think there are two challenges. the names are ted cruz and rick perry. that is simple for us. i want to apologize that our biggest challenge has become america's his talent is shutting down government. senator ted cruz has really led the >> when you have 6 million people who are uninsured, one .5 million of whom cannot qualify for the exchange and have nothing to sign up for, that it could not be further from the truth. that is one of our biggest challenges. and then our governor is the bigger challenge for us. he actually has the ability to medicare00 billion in funding and is the largest block

in a saying no. we showed there was bipartisan support for a number of proposals that would create a texas solution that was palatable to expand medicaid in texas.- in they were ready to put some bills and amendments to give some leeway and flexibility to taxes. ao texas.hs >> he slammed the door on that opportunity and made it very clear that he would slam the budget and veto any bill that came to him. republican legislators willing to go there with us frankly had no reason to walk the plank and put their own reelection in danger when rick perry made it very clear that he would stop that. in terms of success, we measure

.t differently and our state rick perry made this calculation that he could reject the medicare expansion money and the people most impact did would know about it. we count it as a success that we commuted about medicaid expansion and the aca. we checked all the information in the voter files and 44,000 of them either took an action nor pledged to vote in the election coming up. of challenged his people knowso that he's rejecting this money and they will be taking more action this year.

walmart workers, people who work every day. challenging the narrative is very important and we would hope what he is saying is that they just got a job and they would have health care. they are low-wage jobs which is what our economy is based on and they do not have benefits. we organized a group of people directly on a number of bases. they followed him here when he was speaking at a breakfast and made him stop drinking. i talked about how they were really going to stop the aca and he had to answer questions. the first success for time he was forced to meet in .is office

in a ballroom very much like this he was speaking to the chamber of commerce in austin and six of our members were in the realm and interrupt the speeches so many times a day finally said, please just leave. narrative ande here are the faces and families who are impacted and they're not going to take this sitting down. they are going to challenge the governor. that is how we are working on it right now. [applause] we've had another texas version on the navigator rules. i don't know people are areowing this but these appointees of governor perry and they were making proposals on changing rules on navigators where, in addition to the training time, they would have to have 40 additional training

hours, fees and register to be fees and navigators and taxes. we just found out yesterday or wouldy before that there you know additional fees to pay in texas to be a navigator. there will be 20 rather than 40 additional training hours. we don't want to be navigators, just do outreach and education, they were proposing we would also have to register just to do general outreach. we went all the way to the capitol five days before christmas and testified and put 79 people on record slowing down the process. that's another one of our successes, i would say. >> that's terrific.

thank you for your hard work. we all appreciate it. i want to ask you about the states that are kind of in the middle. they want to make the medicaid expansion their own and do something that's a little bit different. as someone who has worked with states across the spectrum they want to expand using another kind of waiver program that requires approval from the federal government. vast middle of states that, exactly as you say, are not just ideologically opposed but are concerned am trying to find out way that will work for them. just go back to the beginning when the supreme court decision came down. the primary question states were asking is if we can do a partial expansion. can we change our mind if we make this decision?

we got those answers very quickly. you can change her mind. firstort of led to the tier at the state level about whether they wanted in or out. there is both a substantive and a political component to where the states are in these discussions. let's start with the substance now that we've moved past the first few questions. talked at this meeting about the private option. it changed the terms of the discussion about expansion. substantive level, of course, arkansas was looking to do the expansion and they wanted it through private health plans. for the vast majority of you in this room, in your states, the vast majority of your medicaid enrollees are already in private health care plans. that was not the case in arkansas. the notion of this being a big change that somehow the expansion would be through

private plans substantively is not the case or would not be the case for most states, but it was a big deal in arkansas. that was the focus there around .rivate lands subsequently, we've seen other states coming in with requests with additional changes that they want, charging premiums, cost-sharing, payments and the like. and in pennsylvania, a lot of attention around work requirements that gets into another domain. we will talk a little later about where this might go. of states thatot are moving forward wanting to have some kind of a trigger where the state will automatically withdraw from the expansion of the federal government changes the terms and backs away from its 100 sent financing. there's a lot of mistrust out

there about whether the enhancements will last. substantively, what we are seeing is small and growing effort that the state level to figure out how to craft a medicaid expansion that fits a little bit more closely to what the state had in mind. into't want to go too deep it, but i want to remind people that in many instances, this is not just opposition would dislike of the medicaid program were people who would be covered by the expansion but a sincere effort to try to block the medicaid expansion into the existing terrain of private coverage for low-wage workers, which in some states is almost nil but in others, it has more of a presence, as well as what the rules would refer people in the insurance exchanges where premiums and cost-sharing's are very much a part of the picture. there's a substantive balance here. areor the politics, there

many who call between the extremes represented here, immediately willing to embrace the expansion as a part of the law and those who opposed it from the outset. lotink what i observed is a of political leaders looking for a way that they can still be against obamacare because they went on record of being against it and they cannot change that view, but starting the season of the dynamics playing out about the dynamic consequences, the human consequences of not doing the expansion. the most common political frame is we want this to work for this state and fill in the blank. i think it's a very exciting, positive development. my colleagues, longtime medicaid director in michigan, early on after the supreme court decision said something to me that i thought was crazy.

this court taking away the expansion and making it a state choices going to end up in positive because states that do the expansion go through a process and embrace it as opposed to just doing it because they have to. i thought that was kind of crazy but over time, i'm starting to see the wisdom of his everytions which is that state that moves forward now has a deeper understanding of the program. it's harder to crawl back on the rhetoric of welfare, people who are not working, being a public program when the reality is it serving working families that the business community is supportive and it's already largely delivered through private plans. don't get me wrong. i have a lot of concerns about the pace of the discussion. the fact is we are having state whatfic discussions about

fits substantively and politically in a way that would not have occurred and we are do we states say, how make this expansion work for us as opposed to saying we have to do it? that's where the discussion is in a lot of states right now. >> let me ask you a quick follow up. some states are saying cms may look to say, you cannot do that. i know you cannot get in the heads of governors, but how do you see requests playing out if they end up not being approved, only partially approved, things like that? what do you see happening in those states cap go >> it's very hard to generalize on this and i don't know what cms will or will not approve. that thereruck by is is a somewhat new conversation of then that is a quirk statute where the expansion goes

taxo 133 but the premium credits start at 100. if you are in a state that did not do the expansion, you would have people between 100 are sent-133% would be eligible for the exchange-- 100%-133% eligible. there are very significant subsidies on both of those. i think what is a hard-line coup hold in the long run is to say to a state, you did not do the between 100 sent- betweeuld have access -- access133% would have do cost-sharing. but we are seeing is a little

bit of wiggle around the blend between going from traditional medicaid of two sort of the poor population covered by the exchanges. i think you have to larry issues like work requirements are going to be strongly resisted, partially because there is no room in the statute really to permit rules like that. i think the issue of wraparound coverage is one that people again,bout a lot but, remember, the medicaid expansion population is eligible for a benefit package that is very close to the essential benefits offered in the exchange and although there are differences, they are small. those of the kind of differences where people will negotiate. the negotiating room is over the sort of core elements that existed in the exchange. when you start putting other things on the table, it's less

likely the federal government will embrace them. how that will play out at the state level in terms of what is accepted or rejected is a harder question. >> i thought maybe you had a distal boldin could speculate. pre-k's i have a magic eight all. -- i thought maybe you had a magic crystal ball and could speculate. >> i have a magic eight ball. >> one thing in both washington and texas that you do have to messaging and outreach. that is something that you share .n common it's important to have messages to get the public invested in the medicaid expansion. can you talk a little bit about your public messaging strategy and the messages that have worked with different grips and particularly when you're reaching out to communities of color, what has resonated the

most? messaging, we have talked about the broad message even though we have one in four texans that do not have health care so we have been thinking a lot about how we talk to everyone in taxes about how we are all in this together and it's a bad decision for texans. what we have kind of come to talk about is we are paying for this three ways. by rejecting this money, we are leaving all of these people uninsured to go to public hospitals and emergency rooms. we are paying for that in our public taxes. by rejecting all of the money, we are paying for it anyway. insurance, who have we have extremely high premiums and taxes and that's the second way that impacts you. the third is her federal taxes are going to another state. everyone hates to hear that.

