-standing tissues cannot be solved by outsiders, they must be

addressed by the muslim communities themselves. we have seen grinding conflict come to an end before, most recently in northern ireland when catholics and muslims both realized that the endless cycle was causing both immunities to fall behind a fast-moving world. we believe those same sectarian conflicts can be overcome in the middle east and north africa. to summarize, the united states has hard-earned humility when it comes to our events and interactions inside countries. the american empire may be useful propaganda, but it does not reflect america's current policy or public opinion. as recent debates within the united states over syria clearly show. this is not an america that is too eager to immerse itself in

the affairs of other countries, or take on responsibility in other regions than itself. the danger for the world is that the united states and after a decade of war, is rightly concerned about issues back home. aware of the hostilities that our engagement in the region has engendered throughout the muslim world, they disengage, creating a vacuum of leadership that no other nation is ready to fill. i believe that such disengagement would be a mistake. i believe america must remain engaged for our own security, but i also believe a world is better for it. some may disagree. but i believe america is exceptional, in part because we have shown a willingness, to the sacrifice of blood and treasure to stand up, not only for our own interests, but for the

interests of all. i must be honest though, we are far more likely to invest in countries who want to work with us, to invest in their people, rather than the select few. to embrace a vision of society e contribute, man, woman, shia, sunni, muslim, or jew. from europe, to asia, from the africa to americas, we are looking for those who are looking to uphold a common humanity. i believe the same will hold true for the arab world. this leads me to a final point. there will be times when the breakdown of society so great, the violence against civilians so substantial, that the

international community will be called upon to act. this will require some very tough choices. the united nations was designed to prevent wars between states, and increasingly we face the challenge of providing slaughter within states. these challenges will grow more pronounced as states grow fragile or fail. places where this violence can put men, women, and children at risk, with no hope from their international institutions. i've made it clear that even when america's core interests are not threatened, we stand ready to protect basic human rights. we cannot, and should not, bear that burden alone.

in mali, we supported both the french intervention and african forces who are keeping the peace. in eastern africa, we are working with partners to bring the lord's resistance army to an end. in libya, when the security council provided a mandate to protect the civilians, we took action. because of what we did there, countless lives were saved. i know that some now criticize libya as an object lesson. they point to a democratically elected government struggling to provide security. they say it is doomed to fail,

look at libya. i would remind them of the americans who are committed to the libyan people, including the ambassador. does anyone truly believe that the situation in libya would be better if he had been allowed to brutalize and kill his people into submission? it is far more likely that without international action, libya would be engaged in civil war and bloodshed. we live in a world of imperfect choices. different nations will not agree on every instant, but sovereignty is that the center of our order.

sovereignty cannot be an excuse for the international community to turn a blind eye. while we need to be modest in our beliefs that we can remedy every evil, while we need to be mindful that the world is full of unintended consequences, do we really accept the notion that the world is powerless in the face of a rwanda? if that is the world that people want to live in, they should say so, and reckon with the cold logic of mass graves. i believe we can embrace a different future. if we do not want to choose between inaction or war, we must get better, all of us. we should respect the sponsor list of nations and of individuals, meaningful sanctions for those who break the rules, dogged diplomacy that

resolves the root causes of conflict, not merely its aftermath. development assistance that brings hope to the marginalized. while this may not be enough, there will be moments that the international committee needs to acknowledge that the multilateral use of military force may be needed to prevent the very worst from occurring. ultimately, this is the international community that america seeks. nations that do not convert the resources and lands of other nations, but those who carry out the founding purposes of this institution, and where we all have a responsibility, to uphold the rules established to prevent the kinds of wars that our

forefathers fought. a world where human beings can live with dignity, whether they live in new york, or nairobi, or damascus. these are extraordinary times, with extraordinary opportunities. thanks to human progress, a child born anywhere on earth today can do things that 60 years ago would have been out of reach for the mass of humanity. i saw this in africa where nations moving are poised to take off. they are able to bring power to places off the grid. i see across the pacific region where hundreds of millions have been lifted out of poverty in a single generation. i see it in the faces of young people everywhere, who can access the entire world with a click of a button, who are eager

to join the cause of eradicating extreme poverty and work on climate change, expand freedom, and leave behind the old ideological battles of the past. that is what is happening in asia, africa, it is happening in europe, across the americas, that is the future of the people of the middle east and north africa deserve as well. that way they can focus on opportunity, rather than whether they will be killed for what they believe. time and again, nations and people have shown our capacity to change, to choose our better history. last month, i stood where 50 years ago martin luther king jr. told the american people, at a time when people of my race cannot even vote.

i stood in the cell where nelson mandela endured decades, from his people and his world. who are we to believe that today's challenges cannot be overcome? we have seen the changes that the human spirit can bring. so in this hall can argue that we will give over to those who would seek to oppress the spirit? i know what side i want this country to be on, and we are ready to meet the challenges of tomorrow with you. we believe that all men and women are created equal, and are possessed with a dignity, and an inalienable right that cannot be denied. they will look to the future with not fear, but hope.

thank you very much. >> his excellency. on behalf of the general assembly, i have the honor to welcome the president of the islamic republic of a ran. -- iran. >> in the name of god, praise be

to god, the lord of the world. --sses mr. president, mr. secretary, general, ladies and gentlemen, at the outset, i would like to offer my most sincere appreciation on the election to the presidency of the general assembly and seize the moment to express appreciation for the valuable efforts of our distinguished general mr. chairman. our world today is replete with fear and hope, fear of war and hostile, regional and global

relations. fear of deadly confrontation of religious, ethnic and national identities, fear of institutionalization of violence and extremisim, fear of poverty and destructive discrimination. fear of decay and destruction of life-sustaining resources, fear of disregard for human dignity and rights and fear of neglect of morality. alongside these fears, however, there are new hopes. the hope of universal acceptance by the people and the elite all across the globe of yes to peace and no to war. and the hope of preference of

dialogue over conflict and moderation over extremism. the recent election in iran represents a clear living example of the wise choice of hope, rationality and moderation by the great people of iran. the realization of democracy, consistent with religion and the peaceful transfer of executive power manifested that iran is the anchor of stability in an otherwise ocean of regional instabilities. the firm belief of our government in enduring peace, stability, tranquility, peaceful resolution of disputes and reliance on the ballot box as the basis of power, public acceptance and legitimacy has

indeed played a key role in creating a safe environment. mr. president, ladies and gentlemen, the current critical period of transition in international relations is replete with dangers although with unique opportunities. any miscalculation of one's position, and of course of others, will bear historic damages, a mistake by one actor will have negative impact on all others. vulnerability is now a global phenomenon. at this sensitive junction, the age of zero-sum game is over.

even though a few actors attempt to rely on archaic and deeply ineffective ways and means to preserve their superiority and domination, resource to violence to subjugate others are failed examples of the perpetration of old ways in new circumstances. coercive, economic and military policies and practices geared to the maintenance and preservation of all superiorities and domination have pursued in a conceptual mindset that negates human ideals.

