stay around washington for the time being and write a book. beyond that, we are still waiting to hear. victoria mcgrane is a wall street journal reporter. on theeciate you coming washington journal this morning. you can read her story in the washington journal >> and we take you live now to the florida house as members get ready to gavel in. -- to the floor of the house as members get ready to gavel in. the speaker pro tempore: the house will be in order. the chair lays before the house a communication from the speaker.

the clerk: the speaker's room, washington, d.c., february 3, 2014. i hereby appoint the honorable thomas e. petri to act as speaker pro tempore on this day. signed, john a. boehner, speaker of the house of representatives. the speaker pro tempore: pursuant to the order of the house of january 7, 2014, the chair will now recognize members from lists submitted by the majority and minority leaders for morning hour ebate. pursuant to clause 12-a of rule 1, the chair declares the house in recess until 2:00 p.m. today.

will have more state of the state speeches for you to -- for you. today, oklahoma republican governor mary fallin will be delivering her speech. that will be live at 1:30 p.m. eastern on our companion network, c-span3. a specialtoday, election debate for the 13th congressional district seat in florida. filled,the seat to be

held by the late representative bill young. he passed away in october of last or after serving 40 years in congress. -- last year after serving 40 years in congress. here's a look at tonight's first lady's program. >> i was in a car wreck that i wrote about extensively in my book. the whole time i was in the hospital -- not injured, really. i had a cut on my leg and a broken ankle. i was praying that the other person in the car would be ok. and the other person in the car ,as one of my best friends which i didn't know. i didn't recognize that at the side of the crash. and i think because i prayed over and over and over for him to be ok and he wasn't, you know, i thought god was not listening. my prayer was not answered.

i went through a very long time , and notlieving believing that prayers could be answered. time and a lotng of growing up to come back to faith. >> first lady laura bush, tonight at 9:00 eastern, live on c-span and c-span three. also on c-span radio and c-span.org. interview at the george w. bush presidential center in dallas at 10:30 a.m. -- 10:30 p.m. >> consumers will win in the end, in that allows isp to continue to innovate, to continue to wring billions of networks and new services and new pricing and business models to consumers. consumers are the main beneficiary. >> the big corporations one out in this decision. they are the ones with the tremendous amount of market power. tremendous amount of

influence in washington, d.c. to try to shape policy in their direction. consumers will be the losers in this deal and that is why so many of them are speaking up and asking the fcc to move forward on a clear path to protect them. >> the impact of the court net neutrality ruling, tonight on the communicators at 8:00 eastern on c-span2. officials running state health insurance exchanges met recently and talked about the processes and the challenges of setting up the exchanges and the successes they had. you'll hear from audrey haynes exchangeky and the director christine ferguson. this was hosted by the robert wood johnson foundation. it's about an hour and 15 minutes.

>> good morning and welcome to our robert wood johnson sponsored roundtable. where are we now with state and roman? i am the policy adviser to the foundation. i also want to briefly introduce some of my foundation colleagues here today. kathy hempstead in the front row who hosts the coverage with the foundation. her colleague, brad thompson, who runs can indication for the team. both of them will be available at the end of the briefing to answer any questions. today marks the end of the fourth month for the held extremists -- health insurance exchange. it was a rocky start. on the other hand, other state for -- state marketplaces fared

much better. in the aggregate, the big picture is that it now appears that millions of people have successfully signed up, either for private health insurance coverage, medicaid, or the still -- the children's health insurance program through the exchanges. today we have gathered five people who have worked closely with some of the most successful state exchanges to report on their experience. none of these were without glitches, but on the other hand, many things worked and we will hear about both the challenges and the successes. we have asked all of our speakers to teach -- to bring us up to date on the enrollment in the exchanges. what outreach strategies worked and which did not work so well, and what they perceived the between now and the end of the enrollment time frame between now and march 31, as well as what plans they are making for open enrollment next year, which

believe it or not, is only nine short months away. let me introduce our speakers. first of all, heather howard is with us. she's the program director of the state health reform programce network, the funded by the robert wood johnson foundation. it is dedicated to providing technical assistance to states to maximize coverage expansion under the affordable care act. she is also a public affairs lecture at the woodrow wilson school at princeton university and a faculty affiliate for the center for health and well-being. heather previously served as the commissioner of the new jersey department of health and senior services and worked before that in the u.s. senate, house of representatives, the domestic policy council at the white house, and the health care task force at the antitrust division at the u.s. to justice department. delighted to have with us audrey haynes, the secretary of the kentucky cabinet for health and family services. she previously served as the senior vice president and chief government affairs officer for the ymca in you -- in

washington, d.c.. her office oversees the kentucky exchange. she served during the clinton administration for women's initiatives and outreach. also with us, we are happy to say is christine ferguson. she is the director of the rhode island health benefits exchange. close toy, she spent eight years as a research professor at the george washington university school of public health and services. she has also served as commissioner of the massachusetts department of public health, the director of the rhode island department of human services, and formerly as counsel and deputy chief of staff to the late u.s. senator john chafee of rhode island. we are very happy to have her with us as well. kaufman, the executive