their taxes are going to these other states like massachusetts and things like that. [laughter] that's very offensive. is we areroad picture all in this together when we are paying for it. i don't think rejecting this money is actually helpful in many way. but then talking the people most directly impacted that we want to engage, 60% uninsured are latino. of thingsa couple that have worked. one is putting a public face on working examples of latino texans who have no insurance and talking about how this is impact in them, how if they lived in arkansas, they would be able to enroll in medicaid right now.

we have a great partnership with and leading up to october, they did a weeklong event and every day was a different angle on health care and how it impacts latinos in texas. it was a different example every night of the week that led to a it phone bank that they did all of their major media markets. if you had questions about the aca, call in. we talked to thousands in just one night and univision got so excited about the stories they were hearing that one of them they picked up. his name was luis and he had to

drop out of college because his parents had medical debt that they could not pay. they both worked low-wage jobs with no benefits. they wanted to interview him and here the story. -- hear the story. they took him around the country and did an entire documentary about the impact of health insurance on latinos. they interviewed mayor castro, flew into florida, had him talk to the governor about his story. we've been doing screenings of this univision documentary at churches and neighborhood centers so people can have a simple conversation about health care. [applause]

>> in states that have expanded, it does not stop. can you talk about what you have learned through outreach and enrollment strategies? particularly strategies surrounding language access? >> the start of that whole messaging is one thing about medicaid is that for some people it tends to come with a bit of a stigma. they tie it to welfare. medicaid is their insurance product. we are calling in washington apple health instead of medicaid. that this ise idea really part of a whole insurance

continue him and whether you are on medicaid, have a qualified health plan, and the commercial marketplace, it starts with some of that. we were taking advantage of every opportunity to get the message out. and we were having a hell summit with the summertime to just .tart to generate interest an opportunity to benefit exchange people were doing, they did a bus tour so we have

medicaid people with them on the tour across the state, the typical things in terms of getting posters in every possible place, churches, community colleges, four year colleges, clinics, working with the local jails in schools. every opportunity that we could find ways to touch people in the community, working with the spanish-speaking radio stations to get the public service announcements out and to target individual populations. you name it, we did it, if we could think about it. .very group that we could each we went out and we trained 2000 community workers. those in various community-based organization, this was in we provided them training on the medicaid

programs and we gave them tools to help reach out to get them enrolled, help sign them up and that really did help us. it helped us in particular have thisen we did one it was slow, they could help people fill out paper applications and so those partners were invaluable to us. using the process of putting some of our own medicaid staff out in communities. they have not been part of our stuff but art of the eligibility but they work with hospitals, community clinics, and other sites across the state. is thing we are also doing tracking by county or leon estimates of what we thought enrollment would be by various counties in the state.

there are a lot of migrant workers and a lot of hispanic speakers so we do think there are some barriers in terms of individuals who don't understand or we have not been able to reach them effectively smear starting to work on ways to figure out how to target the population. we are still working through that. we want to work with their community partners to help us do that. we cannot let up on this. we are putting in another ask for the legislature for money to do that and we will not that happens in another months.

we have some evidence that this is part of the case reaching these groups and rethinking our strategies in those areas. >> continuing work. >> can never let up. >> in terms of states that have expanded, you have the opportunity to work with a lot of different states. are there any you would like to highlight for things they are doing for outreach and enrollment? >> we been trying to work on streamlining eligibility systems in which focused on kids before the aca and we broadened out. as i hope people here know, shortly before open enrollment, cms gave guidance to states on some opportunities to facilitate enrollment under the aca.

there are a number of options here, but the one that is most exciting and visible is the to streamline enrollment of those who are already snap eligible with a letter in response and a handful of states have taken advantage of that. it's a very efficient and quick way to bring people into the program. i want to say something different, which i think is particularly critical given the conversation we just had. there have been reports on states doing it better on getting people in and where the enrollment numbers are higher and lower. i think that is all worth tracking. it's critical to remember that whether states to the medicaid expansion or not, whether they do the exchange or not emma there are important steps they are required to take. the conversion to the modified

adjusted gross income rules is a significant simplification and what the eligibility standards are. there are requirements to be able to transfer data between the exchange and the medicaid system to determine eligibility as quickly and efficiently as possible. .t's a requirement there are a lot of her relic work deep inls who the bureaucracy in your states who are trying to figure out how to do those kinds of changes often,vely as possible as you know, in states where the overall view of the affordable care act is pretty negative. i guess what i want to make sure what people do is not look at these high-profile opportunities for enrollment, which are very important, but also remember that behind-the-scenes, if these basic functions of conversion,

eligibility standards, and data transfers across different eligibility points, if they work well, that will have a huge on efforts for enrollment. it will change the numbers and it will change the experience of people who interact with these systems so they will tell someone else that it worked and they did not have to work out and fill the form out seven times. when i call this number, they told me to go here we have a could actually answer my questions. very important steps that get a lot less attention and i want to make sure people are aware that in many instances they can be as important to long-term success as something more like a traditional outreach effort. >> thank you for reminding us of that. it's very helpful. keeping the efforts going, something that everyone will have to deal with. peopleaccounts, most think you will have to keep your coalition together after this is

passed this year. can you share your thoughts on what you are doing? you've done some great stuff, but to keep people jazzed up passed this year and keep them going, what are your plans on that? >> we are meeting now about the 2015 legislative session. we don't know who will be governor. we know who will not the governor. rick perry will not be our governor. starksly, there are differences between wendy davis and hank abbott, the front- runners for the governor's race on that issue. really, there's a coalition that meets regularly in austin and many of the groups that i are talkingrlier about what it can look like in 2015. if we can revitalize some of these proposals that we had the last legislative session, if

there are other things we can do from pollution to medicaid expansion. the other thing we're doing is launching this website called "taxes, let me out. help those effort to were medicaid eligible and falling through the cracks and continuing to be active. the other thing we are doing -- taxes is a large state and we have smaller coalitions in dallas, houston, san antonio -- texas is a large state. are their community benefit agreements we can win to come up with some local access solutions in each of those counties yo? houston has a pay or play ordinance. if you do business with the city and you do not provide, you have to pay additional money. i think as we all know, the long-haul fights like this, you

have to have some winds along the way. we are looking at local collaborative efforts to push through at the local level. washington, and big part is making coverage work for people and also making sure that the expansion financially a sustainable. i know washington is undertaking a lot of innovation. can he talk about how medicaid is the with that? >> it whole sustainability question and it is one we face every day in terms of how we continue to be able to afford medicaid and looking at it as a program. probably, the major initiative right now we are undertaking, we have a number of different things going on, but we just concluded a five-year plan. we got funding from the federal government to do a state innovation grants looking at how look at how health care