ignoring differences between societies and globalizing western values as universal represent another manifestation of this conceptual mindset, yet another reflection of this model is the persistence of cold war mentality and bipolar division into the superior us and inferior others, fanning fear and phobia around the emergence of world actors on the world scene is another. in such an environment, governmental and nongovernmental religious, ethnic and even -- and there is no guarantee that the era of big

powers will refrain from such violent discourses, practices and actions. catastrophic impact of violence and extremist narratives should not in fact, must not be underestimated. violence that is manifested in the efforts to deprive regional players from their national domain of action containment policies, race regime change from outside and the efforts toward redrawing of political borders and frontiers is extremely dangerous and provocative. the international political discourse surrounded by uncivilized controversies. in this picture, the relation between the centers of world

power is homogenic. the discourse of the center stage and relegating the south to the periphery has led to the establishment of a monologue. the identity of distinctions and the xenophobia is the discourse and unfounded islamophobic to doing this represents serious threats against world peace and human security. this propaganda discourse has assumed dangerous proportions

through portrayal and inculcation of assumed imaginary threats and one is the so-called iranian threat which has been employed as an excuse to justify a long going of crime and practices over the past three decades. the arming of the saddam hussein regime of chemical and supporting al qaeda are two examples of catastrophes. let me say this in all sincerity between this august world assembly, based on irrefutable evidence those who hardship on the so-called threat of iran -- [indiscernible] >> absolutely no threat to the world or the region, in fact in ideals as well as in actual practice.

my country has been a harbinger of peace and comprehensive security. mr. president, and ladies and gentlemen, no where has it be so deadly and destructive as north africa and west asia. military intervention in afghanistan, saddam hussein- imposed war against iran, occupation of kuwait, military intervention against iraq, brutal repression of the palestinian people, assassination of common people and political figures in iran and terrorist bombings in countries such as iraq, afghanistan and lebanon are examples of violence in this region in the last three decades. what has been and continues to be practiced against the innocent people of palestine is nothing less than structural

violence. palestine is under occupation. the basic rights of the palestinians are tragically violated, and they are deprived of the right of return and access to their homes, birthplace and homelands. and one can hardly describe the crimes and the institutionalized aggression against the innocent palestinian people. the human tragedy in syria represents a painful example of catastrophe of violence and extremism in our region. from the very outset of the crisis in one regional and international actors helped to militarize the situation through arms and intelligence into the country and active support of

extremist groups. we emphasize that there was no military solution to the syrian crisis. pursuit of expansion of the tragedies and objectives and attempts to change the regional balance cannot be camoflauged behind human rhetoric. the common objective of the international community should be a quick end to the killing of the innocent. while condemning any use of chemical weapons, we welcome syria's acceptance of the chemical weapons convention and believe that the access by extremist terrorist groups to such weapons is the greatest danger to the region that must be considered in any disarmament

plan. at the same time, i shall underline the end of ineffective use or the actual use of force will only lead to further violence and crisis in the region. terrorism and killing of innocent people are you represents extremism and violence. terrorism is a violent scourge. but the violence and extreme action such as the use of drones against innocent people in the name of combating terrorism should also be condemned. here, i shall say a word about the criminal assassination of iranian nuclear scientists. for what crime have they been assassinated?

the security council should answer the question. have the perpetrators been condemned? unjust sanctions as manifestation of structural violence are perfectly inhumane and against peace and contrary to the claims of those who pursue and impose them and the political elites that are targeted but rather the common people that are victimized by these sanctions. let us not forget millions of iraqis who as a result of sanctions, hovered in international jargon, suffered and many more who continue to suffer all through their lives. these sanctions are violence,

pure and simple, whether called smart or otherwise, unilateral or multi lateral, and right to peace, right to development, right to access to health and education and above all, the right to life. sanctions beyond any and all rhetoric cause war mongering and human suffering. it should be bore in mind however, that the negative impact is not merely limited to the intended victims of sanctions. it also affects the economy and livelihood of other countries and society, including the countries imposing the sanctions.

violence and extremism nowadays have inflicted and tarnished the dimensions of life in human societies, violence and extremism leave no space for understanding and moderation as the necessary foundation of collective life of human beings. intolerance is the predicament of our time. we need to promote and reinforce tolerance of the religious teachings and cultural and political approaches. the human society should be elevated from the state of mere tolerance to that of collector collaboration. we should not just tolerate others. we should rise above mere tolerance and dare to work together. people all over the world are tired of war.

violence and extremism. they hope for a change in the status quo. and this is the opportunity for all, islamic republic of iran believes that all challenges can be managed successfully through a smart judicious hope and moderation. war mongerers are bent on extinguishing all hope but hope for change. inate, religious, widespread and universal concept. in the belief of the universal will of the people across the globe to combat violence and extremism to impose change, to value choice and to act in accordance with human responsibility. hope is no doubt one of the greatest gifts bestowed upon human beings by their all loving

creator and to move in a wise manner, conscious of the time. ideals with choice of effective strategies and policies while cognizant of objective realities. they want a choice. discourse of hope. both at home and abroad. in foreign policy, the combination of these elements means that the islamic republic of iran will act responsibly with regard to regional and international security and is willing and prepared to cooperate in these fields bilaterally as well as multi laterally with other responsible actors. we defend peace based on democracy and the ballot box

everywhere, including syria and bahrain and other countries in the region and believe there are no violent solutions to world crises. the ugly realities of the human society can only be overcome through recourse to end reliance, interaction in moderation, securing peace and democracy and ensuring the legitimate rights of all countries in the world, including the middle east. cannot and will not be realized through militarism. we seek to resolve problems, not to create them. there is no issue that cannot be resolved through reliance through prudent moderation, mute

tall respect. iran's nuclear dossier is a case in point. as clearly stated by the leader of the islamic republic of iran, the right of iran constitutes the best and easiest way of resolving this issue. this is not political rhetoric. rather, it is based on a profound recognition of the state of technology in iran, global and political environment and end of the zero-sum games and imperative of seeking common objectives toward reaching common understanding and shared security. put otherwise, iran and other actors should pursue two common objectives as two mutually inseparable part of a political solution for the nuclear dossier of iran.

one, iran's nuclear program and for the matter that of all other countries must pursue exclusively peaceful purposes. i declare here openly that notwithstanding the position of others, this has been and will always be the objective of islamic republic of iran. nuclear weapon and other weapons of mass destruction have no place in iran's security and defense doctrine. and contradicts our fundamental religious and ethical objectives. it is imperative we remove any and all reasonable concerns of iran's peaceful nuclear program. two, the second objective that is acceptance of and respect for the implementation of the right

of the enrichment inside iran and enjoyment of other nuclear- related rights toward the path of achieving the objective. the nuclear technology inclusive of enrichment has enriched the industrial scale. it is unrealistic to pursue that the peaceful nature of the nuclear program of iran could be insured. in this context, islamic republic of iran insisting on the implementation of its right and imperative of international respect and cooperation in this exercise is prepared to engage immediately in result-oriented talks to build mutual confidence and removal of mutual

uncertainties with full transparency. iran sees instructive engagement based on mutual respect and common interests and within the same framework does not seek to increase tensions with the united states. i listened carefully to the statement made by president obama today at the general assembly. the political will of the leadership in the united states and hoping that they will refrain from following the shortsided interests of war mongering pressure groups. we attempt to arrive at a framework to manage our differences. to this end, equal footing, mutual respect and the

recognized principles of international law should govern the interactions. of course, we expect to hear a consistent voice from washington. mr. president, ladies and gentlemen, in recent years, a dominant voice has been repeatedly heard. the military option is on the table against the backdrop of this ineffective contention -- let me say loud and clear that peace is within reach. so in the name of islamic republic of iran, i propose the consideration by the united nations of the project the world against violence and extremism,

let us all join this. i invite all the states, international organizations and civil institutions to undertake a new effort to guide the world in this direction. we should start thinking about coalition for peace all across the globe instead of the ineffective coalitions for war in various parts of the world. today, the islamic republic of iran invites you and the entire world community to take a step forward and invitation to join world against violence and extremism. should be able to open a new horizon in which peace will prevail over war. tolerance over violence.