is delivered across the system and is not just about medicaid, though it is a large portion of it. that is part of the land that literally just got completed and the focus of the plan is really about value. paying for value and not for volume. how do we look at the kind of reimbursement systems that are our stategoing on in where most providers are paid fee-for-service? we don't have a lot of innovative payment structures where people are paid for out tom's or accountability. they are changing up the thinking and the conversation to be much more out come driven. looking at the community level and it's one thing that i think is so important in these conversations. what happens with community? some of it is formulated at the state and federal level, but one needs to happen at the community

level to really make health care work? this model really empowers the community so we are that weto look at ways call accountable collaborative health. developing infrastructure where the communities are much more involved in decisions about how health care is delivered and much better linked with the health care delivery system. we are starting to focus medicaid differently than it has been in the past but we are the cap the social determinant of health, housing, employment, income on their health outcome and getting away from talking about health care but actually talking about health. if someone does not have a roof over their head and they are diabetic, it will be difficult for them to be successful if they don't have a place to live. also key to this five-year plan is to do better with behavioral health. we have separate delivery

systems for people with significant behavioral health needs and for individuals with physical health needs. had we bring that system in a way that is more integrated and engaging communities to help us think that through? effort,ion to that which is really one of the major initiatives right now, we're are also in the middle of implementing a dual demonstration again. those are people about both medicare and medicaid, dual eligible, and they are often some of the most high cost folks. we want to have them to have better integrated care, better access to care. another project is implementing health homes. some of the highest need individuals within our delivery system for those who have significant health issues and working to them with a care

manager, care coordinator, someone that can work with them to make sure they get the services that they need, understand what is available, help engage them in their own healthcare, creating action plans, getting them more involved. the real focus for us is to move this to the population and think of medicaid as just part of this but different than the past but it really has the help of the community the -- of the community. ask you a follow-up question. provider access is something that gets brought up a lot. what is washington doing to ensure that there are inadequate number of primary care providers ? >> it's always a challenge, particularly with medicaid. a few things. before the implementation of the did somee care act, we pretty significant survey work

of the primary care workforce and the state. for the most part, it looked relatively good. they were taking new patients that have medicaid in many areas of mobile we also found in rural areas where it's a problem for anybody. having some knowledge about where some of the access point and problems are, we are still working to find ways and it's part of an innovation plan. we have a work force to see how we can grow. in preparation for implementation on the medicaid side, we went out and did it read procurement of the plants and brought some new ones into the state. a couple of the plans, they were able to negotiate a gauge providers that had not been in medicaid for. growing the providers that we actually serve has certainly

been helpful. also with accountability and managed care plans, having the adequate network. anlook to them to have providers. if they are not in the community, there's not much we can do about it in the art of the ongoing work we need to do. cms granted an increase to primary care providers for 2013 and 2014 and for washington, that was significant. on the adult side, we have 90%viders that got a 70%- increase in the fee schedule. the rates at our state have relatively low if that only last two years. we will have to evaluate what effect of that has been. we are starting to do that now and will happen in 2015 is still

unknown. the other thing we did is look and we addedserve them to the medicaid enrollment so they can now take medicaid alliance, which they could not afford. trying to look at providers making more except all and for the delivery system perspective, who can be a provider and making sure we are engaging anyone who has the license to use primary care able to provide services. there's no easy answer. we're still working on this one. it's a major question we will continue to grapple with the next few years if not longer. >> it sounds like you are doing some really innovative things. are there any particular state programs you would like to highlight? >> washington is

doing a lot of everything, there's not a lot to add to the list, but it's important to remember that there are many states not doing everything but are doing some things and tie between those initiatives and advocate is important. half the states have state elevation models and they are looking at transformation of the two federal demonstration project. this development was also mentioned dan neely thing i can think of not on the list was there's a lot of attention to birth outcomes. i know you are doing it but you just did not say. obviously tothere medicaid. arkansas gets a lot of attention for the private option but they are in the middle of a payment reform initiative. they don't call it bundling but i think that is the closest

single word to describe it and tennessee is looking at arkansas. i guess the point i would make rather than list the benchmark programs is that it's hard to remember, given the political polarization over the affordable the interest in cost containment and moving the health system more towards value and less towards spending money on individual services is a broadly understood imperative that is not really partisan. how to do that is not simple. it is a long-term project and there are different levels of leadership and engagement on that issue around the country. think is clear from the states that we work with, which is medicaid is a critical partner in any effort to build up the primary care infrastructure or change how you

pay for health care or improve outcomes because of its size and because of the critical role it plays in the health care system. i think part of the evolution over time the state use about the medicaid expansion, some of it is the shifting politics, some of it is the economics of providers and business interests saying the three reasons we are losing, as she described. part of it is if you have an agenda for improving health system delivery and finance, is as levert use medicaid points for that transformation, you're not going to be as is. to me, this is where the pieces come together. if you have a broader set of goals, the tools of the exchange and medicaid are ones that you cannot afford to leave behind. i think the more states that do

the combination of things that marianne described in washington, the clearer it will become that you need all of these forces if you are going to get the health care system where you want it to be. >> that's a nice segue to the question i have, looking at states are right now. i want to talk about where you think things may be doing in the future. earlier, you talked about the so-called private option for expanding medicaid using the exchange plans for medicaid coverage. what do you think are the long- term implications of that approach? this may notealize be a broadly held view, but the private option terminology is more political, effective political communication, than it is the substantive matter. as i said at the outset, the vast majority of you and your

states, medicare enrollees are already in private plans. expansion, medicaid it is a private option. whether you are doing it through the medicaid infrastructure or the exchange infrastructure, it has its sets of pros and cons. i think it comes together and, again, this ties to the marketing and the system change issues. fundamentally, is the medicaid continuum ofthe options available to people depending on their resources? is the insurance exchange a place where the transformation that needs to occur in health- care takes shape because it's betterindividual choice, knowledge, competition, and the type of forces people thing can move this into a more effect of place? what i see is over time, more alignment.

instead of medicaid being a , andam, and exchange private health insurance through your job eating here and medicaid being there, over time, we are seeing a lot more of these.n to me, that creates opportunities partially on a message side that we get away stigma or these black- and-white decisions but also from where the health care system is going, it creates opportunities for purchasers and payers to have more leverage. i think the long-term pass here is a positive one. i think the private option, which is where you asked the tostion, helps clear the way breaking down some of these barriers. don't get me wrong. i do have concerns about the erosion of patient protections if we move too far from the core

of the baseel medicaid program, particularly for high need populations. i used to run the medicaid agency in colorado, so i'm very attuned to the importance of those protections, but the battle over public-private is one that will fade. thanll be more important that people have coverage. >> thank you for bringing that up. is a closingion question and i want to touch on that. tax people assume that in exas, what we call the medicare expansion might not work. >> it would work it's just not going to happen. >> it's not going to happen. they're going to want a text as solution. >> is the many thing that you

see being discussed that will have legs? >> the legislature meets every other year. there were lots of proposals on the table. the governor is asking for a block rant. that was his solution. you give me the money, no strings attached. that was not acceptable because we don't trust him with a block grant of money. the other two major proposals that were being kicked around, one was about co-pays. could we get the medicaid population to at least put some skin in the game and pay something? that's a bit of a slippery slope. how do you know what they're going to be and if they are going to be affordable? the truth is people are really the pay something. we had one of our members who said they found a lump in her breast and could not go to the doctor because she had no health insurance. she said she was willing to pay something.