progress over -- justice over discrimination, prosperity over poverty and freedom over despotism. as beautifully said by the iranian poet, be relentless in striving for the cause of good. bring the spring you must, banish the winter, you should. notwithstanding all difficulties and challenges, i'm deeply optimistic about the future. i have no doubt that the world will be bright rejecting violence and extremism. prudent moderation will ensure a bright future for the world.

my hope eminates from the beliefs shared by all divine religions that a good and bright future invades the world. as stated in the holy koran, as we have proclaimed -- will inherit the earth. thank you, mr. president. [applause] >> i wish to thank the president of the islamic republic of iran for the statement just made. may i request representatives to

remain seated while we greet the president. president. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2013] cybersecurity commander general keith out zander speaks about cybersecurity. :00 -- 10:00, we will be

hearing about roads and highways. the long-termay, financial outlook and ways to improve security. and we will be live at 7 p.m. the major party candidates for governor in virginia. >> c-span on like archives for social study education in america. the c-span video library is a great resource for you to view and share content anytime. it is easy. here's how. and go toc-span.org the video library to watch the newest videos going online. you can also search the video library for specific topic or keyword. just type in your name, hit

search, and hit inter-. -- enter. you can use the set buttons or handle pulls. by facebook or google plus. the cable tv industry and funded by your local cable or satellite provider. >> on the next washington journal, we will discuss the possibility of the government shutdown and efforts to defund the affordable care act with rob woodall from georgia. we will also hear about the debate on congress from a member of the financial services committee, maryland democrat john delaney. noahuest will be timothy who wrote an article about job

creation. see -- washington journal is live every day on c-span. how the discussion of congressional debate over spending on health care will coming elections. from washington journal, this is 40 minutes. >> "washington journal" continues. host: welcome back. we're joined by josh kraushaar, the editor of "hotline." thank you for joining us. guest: good to be here, juana. host: lawmakers are focused on the fiscal fights going on. guest: the battle over obamacare, whether it is going to be defunded and the endgame for republicans and the white house, is going to be decided over the next five to six days. it has political consequences, especially on the republican side of things, where we are seeing these divisions between the ted cruz wing of the party, if you will, and the more establishment wing of the party,

and one of the bigger developments in the last 24 hours is that mitch mcconnell, who is up for reelection, tough primary, and announced he would not be filibustering the cr, would not be joining ted cruz to defund -- his version of the defund movement, and mcconnell is going to draw criticism for that position on the right but it is emblematic of the divisions facing republicans across congress between the house and senate, the more tea party activist wing, and the more establishment republicans host: given the divisions between mitch mcconnell and mike lee and ted cruz on this issue, how important is obamacare in 2014? guest: it is one of the biggest issues is not the biggest issue that republicans will be running on in 2014. a disproportionate number of the races are taking place in southern states, conservative

states, states where obama's health-care law is very unpopular. you look at the polls that show a plurality, majority of the voters disliking the health-care law. those numbers are more significant in states like arkansas, kentucky, where mitch mcconnell is from, what states like alaska. the challenge for republicans is to be on message, any a lot of strategists across town are beside themselves that they have this huge political advantage when it comes to health care, and it comes to criticizing the president's law, but some of the more activist tea party members of the party are choosing to take the fight over government funding and a potential government shutdown, which is the one area of the health-care law where republicans can lose, where republicans are going to be on the losing end of the health-care argument. it seems like there is cohension coming together at the last minute, and it seems like republicans have this

opportunity, but the big question is if they can make the most of it. host: what can this mean for mitch mcconnell and the big primary he is facing? guest: he is facing this largely unknown opponent, who is trying to accuse mitch mcconnell being an establishment figure. they both oppose president obama's health-care law, but bevin has been accusing him of not being aggressive enough, not supporting some of the more aggressive actions to defund the legislation. you have seen the arguments in this race take place over tarp, which mcconnell supported in the bush years. the emergency funding, which many tea party republicans oppose. mitch mcconnell has a two front war going on. he has to worry about this primary, which he is favored to win, but he cannot take a

challenger like matt bevin for granted. he has a credible democratic challenger, who has been hitting him from the left but she is trying to make her page as a more pragmatic democrat. host: we are talking to josh kraushaar of "the hotline." we would love to take your calls. host: josh, what about political risks for democrats? we have talked about republicans and the dissension between them. what could this mean for democrats and the white house? guest: there are new stories coming out on a near regular basis about major employers -- ups, trader joe's. we saw the cleveland clinic

news. big companies are laying off workers and dumping some of the workers they have been covering on their insurance plans. even president obama delayed one big element, the employer mandate, for year because it doesn't seem ready to go. it is a big vulnerability for democrats. if republicans can get their act straight and have a unifying message, we are only a few days away from the actual october 1 deadline, when the law is going to be implemented or a big part of the exchange is going to take place. people are finding that their health situation is changing, if they have economic anxiety or uncertainty as a result of the changes, it would present republicans with a huge opportunity, a big vulnerability for democrats. we have seen polling on how this stance with the public.

pew research found that for the first time in many years, republicans have an advantage on health care, two-point advantage when it comes to republicans versus democrats. you usually don't see that on an issue that favors democrats, but can they become united and have a united message on the issue? host: how will this impact chances of democrats taking over the house of representatives? guest: the way the districts are aligned and the way things are shaping up, it doesn't seem likely. even if democrats have a good year, it will be hard for them to win the 17 seats necessary to take back the house. the big battlefield will be the senate. republicans need to win six seats to take back the senate. that is a pretty tall order. that said, the seats are in conservative states. there are about seven seats that are in states that mitt romney carried. six of those seven he carried by

double-digits. republican strategy for the senate is when all the seats mitt romney won, do well with the base, i could be a key to a majority. host: we start with elizabeth in iowa on our republican line. caller: hello? host: hi, elizabeth, thanks for calling in. caller: i wanted to ask, this man is a reporter, and he should understand that the word "mandate" can no longer be used. the word is "tax." do not refer to an employer mandate. it is an employer tax. it is not an individual mandate, it is an individual tax. that is the only thing that makes obama care legal. host: josh, your take on the semantics. guest: semantics matter, and

mandate or tax, it is both unpopular. the mandate is more in the tax provision. politically speaking, though, mandate, tax, it is not a good situation for democrats unless they can show that the law is effective, that is working and helping to ensure people and they're getting better insurance as a result. host: what's take another call from susan in reading, pennsylvania, on our independent line. caller: i have a question, just a practical question. my understanding of what i have read about obamacare is these exchanges -- bronze, silver, gold, and platinum. the obama administration is going to want everyone insured,

and that is how insurance works. the people who don't need it pay for the people who need it. that is the way the whole idea of insurance works. the question i have is, a poor young man who graduates from college, can't find a job in his chosen career. he is working 2 part-time jobs at fast food, and he is expected to get insurance. what he gets is going to be the bronze package, because that is what he can afford unless he has wealthy parents. so the bronze package he is paying for. he is on his motorcycle, he is riding down the street, he it is wet, he breaks his clavicle, he goes into the emergency room, where he will need an x-ray, probably an mri. and mri is now $1500 to $2000. the deductible on the bronze package is $2000 to $3000.

how can that young man who has student loans, working 2 part- time fast food jobs, pay for the deductible? let's take it to the next step. now he is home, is getting physical therapy -- host: all right, we got the gist of what you are saying. the different levels of care, can you respond to that? guest: one of the challenges the administration has faced in selling the law is they haven't delineated between access and quality. when president obama sold the law, he said you get everything better access, more quality, the whole shebang. the reality is that the law primarily expands access, which is a good policy goal and it helps certain elements, certain constituencies politically. but most want their health care to be better. the hypothetical situation that the caller brought up is why the law is and not polling well. when you ask people if they think it will help their health

care, they are skeptical. they may think the law is good but they are not convinced it will improve the quality of health care. that is the big political challenge of facing the white house. expands access to people who are uninsured or could not access health insurance previously. but a lot of the stories that the newspapers have been reporting on, isn't going to improve health care? host: how of we seen people on the campaign trail frame the issue? guest: it depends on the state and the issue. you saw 2 democrats last week vote with republicans in defunding the law, in north carolina and utah. very conservative districts, they voted against the law, and they could not have won reelection in all likelihood without voting with republicans on health care. in the more battleground states, you are seeing democrats not

defending every part of the law but making points that are more in their favor -- most notably that it will help people who are uninsured get the access they need. they are saying that the law is imperfect and we want to work to fix it but we are not quite there yet. i'm going to work to fix the law, we don't want to repeal the law. that is the democratic messaging in most of the battleground, competitive states. host: we're talking to josh kraushaar of "hotline." greg on the republican line. caller: yes, i am listening to this mr. kraushaar on television now on your c-span program, and i heard him state earlier that he said that the republicans need to get their act together. it is just remarks like that from the democrats to the republicans and from the republicans to the democrats that is creating this power struggle that we have got in

washington now. we need to get in there and just completely restructure washington, get rid of about half of what's in there. they are all overpaid. they're getting paid way too much money. i'm on disability. i'm making $36,000 a year. i'm living comfortably because i know what i'm doing. these people that are up in washington, half of them don't know what they're doing. just like i said, they are overpaid. we could save a lot of money taking that money and pay them all about $75,000 a year. they are not worth any more than that. we could take all those savings and redo our bridges, our infrastructure -- host: greg, thank you so much for calling in. josh, any thoughts there? guest: that sentiment, throw the bums out, which is why we have had so many wave elections, why

the tea party is an influential force in american politics. people who have the view that the establishment has been there too long and are getting paid too much, you are seeing people in grassroots primaries exposing those sentiments and some are winning elections. some of the tea party candidates get elected and become part of the establishment. marco rubio, considered a tea party conservative, unseated charlie crist. host: this summer you asked the question, has the tea party wave peaked? what did you find? guest: the grassroots sentiment is still there, but they have already won. they beat richard lugar, bob bennett, moderates they felt were not conservative enough.

there is still that sentiment. mitch mcconnell's primary shows there is the ability to upset an incumbent. but when we look at these races now in 2014 versus two or four years ago, there are not quite as many tea party challengers running, even with the high- profile ones in that house in the senate. not as many as there were before. host: tennessee, independent line. caller: yes, good morning. i agree with the other gentleman that called. it is not republicans that want to shut the government down. this bill is too big, nobody has read it, it keeps being changed, some people have to have it, some people don't. lenin, the founder of the soviet communist state, said socialized medicine is the keystone to the arc of the socialist state. host: thank you so much.

josh, let me ask you this -- if the shutdown happens, it will be the first since the clinton presidency. as somebody who studies politics, do you think it will come to pass? guest: we have seen this before in recent history, and the game boehner is different than newt gingrich, and that he is part of the establishment wing and he has no illusions that he is more powerful than president obama. newt gingrich in the 1990s thought he was a co-equal and had equal influence with the president. i don't think john boehner has those illusions. i think the most likely outcome is we will see, like we did with sequester and the debt ceiling, some last-minute, very last minute compromise, something struck that does not involve health care were defunding the health-care law.

we will see some punt yet again to avoid a government shutdown. host: larry in tennessee, calling on the democrats line. caller: i would like to just make some comments. first, i think there is a tremendous lack of communication on the details of affordable health care act. there has been obstructionism in the states, whose governors don't want for political reasons the affordable health care act to come out. they don't want the details to come out to the general public. it is all upon the citizens to take upon themselves to learn as much as they can about the affordable health care act. if they would go to www.healthcare.gov, the people

can learn about the affordable health care act. they are going to have to do that by themselves. it seems like everybody -- every time i listen to the radio or television, all i hear is obamacare, obamacare, obamacare, and no details about it. the public is sitting there and all they hear is this negative about obama care and no details. host: thank you so much, larry. you were speaking about the messaging and that goes to the heart of larry's comment. guest: most people don't know what is in the law. they still don't know what is in it. they are very skeptical. people will find out if there are troubles implementing the law. they will find out directly.

if you have trouble with her health care, that is what will make people feel strongly. it is less about what is in the law and what affects your average -- americans aren't paying close attention politically, but if their health changes and they are having trouble getting a job and a small business because of certain changes in the health- care law, that will have a big [captioningtically. performed by national captioning institute] [captions copyright national cable satellite corp. 2013]

vote, a vote that would say yes, i don't believe this is a tax and it should not be considered as a tax by the courts and it should not be upheld by the courts as a tax, it should not be construed under any circumstances a tax because we don't regard it as that.

eresting thing, of course, is that that's naturally the way that people who are the law's biggest defenders would like to vote in some respects because they want to tell the american public and they still are telling the american public it's not a tax, it's a penalty, but if, in fact, they actually put their vote in that direction, if they put their money where their mouth is and they pass that into law, well, guess what happens to the supreme court's ruling. what would happen to the supreme court's ruling in that circumstance, senator cruz, if we were to pass senate bill 560 into law. let's assume that somehow magically it passed the house and the senate and president obama signed it, perhaps it united both parties behind this concept that yeah, this is not a tax. what then would become of the supreme court's ruling upholding the patient protection and affordable care act on that basis? mr. cruz: well, that's an excellent question, senator lee. it's an excellent question from senator lee, and the answer's

quite simple. if congress acted to make clear that nothing in the affordable care act created a tax, that would remove the entire basis for the supreme court's upholding obamacare, and indeed it would be a relatively simple matter in subsequent litigation for the court to conclude under the matters it's already concludeed that the other bases upholding the act are not present. now, when you have elected officials that go to the people and go to the people as senator lee quite rightly noted and still say it's not a tax, you would think they would happily vote for it except there is a vested interest, and i would note there is a difference between calling this a tax when congress said and said it's not, and the examples is we went through the 100 years war and the purple finch and that those are relatively innocuous misnomers or this is something

designed to be actively deceptive. indeed, another one you could add to that litany we went thro

the first is to maximize existing data for automatic enrollment in medicaid. maryland and oregon plan to automatically transfer adults

into full medicaid coverage. oregon is also looking at utilizing eligibility implementation from supplemental assistance programs to facilitate enrollment into medicaid. the second key strategy identified is really reaching out to uninsured parents, who already have children enrolled in medicaid and chip. many parents will be eligible for the medicaid expansion or the marketplace subsidies. all three states have targeted outreach plans for certain sub segments of the population, including communities of color and those with limited english proficiency. efficiency. nevada really emphasizes their plans to do significant outreach

to spanish-speaking hispanics in the states, who make up a large segment of the eligible population. similarly, in oregon and nevada, states are working directly with the tribes to conduct targeted outreach to american indians and provide them with enrollment. across all three states, you have heard the important role of the faith community, and plans to conduct outreach and enrollment efforts through the faith community and faith leaders. the last set of findings i wanted to touch on relates to political leadership and stakeholder collaboration. what we heard from respondents involved in all three states was that close collaborative working relationships among another -- a number of state agencies is really key for successful preparation. in particular, some of these agencies included the medicaid agency and the department of insurance. in all three states, they are talking amongst these agencies every day, working as a team to move forward with the expansion preparation. moreover, we heard consistently that strong state leadership has been important for moving efforts forward and spurring that collaboration among different groups within the state.