she just cannot pay what she cannot afford. i think the co-pays are not an ideal solution but it is something we would be willing to leave on the table but we have to be careful about them not running away with it and it he coming out of hand. obviously, the private option of using the medicaid expansion money to subsidize people to buy into the exchanges is definitely something people are willing to leave on the table. for us, it's about the political will and solutions that can work. but with protection so that they become affordable. for those who are not poor enough to qualify, which have to be extremely low income to qualify for, but do not make enough of the exchanges, those people in the middle, there has to be a plan and they are willing to put skin in the game but they need to be protected.

quicksand as things are changing in other states, does that have any applications for you? -- >> and as things are changing in other states? >> this particular legislative , last year there were certainly conversations about looking at some of the similar programs like arkansas and other states are proposing. i don't anticipate it will be this year. it could happen in the future. a lot will be watching what happens am looking at the .ehavior of individuals what utilization looks like, how the plan gets rolled out, who is engaged. for me, it's too early to answer that question. it would be something to think about half a year from now because there would be this time when we could actually see what was happening, who in rolling, who is left out, who coming into the system and why?

at how we would like the health care delivery system to be utilized understanding the delivery system, how they unrolled the primary care provider, how they look to going andtter health getting preventive types of exams. follow these things are going to , it's difference, for us more about how you get the delivery system up and running, working, and making sure that folks have the access that they are entitled to and not so much about whether we are going to institute a co-pay or something like that. >> one last question before we look at the audience. ie role for advocates, and want to go back to what you talked about medicaid protection in states that are doing something that is a little different in terms of financing

on the exchange plans, what do you see the role for advocates are to make sure it is a program to provide robust access for people and includes the protections that made it such a good health insurance program? i cannot put myself in your shoes. as jenny described, is that the first place i would want to go? no. if it's the choice between getting people health coverage and not, that's the decision have to make a locally based on what you're hearing from your own folks and what the political environment is that you are in. comfortable feel saying you should draw the line here because you have to draw the line where it fits best for your folks. what i want to caution -- and i will keep it quick, but i want to caution that i think the more we wall off medicaid and say there are a bunch of protections over here, what we are forgetting is that the world over here is changing.

target just announced dropping coverage for part-time workers. you can say it's terrible but you can also say only 10% of the workers even thought it was good enough to pay for. maybe we should be more worried about protection over here. if firms have been offering such lousy coverage, that might be a bigger problem than whether we have five dollar co-pays for a portion of the medicaid enrollees. i just ain't the trick is to as a package, both substantively and politically. we draw a line in the sand and say this is the old program and we will fight to the death not to touch anything in that medicaid program because, after all, it was a change in the statute in the rest of the health care system falls apart, i don't think we've won. we need to be a little more dynamic in our thinking even though, as i said, i would not walk away from those protections

lightly but you have to make the judgment call. >> ok. we have some questions coming up. how does the private option affect the bottom line of private insurers? would anyone like to take that? >> i would just quickly say that it depends. states have a broad range of approaches they use for ratesetting and medicaid and states that run their own exchanges have a narrow but growing range of approaches they take in the scrutiny that they submitted for coverage options within the exchange. the interplay between those two determines the margins that the plants can earn.

how competitive the market is also determines how they bid and what kind of margins they will achieve. am not a big fan of giving whole lot more money to the bottom line of insurance companies through a so-called private option. my only point is that horse left the barn a long time ago when three corridors of those and medicaid are already enrolled in private plans. it's not a question if it is good or bad but it was fought a long time ago and it's a little bit of a mistake to pretend we were fighting it from the start when it is the same story. here have another question that i would like to ask you hama marianne. enrolled beneficiaries, making sure they are getting into the right benefit options so that medically needy people get into the program best for , what are you doing to make

sure that it happens? i know it's only been a few weeks, but are there any lessons you learned yet or lessons from the past that you've learned? did think what washington was wisely making a decision and aligning the benefits. whether you are traditional medicaid or newly eligible, you have the same benefit design so there is the choice you have to make in terms of whether you go one pathway or another. the issue will become something we will have to watch for the newly eligible. there is an array of services if they need long-term services and toport that they would have go into traditional medicaid to receive those. that is something we will have to watch because the population we are seeing in terms of the newly eligible are not really those individuals that are pending going into long-term

care or have long-term needs so that is something we will have to watch. making the decision to have the same identical benefit package has made it easier so we do not if you go down the frail pass versus in rolling down the regular program. >> it's a terrific choice to make. the you have any thoughts for states that have not made the same choice for the benefit packages? there may be advocates in the room, what people should be looking for as the program unfolds to keep track of so that as advocates you can make sure you are getting engaged to make sure the system is working. >> the emerging issues are going renewals and part of the issue is to make sure that we are ahead of those issues. again, the alignment is just the flip side of the protections question. you cannot align things that are

two different. to align means being willing to give up on a little bit of the pressure you might have for a more comprehensive benefit package. is a tool forent better administration and more effective engagement with the public. i think it will end up being a ,ig problem for people medically, clinically, financially, if they are changing and the affordability options change and they don't know it. those are the places i think we are seeing the leading states after they get the operations up and running. that is where they are putting their attention. >> can you give the audience some information on how to get a hold of the univision documentary? advocates would like to show it and i'm sure -- >> good question.

we have some dvds perhaps we can mail you. i would just communicate with you that we do not have a public way for people to download it that i know of. go to the texas organizing project website, find me and we will get you what you need. it really is a good broadcast. i'm trying to remember when they put it on univision and it went nationally or you might be able to contact univision. >> great. this one is for marianne. what is the recourse for gaps in theth major washington pathfinder plans? here. an example one family newly covered has to .over the entire cost

>> am trying to figure out clarification in terms of -- >> i will answer what i think the question is, asking about what families can do if they are in one of the qualified health plans as opposed to medicaid. that's a little bit different. they have the array of plans they can choose, bronze, silver, goal. we don't offer any platinum plans in washington. challenginge because people are choosing what coverage or benefits they see as affordable. i know that we have had individuals that have made different choices. they don't want to be on medicaid even though they are eligible and they are men that 133% where they can choose and still get the tax credit. it is about the end of all

choice and the land selection you make and that is the service package available. i know within the exchange, there are not the same istections and the benefit designed and you have the same access to the same array of essential benefits. for out-of-pocket can vary widely depending if you are bronze or gold. i'm not sure if that answers the question. it's different when someone has an exchange plan versus medicaid. it's very different. >> i have another question here on washington state. states a new option for allowing community- based organizations to provide services recommended by health care providers. as washington state looking at this option? >> we are looking at it in terms of looking at who can provide

those prevention services and get them paid for. it is something we are looking at the we have not implemented it yet. we think it's probably a good idea and how we would spread that around the state is on the list of many things that hhs has come out with over the last couple of years giving states options and that's one thing we are looking at doing. we are just not there yet. >> what do you think is the better utilization of resources, including nurse lactation nurse? -- practitioners? a we useshington am nurse practitioners. they are a major part of our delivery system, and they can practice independently unlike in some states. our nurse practitioners can practice independently. they are a major part of our

delivery system and we use them in many of our clinics, pediatric care, behavioral health care is already provided by nurse practitioners. they are a mainstay in her delivery. in terms of clinics, that is an interesting question because when we think about people going to the emergency room, a could look at some other alternatives, that is less costly to the system, we think those might be goo ideas. i would say the whole continuity piece, we want them with a primary care provider. if you have the electronic health records, you have ways of connecting so someone at 8:00 at night goes into a drugstore clinic because of a strep throat, that is a good utilization of the system that can make sure their primary care