similarly, all three states invested early on in gaming stakeholder input, which contributed to the ongoing involvement of stakeholders throughout the process of preparing for enrollment. lastly, all three states described the positive relationship with federal partners on implementation, but noted that the delay in some of this has been an implementation challenge, to move forward while waiting for final rules from the federal government. just to wrap up, i think the experiences from these three states show us -- the states that are committed to moving forward have really achieved significant progress in preparing for the expansions. and strong political leadership and close collaborative relationships, as well as creativity, adaptability, and a

willingness to improve over time have all been key components to their success. looking ahead, october 1 will mark the start of opportunity for individuals to begin accessing coverage that will begin in january. some people are going to enroll right away, while some will take time to explore their options. since coverage will not begin until january, individuals can take time to research their options without missing out on coverage. the six-month long enrollment period would give states the opportunity to continue to improve their systems. we believe that experiences will likely continue to improve over time. while marketing campaigns will help educate individuals and raise awareness, enrollment efforts will really be driven at the local level, through on the ground work. i look forward to hearing from our panelists, who i think are

going to have great perspectives on what those efforts will look like in their respective states. thank you. [applause] we are going to turn to our panelists. we are going to start with the state of maryland. i am cathy. i thought it was important to provide a brief overview of our organization, so you can realize why a connector entity in maryland was a natural fit for us. we have been in operation 17 years. we were the key agency to enroll children into children's health care programs. we also provide a wide variety of case management to baltimore populations in the greater baltimore area. individuals who are homeless,

children in foster care, immigrants -- you name it. we are working very closely with vulnerable populations. in maryland, we are an amazing state, really far ahead of the game. the lieutenant governor and the health secretary -- it has been remarkable to watch. they invested a lot of time, energy, and resources into making sure this goes well. health care access maryland was recently awarded a connector grant. health care access maryland has baltimore city, baltimore county, and anne arundel county. there are approximately 200,000 people who are uninsured in that region. we have established partnerships with 17 different partners, which we will talk more about later. i am going to keep remarks focused on our outreach and enrollment strategies, as requested. more globally, we are looking to capitalize on the state

marketing campaign. the state has invested $2.5 million in commercials, tv ads, radio ads, bus ads, bus shelters, and so forth. they have also developed partnerships with grocery stores safeway, giant, cvs -- and the baltimore ravens. they found seven out of 10 people in maryland watch ravens games. we will have commercials during the ravens games, as well as on the big screen. our staff will go into giant, safeway, and cvs, and meet people where they are to help with some of the enrollment processes. at the local -- actually, let me talk a little bit about our connector program. we have a $7.9 million grant. we recently hired 107 navigators. that is one navigator to about 2000 people. that sounds like a lot of people, but when you look at

that ratio, you shake your head a little bit. we have developed a wide variety of partnerships with formal partners and informal partners. our 17 partners, what we call formal partnerships, is where there is a lot -- a monetary exchange. we have given them money to hire their own navigators in their organization. we are working with hospitals and a wide variety of community- based organizations to hire their own navigator as sisters assistors. we plan to embed our own staff into other venues. we think libraries are a very important ways to go. ymca in central maryland. we are working very closely with all the school systems in each county. for instance, the baltimore city public school students, on their very first day of school, brought some information about

the affordable care act and how their parents can enroll and sign up. we have lots of calls already from that outreach. working with community colleges as well. it is a great place to go in all three of the regions. we also felt that talkinto high school seniors was very important.theyre graduating. they are a very good population to talk to as they enter college and are looking for other resources. we really are going to capitalize on our existing infrastructure. there is a lot of infrastructure already in place. we are working closely with local departments of social services. we are working with local health departments and clinics.

also working with our in-house home visiting programs to provide case management to 80,000 people every year. health care access maryland serves 150,000 people every year. we are also out reaching a child or pregnant women. there are several other people in the home that qualify for benefits. we plan to do the in-reach in their homes to spread the word about the affordable care act and how people can enroll. it is important for them to understand that our staff will not be sitting in the offices -- it is important to understand that our staff will not be sitting in the offices. they will have laptops, scanners, and printers, all portable. they really do hope to put them in a wide variety of locations in our jurisdiction. one other important thing is,

health care access maryland -- we have already had a health care insurance hotline since 2008. we already get 5000 two 7000 -- to 7000 calls a year on that hotline. we hope people will get through in that approach we have. >> we are going to turn to the other side of the country, to oregon. on the telephone, i would like to welcome samantha sheppard to offer some comments on behalf of the state of oregon. >> thank you so much for having me here today. i am sorry i cannot join you in person and i'm joining by phone. a pretty busy time on the ground in oregon. hard to step away. thank you so much for looking at the challenges we have faced. in oregon, for outreach and enrollment assistance, we have established a community partner program. we put under one umbrella navigators, application assistance, provider entities,

hospitals, and more. we had a pretty robust program already in oregon, two hundred organizations that already did application assistance for medicaid and chip for a number of years. we were able to build on that community partner program and invite new entities to join as well. we have administered some grants to outreach and enrollment grantees. we have a few other opportunities that just closed, and we are getting the final agreements. most of our partners will be funded. the rest are provider entities that receive general fund dollars from the state or federal government, or received grants to do this work. we are not treating them any differently. we think it is a strong program to have everybody in one bundle. it makes it easier from a staffing perspective. one of our key strategies in

oregon is to have ongoing staffing for our community partner program. we have regional outreach programmers who should be front line in communities across oregon, to make sure partners and insurance agents are coming forward to collaborate and look for the best customer service possible. our regional outreach programs develop monthly collaborative meetings, where people doing outreach and enrollment, or insurance agents and health directors, can come together and talk about best practices, what opportunities they can partner on, etc. our staff also have an online social networking tool that we put together for our community partners and agents, where we can stockpile resources for them, fact sheets, flyers, and handouts they can access or reference while doing their work in the field. we know that it is hard to give every agent what they need on

september 30, to go live on october 1, so we wanted to make sure we had ongoing resources available to them. not everything is going to stick in training and not everything makes sense. so we knew having this technical assistance would be key. collaboration is key and have tried to rise the function functionality. -- the functionality and the system for partners. it is the same. how they work with the consumer and access client accounts and find someone eligible and help them enroll. it is the same functionality. we are able to have conversations on the same plane. we think that's strong. the overall marketing campaign, you heard our ad. you have heard our campaign. we have had several musicians

write us music that we are using as our key strategy and great way to get stuck in peoples' minds and doing google hangouts and other social media to reach young people and the isolated areas of our state. if anyone has traveled to oregon, you know about one half of our population lives in the portland area. to reach the rest of the state, social media will help. we have also done community meetings for the public and other things like that as well. we have a strong relationship in our state medicaid agency to cover oregon, but we are streamlining our organization as well as our outreach program which reinforces the overall system. we expect on day one to have about 250 community partner organizations that are doing this work. we don't certify any individuals to do application assistance. we certify organizations. we have contracts with them. and they hire staff and bring on volunteers that they are responsible for. we train the volunteers and make sure they jump through the hoops and the organization makes