provider the next day he about it, to follow up with that individual, and it is having a more systemic look at the delivery system and not having but as long as the systems can talk to each other, it may be an efficient way to deliver care. part of they as payment reform discussions under way in the country, at the level, there is an effort to move away from paying for each intervention or interaction with the health care system to broader heymans for systems of care. thosee of the hopes of changes is that at the system level you start realizing that as thise providers, example is, or even activities

outside the traditional health care system, social services and the like, that relatively modest payments made for clinical services can yield very positive health outcomes. the ide is to facilitate -- the ,dea is to facilitate the shift gradual, toward a more systematic way of looking at care which then creates more room for the examples the questioner asked. telemedicine, which can run into lots of terriers, more social interventions. it is an elephant illusionary process. >> we only have a couple minutes left. i want to wrap up with continuing the last question i had from what i prepared on the role of advocates, and you answered that well. i appreciate it. in states that are going to be short term, and i did not want to use it long haul. for advocates that are in a

state like texas, any particular words of advice, encouragement that you can give us. >> i would say dig in because it is a long haul. we prepared. if you need to jump in there, do not pretend that you are going to be out of this in six months to a year. we prepared for the long haul. i would say look for the opportunities along the way and insert yourself and get some short term victories and tangible results to keep the momentum and energy and folks moving. localize it because people need to work on something in their own communities. be afraid tot connect this to the importance of voting. we cannot pretend these decisions would not be different if the political leadership were different. we have had people in the past

who were not afraid to use it, but you are able to tell people here is so and so's position on medicaid expansion. do whatever he, but do not forget to vote. tople have to be willing work long-term, naked local, and do not be afraid to connect it to voting because it is critical. >> in states that have expanded, how advocates can work with the medicaid department and make the extension a success? inadvocates have been viable to us. just in terms of setting up our own programs, how do we do outreach, linkage, how to get the training, what do our training materials look like, being with us there a long way, and on so many occasions, things like constructing forms, think be sent outat will

to members of they can be critical in making sure that that communication is going out in a way that is user friendly and helpful. they have been out there with us in terms of being willing to be trained, be that linkage with an individual having difficulty, arranging services, just being part of the whole delivery system. i think again, in our state, we could not i do not think that we would have been as successful without the partnerships, with advocacy folks. the other thing they are having -- being helpful with, they are the eyes and years in the community. i can let us know of problems long before we might share them otherwise. that partnership is extremely critical in the success of the implementation. beshear also spoke.

he talked about setting up the health insurance exchange. this is a little over 20 minutes. [applause] thank you. thank you all very much. ron, thanks for the kind introduction. evangelisto me as an has some credibility to it, because my dad was a baptist preacher. and so right toward the end of my talk today, if you do not want to answer the altar call, you better leave early. [laughter] my audience with me because i think we have got a table of kentuckians right down here in front. [applause]

i appreciate the opportunity to come here and talk to you about a subject that we are not all only interested in, but very in our feelings about what ought to be done to this country. people who do not know kentucky might consider the commonwealth an odd choice to be leading the nation in implementing federal health care reform. after all, my state has historically suffered from a national stereotype of being just another one of those southern states that are a little bit behind the times. furthermore, as ron pointed out, u.s. senators, mitch mcconnell and rand paul, are vocal and vehement about their opposition to the affordable care act, to medicaid expansion,

to government spending, and about anything related to president obama. they feel comfortable doing that because our electorate in kentucky has been somewhat cool to president obama through two elections, coming out against them by about a 2-1 majority in 2012. so classic red state persona, right? wrong. know, turkey has been the only southern state to both expand medicaid and develop its own state-based exchange. [applause] today, today every time the topic of reform comes up, both pundits and the president of the

united states himself say look at what kentucky is doing. in fact, i have been invited to tell our story on programs like "meet the press," c-span, cnn, "cbs evening news," journal,"ll street and "the new york times." i have been asked again and again, governor, how are you doing this? and also, governor, why are you doing this? first let me talk about the how, because that is an easy conversation. i had theed that legal authority under kentucky law to do it. that is the way some governors do, you know. but historically, the general assembly in our state had

delegated and has delegated to the executive branch the authority to determine medicaid eligibility. so instead of having to wrestle with a legislature, i simply had our cabinet for health and family services amend our regulations. and so we expanded medicaid. had the i determined i authority to establish our own exchange, and so i issued an executive order, and we just did it. [applause] and as you can imagine, yes, he ites that tea party- immediately challenged me in court. well, we won. or i should say actually the people of the commonwealth of kentucky won. they won because their ability to access health care is no longer being held hostage by political considerations. [applause]

level,w, on a national kentucky's senators may be screaming about president obama and also the cost of society of taking care of those in need, but there is a huge disconnect ofween the rank partisanship national politics and governors whose job it is to help beleaguered families, to strengthen our workforces, and to attract companies, and to build a balanced budget. look him i do not have time for all the political craziness that goes on in this town. [laughter] i do not have time for that. i have got a job to do, and that is to take care of 4.3 million kentuckians and their needs. and you know, other governors get that, too, because it is no coincidence that many governors -- and not only democrats -- but

also even some republicans like -- bush jan brewer to use medicaid to help more of their people, because like me act saw the affordable care not as a referendum on president obama, but a tool for historic transformation. now, let me talk about the why. why has kentucky, under my leadership, moved forward so aggressively on health care reforms? the decision last may to expand medicaid, i open my press conference with these words -- today we change the course of kentucky's history. i was not really being dramatic. i was being truthful. kentucky is a state whose collective health has long been

horrendous. worst, if notthe the worst, in almost every major health category, from smoking to cancer deaths, preventable hospitalizations, printable or premature death, cardiac heart disease, diabetes. you named the condition, we do not look very good in it. and those harmful rankings did not does come about last week or last year. we have ranked ike that ever since they started keeping rankings of these things in the united states. now, do not get emmy rossum. we have made progress over the in kentucky in health care, but those incremental improvements are not enough. i knew to make fun of mental change and a transformational change in our health status, i needed a big solution. along came the affordable care act and gave that big solution to me. fornow because of the aca,

the first time in our history, kentucky is making affordable health coverage available to every single kentuckian in the commonwealth of kentucky. [applause] any olds not just insurance. it is darn good coverage, comprehensive coverage, and it is desperately needed. when we began the process, some 640,000 people in kentucky were uninsured. that is almost one in six kentuckians. folks, these are not some group of aliens or make distant planet. these are our friends and our neighbors. these are people we go to church with on sunday. we shopped in the grocery with during the week. we sit in the bleachers on friday night and watch our kids played a small or for all or soccer.

we hunt with them, we fish with them. they are farmers on the tractor. they are substitute teachers. they are seasonal construction workers. er nurses -- they are nurses' aides. i tell some of the other kentucky leaders all the time you would be surprised at how many of kentucky poss uninsured that you know. and for the uninsured, the lack of health coverage puts their health and financial security at risk. these folks get up every morning and go to work, just hoping and praying they do not get sick. they have to choose sometimes between food and medicine. they skip visits to the doctor, hoping a condition and praying a condition turns out to be nothing. they live in fear and anxiety is knowing that encrypts he is only thatad diagnosis away --

bankruptcy is only one bag diagnosis away. their children go long periods without checkups that focus on immunizations, on preventive care, on vision tests, hearing tests. that is unacceptable. the short answer to why is kentucky being so aggressive in implementing the aca? because it is the morally right thing to do. [applause] that is why. but as governor, i have got another obligation. and that is to look after the financial health of my state. whole, they as a consequences of having so many uninsured families are huge and they are negative. jacked up health care costs, --vell collective health

horrible collective health, decreased worker productivity, depressed school attendance, a poor image, and a lower quality of life for our people. finances, like the finances of every state in the nation right now, are extremely tight, and i needed to impact thatnancial expanding medicaid would have on kentucky and on my budget. can i afford it? and so i went out and hired not one but two independent experts. the urbanon board studies institute at the university of louisville to do an academic impact study. and i asked the nationally renowned actuarial firm price waterhouse coopers to do an analysis of cost and benefits. their findings in about six months came back to me and provided an absolutely overwhelming case for making

these steps. includeddings informing me that medicaid expanding -- medicaid, expanding medicaid, would inject 15.6 billion dollars into our coming over the next eight years. it would create almost 17,000 new jobs. it would turn costly, new federal mandates into an $802 million positive general fund budget impact. and it would protect our indigent from cuts in care funding and shield our businesses from up to $48 million in annual penalties. in short, they looked me in the eye and said, governor, you cannot afford not to do this. and i would hope that every governor out here that has not yet taken this step will put aside the political considerations and do the same kind of analysis, because i will guarantee you they will come to

the same conclusion. now -- [applause] you all have all heard about connect, that funny spelled word. kynect. that is our health care exchange. i know you have also heard about our successful implementation that has become the model in this entire country. i'm very proud of that. i am proud of where we are and the reputation we have gained, and i am proud of the people who have done it. because it is awfully easy for me to stand up here and take credit, but you know the hundreds of people that work night and day for months to make sure that our health benefits exchange worked and work well. led the charge.

we have a large group of people like them that are so proud right now because they are helping the change the course of kentucky poss history. over 175,000 people have used kynect to either sign up for expanded medicaid or for qualified health plans. [applause] inundated has been with stories of gratitude. it has been amazing. it has been amazing to experience it. one came from a lady called suzanne. she is a grandmother. she had not had insurance since her husband died, even though they helped to take care of and about disabled child and four grandchildren. everybody in that seven-person home had health insurance except her, even though she suffers from asthma, high

cholesterol, arthritis, and other complaints. she could not afford medication and has not been to the doctor in a long time. we helped her get health insurance. and now she is visiting a doctor and she has got her needed meds. she says she sleeps better knowing that she can stay healthy so that she can care for that large household. lisaer thank you came from . she is a social worker. her husband has renal disease. his employer did not offer insurance, and they have been paying up to $9,000 in premiums for insurance that he just has to have. now, they have got insurance and they are paying a lot less. they can afford it. another note came from a fellow named gerald, 45 years old. his good job and his insurance this appeared airing the

recession -- disappear during the recession. yes a new job, but it is about 1/4 of his last job, and it does not offer insurance. during that time he got hit with a $30,000 hospital bill. will, but hes that now has insurance that will protect him from further financial catastrophes like that one. other notes come from stephen, a 27-year-old with a masters degree, but no job. michelle, who was self-employed and had conditions that kept her from finding insurance. i know that each of you out here knows stories just like that. it is amazing. how this decision made on a state level has been changing so many people's lives. it is also interest in how we have been able to start changing the narrative of little but in

kentucky -- a little bit in kentucky will. -- in kentucky. even though people call kentucky a red state, a new poll says almost eight in 10 a techie 10 kentuckyght in adults favor our decision to cover low income people. so perhaps we are finally getting that point across. and that point is this -- politicians see issues only in terms of political ground to be won and lost. folks, in kentucky, and i know sn your states, the stateke are too high for that. it is about human beings, and we better bring that debate back to this point. this is about human beings, not about democrats and republicans. i have spent more than six years governor, andy's

like many other governors before me, i have focused on three fundamental needs of our state. and jobn, health care, creation. because you and i both know that those are the three areas more than anything else that will dictate kentucky poss success -- kentucky's success in the 21st century. those three areas are intertwined, because with a healthier, smarter, and more energetic workforce we greatly strengthened kentucky's ability to attract jobs and improve our quality of life. tackling those issues has always, that is a huge challenge, but we are seeing payoffs in kentucky. and what i am about to tell you i will actually argue with you that kentucky is really a red state. national persona, because of the face of our congressional delegation, houses

those that do not know about kentucky to think that. -- causes those that do not know about kentucky to think that. kentucky is actually progressive state. doing inwhat we're health care. in education, decades ago, you mentioned education, it was was afor baroness -- it cause for embarrassment. we are a leader in education reform. since i took up office in 2007, we have set up a new testing and accountability system. we became the very first state to adopt the common core standards in english, language, and mathematics. we are the second state in the country to adopt the next- generation science standards. think about that. we are going to take science in science class. [laughter] [applause] improvedramatically

our school graduation rates. just last year we raised our dropout age from 16 to 18. i fought for five years and really my wife and i fought for five years, because jane was a big mover in this. we fought for five years to pass that law, and i finally convinced the republicans in the senate -- i have a split i said assembly -- pass it on a voluntary basis. and i got them to pass it, and it said, each district, we have 173 school district in kentucky. each district can voluntarily adopt this policy. once 55% of them adopted, then it will become mandatory statewide. they did not think we could do it. in two weeks, after that law became effective, over 95 school districts adopted a policy. today we have 140 of the 173 districts already on board with it. it is going to be mandatory.

that shows you what kentucky's education community is all about. [applause] and the quality count survey, which education week does every year, in two years we've moved up from 34th to 10th in the nation in terms of student performance and in a number of measures on education. i am proud of that. [applause] business,ld of kentucky has also been recognized for our aggressive efforts to emerge from this global recession sooner than most. we rank number two -- we ranked two in the nation for job growth over the previous year. we moved up in 2013 to number three in building cars. we are number one in the creation of new business, and we are setting records in exports. to me, it is not surprising what we are doing in health care reform, because we are doing the same thing in the areas that are going to make a difference for our people in the 21st century.

it is not surprising to me what we are doing. it is surprising to me -- i might say what is disappointing to me -- is that more states are not putting politics aside and following us. thank you very much for having me. [applause] >> also today in washington, jeh johnson made his first major speech since taking office. here's a few minutes of his remarks at the u.s. conference of mayors meeting. isimmigration reform supported by the u.s. conference of mayors, businesses, and if the polls are to be believed, a majority of the american people. border security is inseparable from homeland security, and border security must and should comprehensive

immigration reform, protecting our borders, securing our ports, promoting a lawful flow of trade and travel through our ports, two cities and other communities . over the past four years dhs has made history investments at borders in terms of manpower, comprehensive immigration reform would add even more to that effort. comprehensive immigration reform would also promote a more effective and efficient system for enforcing our immigration and should include an fored path to citizenship the approximately 11.5 million undocumented immigrants present in this country. something like 86% of whom have been here almost 10 years. an earned path to citizenship for those currently present in

of inountry is a matter my view homeland security, to encourage people to come out from the shadows, to be accountable, to participate in the american experience, the american society. it is also frankly in my judgment a matter of who we are as americans, to offer the opportunity to those who want to be citizens, who have earned the right to be citizens, who are present in this country, many of whom who came here as children to have the opportunity that we all have to try to become american citizens. i sworeore i came here, in out in northern virginia at a 8 newalization sermon he 43