sure they through they go through criminal histories, et cetera, to get them into the system and make sure privacy is protected. i think that's a pretty good overview. i would add as i said earlier, we were able to build off of an existing program here but also for outreach we have a strong stakeholder that has been doing outreach and we found no reason to recreate the wheel and we have tried to steal it. we would like to put a different spin on it. we have been trying to build off of what works. that includes the school flyers, as well as making sure that we are using integrated outreach strategies things like provider clinics, people ask the question, are you uninsured, easy strategies that are low-

dollar costs and something sustainable for years to come. thank you so much for your time. >> thank you, samantha and i know you will be with us for the questions and answers. we are going to not turn back to now turn back to nikki king, from nevada. >> thank you for having me. i'm with access to health care in nevada. we are one of the only statewide nonprofits, which is quite a feat, because it takes nine hours to drive from reno to vegas. nevada is huge. what do we do? i wanted to provide you background on who we are because i'm coming here from a perspective, we aren't affiliated with the exchange but

here for the micro. we operate a medical discount plan. we have been serving the uninsured before it was cool. so for seven years, we have been serving the uninsured with a medical discount plan. we built a network of providers. it looks like an insurance product, but it's not. built a network of 2,000 providers. our members are between 100% and 250% of the fpl and they have access to the network and access to care coordination, which has been huge for their success. they pay the providers at the time of service a vastly discounted rate. each member gets to choose a provider. that visit is $40. we have every kind of specialty. we have hospitals, every health care service that someone would need all at vastly reduced rate. our hospital rate is $400 a day.

with a $3000 cap. specialty care is $65 and mri costs $260. we have flat rates for everything. it has been a life saver in nevada, where if you are a single adult, female or male, you cannot get on medicaid. we have very few services apart from our safety net services. but we are the only entity in nevada that has been serving the uninsured with a comprehensive program. so we are well positioned to continue this effort. about 40% of our members will go on medicaid, because once in our history, nevada did something right, we are not at the bottom. so our state did -- we are expanding medicaid and do have our marketplace. we are going to assist that 40% on to medicaid partnering with our navigators that are with our community health clinic.

the rest of them, 60%, we have grown to know and love our members on an individual members. -- on an individual basis because of the care coordination. most of our members have never had access with dignity to the health care system. and that's what we have rhode have provided for them. we literally have had people crying in our enrollment room because timely they are going to be able to get the care they need at a price they can pay with their dignity. we give them a card and access the care just like the rest of us who have had the privilege of having insurance. we felt strongly that we needed to continue to serve our population. what we have done is partnered with a local nevada insurance company. they will provide the health insurance and we will continue to provide the care coordination. so what does outreach and

enrollment look like for us? it's completely one-to-one, because we are using our care coordinators who have a relationship to first, the message is health care reform is here. most of our members are not aware that it actually did pass. we do use the term obamacare, because it does resonate and while it is negative for some, at least we don't have to explain what health care reform is. then we have moved on to -- we did that through robot calls, e- blast, facebook and one-to-one because our members pay a monthly membership fee and they like to pay with cash. we are a cash economy in nevada because of the service industry. so they come in a lot and pay. we have a lot of contact with our membership. a lot of opportunity to tell them what's happening. but then beyond that, they are like, ok, it's coming. how much does it cost? cost is everything to this group, everything.

and health plans are not used to publishing costs and so, it has been a real challenge for our health plan to get comfortable with putting in writing what it's going to cost. only four rating criteria. if you are a woman that lives in a county and makes $32,000 a year and have three children, this is how much your premium will be. finally, we are able to release costs to our membership, which is all they care about. tell me how much it's going to cost. are you talking hundreds of dollars or are talking like $40? this has been a huge break- through for us in terms of our outreach. enrollment will be with brokers. we have become a brokerage. we have a for-profit side because that's the only legal way to do it and will be one-on- one and booked out for the

entire month of october to enroll them one on one with brokers we have hired. it's been an incredible ride. the biggest challenge we are facing is misinformation. it's hard to get the right information in a timely information because everything is so new. thank you. >> thank you very much. we'll return to the east coast to the experience of massachusetts with manny. >> it is great to be here. federallyarge qualified health center located in the heart of boston. we operate out of a single location. 100 million in revenue. 300,000 patient visits. we are also unique, as we operate one of the only 24/seven

departments in the community health center. in 2006, when massachusetts passed health care reform law chapter 58, which required every resident of massachusetts to have health insurance coverage, that meant expanding medicaid, but it also meant creating an organization called connector group, which is responsible for the exchange and for providing subsidized health insurance plans to those who do not qualify for medicaid. alsoonnector was responsible for the enrollment and marketing campaign for the state when they spent millions s including --psa 1 --

youof the population -- need to be a red sox fan to live in massachusetts. [laughter] park of fans at fenway seeing this coming from our professional athletes. particularly our young adults. the connector also made available $3.5 million to community-based organizations. expandney was used to the enrollment staff. are familiarho with community health centers know that we have been doing this for a long time. for over 40 years. we have had financial advisors, and roman wraps -- enrollment reps. with this money we were able to to 20 that staff

individuals. we also used the money to train the entire organization for what was coming. that was important because we felt that this was truly a team effort. at any one point, our patients would be asking the front desk -- we nursing staff wanted to make sure everyone was educated on some level that was appropriate for their position in what was coming. and intensive training to the enrollment staff so they could truly be experts in this area. then we did our own community outreach, knowing that our individuals, our patients were not attending red sox games at $100 per ticket. we needed to got to the churches, the parks, the train stations, where they lived, worked, and spent their leisure time. -- to let themow

know what was coming. we provided one-on-one assistance through the process. this has been an ongoing effort. though we have been doing this for the last five to seven years, it does not stop there. many of our patients have experienced break in coverage or need to go through a redetermination process. we have maintained that staff and they still remain busy. sure folks who have a breaking coverage get back on the appropriate plan or those who have never signed up, making sure they do get signed up. thank you. >> thank you very much. i want to ask samantha to be available for questions. if the audience wants to ask questions and direct them to samantha -- we have to samantha's -- i am talking about

hepherd in oregon. identify yourself first by raising her hand -- your hand. then pose your question. high -- hi, yesterday the new york times wrote an article that said in order to , the limitedwn number of doctor and hospital's incorporated, some as low as 50% or 40% to the surrounding area, that is a huge concern that people who go on the exchanges will have limited choices as far as dr. groups and hospital groups. to ask the states would your experience has been so far.

i would like to preface this by saying i am not a network expert. i do know the maryland insurance administration did establish benchmarks for network adequacy. all the products on the exchange did have to meet certain benchmarks to make their products available on the health insurance exchange. to the best of my knowledge, all the networks on the exchange are adequate. >> i can only speak intelligently about the plan we are affiliated with, st. mary's health plan. with a broad network multiple facilities. the one unique thing they have done is that they have built a pen network for the primary side. they will work closely with them and us and our care court nader's. nators.diat

they're doing cost share incentives. the specialty care network is the same that they have with their other small-group plans. it is quite broad. massachusetts, similar to maryland, the insurance wasission made sure there adequate coverage throughout the state. the reality of this health care reform is that there will be limited networks for particular groups. we are seeing that in massachusetts. expensive academic teaching hospitals in massachusetts. some health plans have limited their members from those groups. thosey have required members to pay half the deductibles of the co-pays if

they prefer to get their care there. is also true of general health insurance as well. the question over here. hi, i am with the national senior citizens law center. this is a question for anyone. how you are dealing with the , your population -- nikki mentioned misinformation. are you doing anything to counter that? more specifically if you are talking about the dual demonstrations that some of the seniors might be eligible for and how it might change things for them. to make a like comment about the senior population. many senior citizens are attending the health care forms. the reality is that this law is

not applicable to them at all. they have medicare. many of them -- this does not apply to them. the dual eligibles -- that is a completely separate topic. the majority of people coming to us, for them it is not applicable. we run the medicare counseling program. we have over 40 volunteers throughout the state of nevada. we administer the program. last week, i spoke with the direct your -- erector-- director. there is a lot of confusion. we set upe doing is town halls through the state of nevada. volunteers are going out to educate our senior population that everything stays the same for them. there is a lot of confusion about what is happening. about how the two work together.

>> i can chime in from oregon. we are partnering with our ship program. we have been cross pollinating our community programs and inviting them to our online collaboration tools. so that we can send that population to where they will get the best service. we have also been incorporating fraud messaging into our messaging campaign. we have been making sure people in oregoncoverage people will and will not ask for. we willg to our list -- never call you and ask you for our credit card number -- your credit card number. you will never be asked for payment to apply. we want to make sure people know how to call our customer service vendor. and not somebody that is not certified to do this work.

we are aware of the concern and are trying to address it head on. i am with and roll america. -- enroll america. we are looking for people to be volunteers. we would appreciate any help in maryland recruiting volunteers. my question to several of you is , what ways can volunteers help you? that is one of the questions that i don't know the answer to yet. i would be glad to hear what kind of needs you have that we can provide help with. the connector entities need as much help as possible to get the word out. about the law, about who to call about enrollment. notonly do people understand the law, they don't understand where to go to enroll. hopefully the local campaigns

will help inform individuals. if you are able to do a regional approach in your volunteer approach, working with the connector entity in the geographic region and having ties in with them would be tremendously helpful. >> hello, we do a lot of health communications work. one of my questions came from the slides. you mentioned challenges with it. can some of you describe what those challenges, or what the biggest challenge has been setting up i.t. and the solutions or the things that have been helpful? >> i am probably going to kick this off to samantha in oregon because she can speak more directly to her experiences.

when we directed -- conducted the case studies, they were building new systems. there is a lot of effort involved in getting those systems off the ground. to me indicating complex policy to the individuals actually building the systems -- there was a learning curve for the i.t. folks to communicate with the policy folks. because the systems are doing integrated determinations for medicaid as well as the marketplaces, it involves the coordination of a lot of different folks at the state level. the statesrd is that needed to establish strong, close, collaborative working relationships in the agencies to get those systems built. the other challenge, which i referenced at the end am a is that a lot of the final rules from the federal government came out a lot slower than the states would like. a need to meet

certain target deadlines in order for their systems to be ready to go on october 1. in many cases, at some point states had to move forward while they were still awaiting those final rules. they would stay in contact with mf, to make sure they knew where they were going. because the i.t. build has been such a new -- new challenge, we have heard that the systems are not exactly what they would like to be on a sober first. they had to prioritize. they are planning to continue to enhance the capability over time and are building in workarounds until they can get those capabilities built-in. samantha, do you want to touch on oregon? that there are a

lot of cooks in the kitchen when it comes to this. we have to be able to communicate with all of the state systems. to build interfaces with them. this legacy system can be anywhere from numeral -- from 10 to 15 years old. be able to transmit information with carriers and the federal hobbit. -- federal hub. ways is a lot of information can be interpreted and all of the carriers have their own systems as well. getting all of the i.t. people to speak the same language is hard. there was also the idea that we can develop the communication, ot transmit any information yet.

correct eligibility determination, shopping environment -- those two things are different. a lot of the pieces were developed, but over the last few months they have been connected. you can test different segments but until you get end-to-end, some of those gaps will be identified. that is the way it is. we have a slide in our general presentation that we show -- our executive director told the personables a person, he tells this story of a 1972 honda. that is basically our goal. we want to drive across the strait -- state on the best gas mileage and make sure we don't break down. we will get to leather interior daycruise control, but on one there is no radio, no power locks, no power windows. that is ok. [laughter]

and we think about medicaid medicare, there have been hundreds of applications in every one of our states. we are not supposed to get it right on day one. we want the opportunity to make it better. we can keep building, keep perfecting, and make it better and better as we go on. >> that is terrific. we will take the next question. >> hemophilia federation of america. on -- youn is based mentioned breaks in coverage. what are the primary reasons for breaks in coverage, the duration , and what the other states, including use amanda -- you samantha, and how to prevent those from happening? >> the duration question is difficult to answer.

it varies based on the individual situation. the breaks we have seen have been seasonal workers. those that are not in permanent employment or employment like migrant workers, employment based on the seasons. communication is where we have seen most of our breaks come in. mailings responding to that are not coming -- that are coming from the state or private insurance companies. the state is doing a lot to try to standardize these letters and make it at a reading level that is appropriate for that population. or even in the language that is necessary. we try to encourage our patients, whenever they receive any one of those mailings or letters or communications from the state or the private entity, try to bring those in. we try to use our enrollment or financial advisors to help them

interpret the letters and take action if it is necessary. >> i would agree with everything that was just said. ,ransient populations populations that fall between the cracks and many programs, -- in many programs, are the most likely to fall off. those people walk back in the door again often. portal, we have the ability for community partners and agents to maintain relationship with the clients they serve. they will have a renewal date eventually that they can see in their dashboard for anyone they have ever helped. they can reach out to those people to send reminders. as well as notifications coming chip, orr or again, medicaid, there may be an e-mail coming from the person who

helped the mineral. -- them and roll. -- them enroll. >> i'm a navigator at community clinic inc. so, maryland. that you have existing programs, you have a clinic setting, or a community outreach setting -- how did you reconcile having an existing system and incorporating these big changes? what were some of the biggest challenges? let andre all i sometimes state and county officials are busy and they are not communicating. what is, internally, something or play on our

strengths rather than waiting for communications? things that you were able to, like, either your staff or other programs that you are able to pick up on? >> i would recommend that you work on your workflows carefully. this can be overwhelming. what you will find is increase in volume in that area. we went all the way to redesigning the actual waiting room space, office space for the enrollment advisors, and looking at the workflows. adding a triage greeter at the front, identifying the issue and identifying -- directing the patient to the right enrollment rep.

the space in the workflow. >> that is a great question. it is easy when you are building a program, it is easy to lay a more difficult to lay one when a train is going 1000 miles per hour. we have been strategic about what we can do and what we cannot do. my main goal is managing expectations of my staff and letting them know it is ok to not do everything right out of the gate. giving them a lot of freedom to make decisions in the comfort to fail. startup,are doing without the right information, no one has the right answer. opinion, be, in my done in a team approach. that is so we approached it. i wanted to go back to the breaks in coverage question. we do a monthly membership fee,

which you could liken to a premium. 10% of our membership drops every month. we talk about retention on a daily basis. how are these insurance companies going to retain their membership and, therefore, their product -- profit to keep going? they are in for a rude awakening. retention for this group comes down to relationship. if you don't have a relationship, there is no reason why they will select to pay their premium over gas or food. it is not going to happen. we are constantly encouraging our members through relationships. we are encouraging the value of their health and putting their funding toward their health. owning their limited resources toward their health. if you don't have a relationship with them, if you are a piece of paper, they will drop. i see it every day in our

companies. they will drop. that is what we're doing. it retention starts with enrollment. that is where it starts. if they do you care about them, they will stay with you. i am a navigator at the same organization. my question is specifically for marilyn -- maryland. directlyard conflicting things about what is going to happen to the resources for uncompensated care. people are saying that it will be more money going toward that as well. that places are saying those resources are going to get cut. i don't know if any of you would like to speak to that? >> i have heard conflicting information as well. with the affordable care act, there may be more people who newly do have health used toe and are not

navigating the health care system. anecdotals is really -- all that i have heard. it remains to be seen. the key with enrollment, piggybacking on when mickey was helping people understand how to navigate the health care system and to understand the nuances of the plan are critically important. that is part of the navigators role. it is critical to have that relationship and help people understand how to use insurance. it may be the first time they ever had it. think we all know that inasmuch as this out reach is important, there will be people who remain uninsured. uncompensated care will not go away for the system but hopefully it will be less as more people gain coverage.