americans, including a member of the armed forces. it was probably the best thing that i do in my job. there is a law of love in that room, and not for the secretary of homeland security, but for the families who love and support those who have done what it takes to become americans. are as part of who we americans. it is part of who we are in our heritage. and i believe comprehensive immigration reform should include the opportunity for those present in this country who earn it and who are entitled to it, to become citizens. in my view, as a matter of homeland security and as a matter of who we are as americans, address comprehensive , commonsense immigration reform and address it this year. >> you can see all of jeh

johnson's speech tonight at 9:10 p.m. eastern on our companion network, c-span3. >> we bring public affairs events from washington to you, putting you in the room at congressional hearings, white house events, briefings, and conferences, and offering complete gavel-to-gavel coverage of the u.s. house, all as a public service a private industry. we are c-span, created by the cable industry 35 years ago and funded by your local cable or satellite provider. hd and follow us on twitter. >> tomorrow, i conversation on the investigations of chris christie and bob mcdonnell. we will talk to gordon witkin. also i conversation on the west virginia chemical spill and whether new revelations are needed. our guests are from the competitive enterprise institute and from the center from

progressive reform. and they look at mandatory life sentences for young people, with a guest from the catholic university law school. journal" everyon morning live at 7:00 a.m. eastern on season. --m this morning's program reallyoining us is greg -- gregory wallance. he is the former assistance u.s. attorney for new york. it was aimed at kirks.

as the news report indicated a very wealthy arab sheik was .d's and to buy stolen cd pay off politicians. and no one at that time ever -- it would it was result in the conviction of six congressmen, a united states senator, and a host of lesser officials. host: how did it get to bribery charges? guest: at the core of abscam was a professional con man known as mel weinberg. he's is played by christian bale in "american hustle." he made it come alive. he could create an illusion that he was working for a very

wealthy sheik. he convinced people that the sheik had an enormous amount of money to spread around. this was after the oil boycotts by the middle eastern oil producers where oil prices shot through the roof. it was not that hard convince people. essentially it was like flies to honey. word got around and the lower- level crooks they were dealing with put them in touch with higher-level people, lawyers with contacts with congressmen and senators, city councilmen, the mayor of camden, new jersey. it was a kind of a form of underworld networking. the turning point, the key of

what turned it from a local sting operation to a national one was the mayor of camden, new jersey. i thought "american hustle" was a great movie. in the movie he is portrayed as a reluctant. christian bale has to bring them back into a meeting. in the end there is a certain amount of sympathy generated for him when he ends up getting caught. in fact, the mayor was about as corrupt as they come. early on he gave the undercover operatives lists of new jersey public that lists of public officials who said they are willing to sell their offices for cash. he was willing to engage in any kind of scheme, from counterfeiting to bribery.

at one point he was discussing turning the port of camden into a narcotics entry point. the judge who presided over most of the trials called him a cesspool of corruption. to the operatives, he was a gold mine because he was the one who put them in touch with many of the congressmen and with senator harrison williams, who ultimately agreed to take bribes or use their office to influence to get legislative favors for the sheik and his operatives. that is where i do take issue with the movie. as good a movie as it was, that is not an accurate portrayal. host: you write in a recent piece for "usa today" that the sting was a mix of slapdash improvisation and vaudeville

showmanship. was it a sting? were these congressmen and senators set up? guest: they weren't set up in the sense that they were induced to engage in illegal acts that they weren't otherwise disposed to do. that is what some of the congressmen assert as the entrapment defense. it is well established in the law and for many decades that there is nothing improper in law enforcement setting up an opportunity or a means for a criminal or someone who's disposed to criminal activities to commit a crime. i think undercover operations play a very important role, particularly when it comes to consensual crimes. by that i mean crimes where

there are no victims who can then notify law enforcement. when you talk about bribery, the bribe payer and the bribe receiver are in it together and they are not going to go and say something terrible has taken place. often the only way you can find out is set up a sting operation, undercover operation, participate in the bribery activity, and record it, which often means you are going to get very reliable evidence. in abscam there were audio and video recordings that left no issue about what happened. the issue that came up was were these senators entrapped? when you watch them on the tape, the congressmen who comes in and says, let me tell you something simple and short, you guys are going about this the right way. money talks and bullshit walks.

another congressmen walked in and said i have got larceny in my heart. a third congressmen took the cash, put it in his inside jacket pocket, patted it down and asked the undercover operatives, says does it show? this is not a case where mel weinberg were leading children by throwing candy in there path. these were highly sophisticated politicians. many of them were powerful or in charge of powerful committees. they were used to dealing with strong personalities and saying no, to engaging in give-and- take. they could have at any point

said no, this is wrong. in fact, one or two did. in those instances, they were pretty polite about it and they never reported that they had been approached by an arab sheik who asked them to commit an illegal act. they never went to the fbi. compared to the congressmen who did take the money, they became practically national heroes. some people thought it was a sad commentary. host: that was a quote from larry pressler. one of the congressmen was john murtha. i want to show you a little bit of video from john murtha. there is some language that

someone might find offensive, but here is video. [video clip] introducing legislation -- >> you could buy something there. business commitment. business commitment that makes for me to help. i am sure that there are a lot of things i have done here with red environmental regulations, and all kinds of waivers of loss and regulations. if it weren't in my district, people would say this guy is on the take. once they say that, what happens? then they start looking for the money. i want to avoid that by having something in the district, that is all. host: what were we watching their? -- there?

guest: you were watching a congressmen turned out a bribe, for alsong it open accomplishing the same objective. cubesmart murtha was not prosecuted. -- congressman murtha was not prosecuted. it raises some questions, and i'm not sure he ever got out from under that cloud. that was an example of how a congressmen, if he wanted to, but say no, could decline a bribe, and in the case of the six congressmen who were convicted -- and the united states senator who was convicted -- they chose not to do that. they chose it deliberately. and they acted in a way as though -- they did not look though -- they did not look nervous. they did not look uneasy. they did not look like somehow there will was being overboard

or they couldn't resist, that they were helpless to resist the money. they had a kind of a dignified matter of fact aplomb about how they went about taking the money and engaging with the undercover operatives who were very clear in their role as the sheik's emissaries, that they were corrupt, and they did not look like they were doing this for the first time. and i think that is what convinced the juries they were not being entrapped, which is because they were so comfortable in the way they went about it. i might add that most of the congressman did not insert the entrapment defense, that he did something i was not predisposed to do. one of the reasons i think they didn't tactically go down that road was because in order to assert the entrapment defense, you have to admit you committed the crime. then you say, but i was induced to do it by these undercover agents. so for a politician holding high office, that is a difficult feat to pull off.

so some of them came in with defenses that were -- for example, one claimed that he was conning the sheik, he never intended to introduce the legislation the sheik was ostensibly paying for. another came in and said i was conducting my own investigation and i was getting evidence and i was going to report it to the fbi. and the defenses in some ways was almost as outlandish as the crimes they were accused of. nonetheless, from a prosecutor's point of view, the ultimate test is, does a jury believe beyond a reasonable doubt that these individuals are not entrapped and/or they committed the crime. and every jury that listen to the testimony, every jury returned a conviction. and every appellate court who reviewed the fairness of both the investigation end of the trial affirmed the convictions.