>> american association on health and disability. in every state, we have a statement all health agency, a designated state substance abuse agency, a developmental disability agency -- a number of you have talked about medicaid and insurance collaboration among what are your experiences in working with the special, disabled subpopulation agencies? >> as part of our grant applications, it is critical that we work with a wide variety of organizations that serve vulnerable, hard-to-reach organizations. we have partnered with the stability agencies, mental health agencies. embedded in 20 drug treatment sites in maryland. we felt it was important to have a focus. we did invest resources in community-based organizations

that serve the disabled, mentally ill and those in drug treatment. >> next question. >> i am from the truman foundation. i appreciate the emphasis on a one-to-one consumer assistance. speaking about vulnerable populations, rural populations in particular, 40% of americans don't have broadband internet connection ash had we plan to reach them -- how to we plan to reach them? >> having community-based organizations, having relationships in those communities helps a lot. working with county governments in those communities that are delivering service and getting creative. bringing people out of their homes and into the community where you can interact with

them. fast --p has a crab fest every spring. finding events like that, where people do come out and you can get a hold of them. partnersave several that have membership lists and donation list from previous campaigns. as well as neighborhood canvassing. that can be hard in isolated communities, but it is another way to get out and make that connection. makers, finding decision- and community leaders. perhaps a faith leader that can come out and make a statement and endorse, for lack of a better term, what is happening and how folks should get covered and get in play. mayors,as using chambers of commerce is, -- here

in oregon, we can't talk to everybody in the county. we need to go to the places and listen to needs and empower them to do so in their own communities. >> i met public health policy consultant, working with the bleeding disorders community. to do with some things that are going on in other states far more than in yours. i'm glad it is not going on in yours. it navigators are required to be -- that is thes worst i can think of right now. similar to creating a new system where there was a system -- you have to negotiate roles. obviously, the uninsured didn't occupy a lot of

insurance agents time. i would be interested in hearing what you have to say about the role of a sister navigator, agent, and broker. thanks. >> i would say the situation is going to be different. it will be slightly different in every state. process ofare in the setting up what their assistance programs will look like. the brief in your packet goes through some of the variation we are seeing, and structure and design in each state. as is clear from the comments today, access has key implications for the success of enrollment efforts. drawing on the case study going to a how nevada has dealt with this issue, we went out and spoke directly with insurance brokers in the state

and heard very clearly that, in the beginning, they were adversarial to the changes coming. they felt it was a threat to their market share. they were unsure what it would mean to them. over time, and through a lot of reach, they- out have come around and feel that they will have a role -- a defined role. and they recognize that the target population being reached is very broad and the navigators s, manyters -- assistor are looking at it as an opportunity to create -- increase their market share. in that state they have worked out an arrangement where all of the brokers are working together, recognizing they will

each be targeting different segments of the population. >> i wanted to add that in -- you have toi take a 40 hour class and pass a test. all of our navigators took a test on friday. hopefully they did well. >> did you charge for that? >> there was a small charge, yes. to gonevada you do have through training. they are charging for it. or the brokers, navigators, and assistors -- in the beginning, we were told we could be assistors. this comes down to the misinformation. the exchange is telling us one is telling us another thing, and the law is saying something else. it was not until three weeks ago that our insurance commissioner become a have to

brokerage and you have to have brokers on staff. that is what we had to do that. we did noto th. that is weird for us. nonprofit, buta to be legal that is what we have decided to do. the training, the brokers went through the training. we don't even know what our application looks like or how long it is. the brokers have not had the opportunity to play around with it. onis going to be interesting october 1. [laughter] it is that car rolling through with a lot of extra equipment. >> we serve homeless populations. you had mentioned specifically working with homeless samantha at you mentioned working with transient populations. mentioned 100% spl.

manny, what has worked in massachusetts to reach a marginalized population that does not have stable addresses and tends to use in a different way, a lot more haphazard? reaching them and what has worked and what you are trying? that.ish i could speak to i can't. i don't know. we have a huge homeless population in las vegas. only two agencies in vegas who got the navigators. i am a little bit fearful that they will be left out. us, we have a large health benefit services homeless population. and find great job these individuals in bringing

the information to them. they have enrollment reps and financial advisors to help them. this is also the population that is covered under the uncompensated care pool. for individuals that don't have stable addresses or cannot produce any documents to be eligible for medicaid or other services, these individuals are covered under the uncompensated care pool, which, in massachusetts, was cut in half, but remained higher than the ,ational average -- or at least many states. we are fortunate to have that. we have had tremendous success in rolling homeless individuals to our program. 85%ere able to link about of our homeless population to health insurance last year.

with medicaid going into full effect january 1, about 75,000 people, including many of the homeless emma will roll into full benefits. it can be done. oregon, through our state medicaid agency, they have plan to usetate data to fast-track and roll people who are mel -- eligible for medicaid or likely eligible. snap willligible for receive a message that they will be auto enrolled in health coverage. have their eligibility information from another program and we are able to fast-track and roll with that data. element.ne he -- key

we have our sisters, our community partners, the boots on the ground offering assistance, but we also have a lot of entities that are just chewing public outreach and education. at making sure states are reaching out to community action programs. when folks to the homeless count in february, there are great opportunities to hit communities. we also have a good connection with all of the homeless liaisons. there is someone appointed in every school district to help homeless kids access resources. that is another great connection to make sure folks know where to refer families and where they can get help or assistance. >> we heard from three states that elected to expand the medicaid role. those who live in the states would not chosen to do that

would be the most left out. we have one more question here. >> i am a reporter with kaiser health news. i have two questions. the first one -- can you walk us arough the process of navigator helping a person in rolling coverage? there seems to be confusion and what they are and are not allowed to do in giving advice and entering personal information. whether those limits will hinder enrollment for those who don't know much about insurance? secondly, what happens to all of these navigators or assistors after open enrollment ends? there will be a six-month. after that where they will not have jobs and then they will have to come in for three months next year. are the seasonal employees or what happens? >> to your first question, in maryland, there is a distinction

assistorsistors -- were navigators. -- and navigators. the navigator is able to do medicaid, as well as enroll people on the qualified health care plans him explain subsidies and so on and so forth and select a specific plan. question, we were banging our heads against the wall, to. they are full-time employees. we will really boost up the education campaign. get will be a few years to people to understand what is going on. enrollmentafter open to hit the high schools, community colleges to do a very