and that, i think, ultimately was the stamp of approval on abscam, and to my thinking, made it one of the most effective undercover operations of political crime in our countries history. host: what was your role in abscam? guest: right after that news report in early 1980 -- and i was a relatively new assistant u.s. attorney -- i was in effect assigned to work as part of the trial team, and i spent the next two years in pretrial preparation. i listened to a lot of those tapes. and then the trials and the appellate process. at that point, i was just a few years out of law school and it was quite an experience to come into that kind of a case and quite eye-opening listening to those tapes and the way people talked when they didn't think

they were being watched. host: do you think that sting operations -- do you think the word "sting" is fair, first of all? and you think sting operations is a fair way of doing business on the prosecutorial side? host: "sting" is a euphemism for undercover operation where the operatives assume the role of a criminal in some way. yes, i do think it is a fair way to conduct investigations. after abscam, there was another undercover operation in chicago which investigated corruption in the judiciary and used similar techniques, and the result had been the conviction of a dozen or more very corrupt judges. but these operations are not without their risks. and a lot depends on the

judgment of the agents and the prosecutors who are handling them. i will give you an example. a sting operation that i think much more than anything that "american hustle" was addressing illustrates the ambiguous, the moral ambiguity of some. if you recall, in 1965, after the selma, montgomery, voting rights march, a white woman who was participating in the march was shot and killed. that was a huge event and it probably was a very strong consuming factor to the change of the voting rights laws. the men who shot her were apprehended and convicted. why was that? even sometime earlier, the fbi had infiltrated an fbi agent, gary, into the ku klux klan in birmingham.

and what i have described so far sounds pretty good. but while he was part of the ku klux klan, in order to maintain his credibility, he had to both witness acts of violence by the klan and indeed at times participate in beatings. he was under orders, under no circumstances was he to initiate or lead such a violent event, but nonetheless, he could not hold back because otherwise he would be found out. that is a sting operation, if you will. where the moral ambiguity is pretty profoundly troubling and one that i don't think we have ever quite come to terms with. i am very glad that the woman's killers were apprehended, but nonetheless, the fbi had to engage into some questionable conduct. host: gregory wallance, former assistant u.s. attorney from new york. we are talking about the abscam

investigation of the late 1970's and early 1980's. its tie into the "american hustle" movie. we will put the numbers on the screen if you would like to dial in. or you can tweet as well. peter is calling from new york. the morning. caller: good morning, mr. wallance. you have prosecuted government officials. building seven of the world trade -- host: he is not calling on the topic we are calling on. steve in indiana. please go ahead with your question or comment about abscam. caller: $9 billion was cut from people for food stamps, $80

billion was given for banks. my question is, is this because the people with banks could afford to buy or influence congress where the ones on food stamps had no money? host: mr. wallance, if we can take this further, just to talk about congressional influence at this point, is it still possible to connect money to politicians? guest: absolutely. and it is unavoidable. here is the ambiguity that i think abscam revealed, which i think may partly answer the question, which is there is a very fine line between lawful campaign contributions and bribery. and the reason it arises is because politicians are in the

business -- that is, elected legislators -- are in the business of introducing legislation. perfectly normal. that is what they are expected to do. and they are also in the business of running for office and therefore having to raise money to run for office. and the distinction is this -- a donor may give money to a congressman with the expectation that the congressman will introduce legislation that will favor his position, his goals. the congressman may know that that is why he has been given the money. so far nothing illegal has occurred. but when the elected official and the donor, the giver of the money, have an express agreement that there is a quid pro quo -- in other words, you give me money, i give you the influence of my office -- then they have crossed the line, and that is bribery. and in the examples you are citing, i don't know if that occurred. i can just say generally that there is a perception among the

american public -- in fact, a cnn poll indicated 85% just a few years ago of the american public believed that congressmen, legislators are heavily influenced, if not controlled by the people who fund their campaigns. this distinction is what abscam was focused on, and when you look at these tapes, when you read the accounts of what the congressman said, there was no question. and that was a real issue for the jury. that they were engaged in quid pro quo. you give me money, i will introduce legislation that would get the sheik a visa to live in the united states permanently so he does not have to worry about unrest in the middle east. that is crossing the line. host: a question, why do they call it abscam? guest: initially it was reported erroneously as arab scam and

there were protests. in fact, abscam stood for abdul scam. there were two sheiks played by different fbi agents and the first one set of abdul enterprises, an investment operation in the united states. the operation became known as abdul scam, abscam. but arab scam stuck in people's minds caused a diplomatic event. host: a viewer wants to know via twitter, can mr. wallance comment on the politicians that refused the money? host: well, yeah, they were corrupt. that was established. it had to be established to convict them beyond a reasonable doubt. but i think there was a range of

style and how they approached the corrupt proposition offered by the undercover operatives. i described the ones who were pretty blatant about it and did not leave a lot to the imagination. but there were others, for example, who were a lot more careful, wary, and crafty. for example, one congressman was sitting in the hotel room where the videotapes were recording what was taking place with mel weinberg and another fbi agent pretending to be the sheik's representative, and they discuss ed the immigration legislation that they were seeking to have the congressman introduced to help the sheik come to the united states. then they passed across to the congressman a suitcase of $50,000 in $100 bills. the congressman turned to the lawyer accompanying him and he said, howard, take care of that for me. he was very careful.

the issue at his trial was whether he knew what was in that suitcase was cash being paid in return for his legislative favor. ultimately, the jury concluded from all of the circumstances that he had to know that this was cash and convicted him. but i was struck by the range of approaches that the congressman took in dealing with the undercover officer. -- operative. host: 31 officials targeted. seven convictions, correct? guest: no, i think it was almost every official -- targeted is not quite the right word -- who met with the undercover agents, listened to their illegal proposals, and agreed to them. virtually all of them were convicted. six congressman, a united states senator, there were three members of the philadelphia city council, the mayor of camden,

new jersey, also a state senator, and a number of other lesser officials. i can't recall if virtually every jury returned a conviction but the vast, vast majority of them did. host: i apologize. i meant seven from capitol hill were convicted. a senator and six congressman. how long were they in jail? host: they all served jail time and they were in jail for at least several years. host: harrison williams was the sole u.s. senator that got convicted. mr. wallance, why did some non- congressional members of city councils, etc., get involved in this fbi sting? host: i referred earlier to the networking, that the outer circle, where these low-level crooks who were selling stolen art or stolen cd's who then put

the undercover operation in touch with the next level. that was angelo errichetti and corrupt lawyers in corrupt city councilmen. they in turn, after satisfying themselves that they were dealing with authentically corrupt arab sheik then passed the undercover agents, or set up meetings for the undercover team with the congressman and the senator. it was a networking from the outer circles to the inner circles that is what really made abscam so effective. host: a viewer tweets in -- now, we covered a little bit of that, but please go ahead and revisit that. again, was there a targeting of specific officials or was this going to be wide open to all 535

members of the congress? guest: that is a good question. in the first instance, there was no targeting of an official. the undercover operation simply continued -- let's say, when angelo said i want to introduce you to a congressman who can help the sheik with legislation, it would have been a dereliction of their law enforcement duties if they said, no, we don't want to meet with them. eliction of their law enforcement duties if they said, no, we don't want to meet with them. they had to meet with them. this goes back to what i said. there is nothing wrong with setting up the opportunity or a means for somebody to commit a crime, provided you do not induce them to do something he was not predisposed to do. that is not targeting, that is simply good law enforcement. thinktely, i