director of the d.c. health benefit exchange authority has also joined us. she is a nationally recognized expert on private health insurance markets, and served as the superintendent of insurance of the state of maine from true thousand 8-11. she has served in key leadership positions -- from 2008-11. she has served in key leadership positions and was project director at the university of georgetown health policy institute. on the phone from california, peter lee, the executive director of covered california, a sacramento-based statence exchange and the insurance exchange for individuals and small businesses. he formerly served as the deputy director of the center for medicare and medicaid intervention at cms where he helped shape implement -- shaped initiatives to implement higher quality care and lower costs. of the was the ceo

pacific business group on health and the executive director for the center for health care rights. welcome to all of you. we will start with an overview from heather howard, setting the stage for what we have seen to date in the state-based health insurance exchanges. heather, welcome. thank you for bringing us together. i have a few slides for the key takeaways. -- >> thank you for bringing us together. i have a few slides were the key takeaways. what are we seeing? despite the rocky start, we have seen that enrollment in state-based marketplaces is generally outpacing the enrollment in the federally facilitated marketplace. that is because most of the

system glitches have been worked out relatively quickly in those state-based market places. it is also because we are seeing far more robust consumer assistance and marketing efforts in the state-based market places. an important also a seamless eligibility between the marketplaces and medicaid. it is worth noting, too, that there is a success story in five states, and this is just early on -- that have been doing what expeditedst-track enrollment for food stamp beneficiaries into medicaid. oregon, for example, despite their ongoing exchange implementation challenges, have been able to enroll 121,000 people into medicaid into that fast-track enrollment. and we are also seeing that plan choice varies by state level across the state-based exchanges. we will hear from our friends about what it looks like in their states. but overall, we are seeing that 80% are choosing silver or higher levels. the aid distribution also varies across the state, but

overall, 24% of the enrollees are in the 18-34 age range, that covered age range. consumerioned, assistance varies. one important distinction between the state-based exchanges in the federally facilitated marketplace is active, robust consumer assistance. this chart demonstrates how much more funding is going into marketing and outreach. this -- we know how important that is, given the general confusion about options. people are learning more and more the state-based market places have more resources to get the word out. this chart includes state-based market places, but also the consumer assistance partnership states, which are also receiving funding from the federal government for outreach. have seen these early successes, but there are challenges. we will hear about those as well today. first up are the systems failures. we have seen in some states that some vendors have not been able to deliver. withtates have struggled the i.t. implementation and

several of those states have been doing audits to go back and look at what went wrong and what the path forward is. those are prompting decisions about whether and how to salvage what they have built thus far and whether to start over. it demonstrates a commitment from the state to system repair and enhancement. that suggests that ultimately, those state-based exchanges will be successful over time. there have been significant investments in i.t. and if they can salvage or repair, they will be successful. not only have there been system failures, but states have figured out workarounds, as they tend to be good at doing. first, there has been paper processing. in several states, states have been pursuing policy options to allow people to keep their previous coverage option during this transitional time frame. while we have had some rocky start in some states, states have been looking at transitional paths to allow people to keep their coverage. it is very important to make sure we are a sexual it in the enrollment and the coverage. the enrollment

and the coverage. there were some good reports out about how many people have been paying their premiums. but something that has been a real focus for state-based marketplaces is a effectuating that coverage and making sure that they are able to transfer that data back to the carriers without enrollment and to the payment to make sure that is effectuated. overall, very promising news from these state-based marketplaces as we look forward to promising enrollment data, which we know we will be hearing more about today. think you. i'm -- thank you. i will turn it over to audrey. >> i'm very pleased to be here.

we have heard a lot about kentucky, which we're very pleased about. and as you know, our governor is really pleased about it. this is a short version of our story. in kentucky, there were 640,000 uninsured in a state that is just over 4 million. we have about -- the exact --ber is 300-8000 that we 300-8000 that we expect to qualify for medicaid under the new eligibility rules when we expanded medicaid. that wet 290,000 decided to qualify for premium assistance through the exchange. kentuckyt happened in is the governor signed an executive order, which created the exchange. it is organized in my cabinet, the cabinet for health and family services. i want to mention this just a little bit. we found that this has been part

of what we call the "secret sauce" i suppose. they cabinet, you have department for medicaid services. you have the department for community-based services, which has been doing all of the eligibility for medicaid. andalso provides food stamp the snap program benefits and tanf childcare. those programs. the in our department is department for public health, and the department for behavioral health, the office of health policy, just to mention a few of the major departments. we think this is rather significant because we have not had as many of the structural barriers that you would think -- everyone works for one big administration and it should be a -- it should not be a problem, but we all know that organizations sometimes become barriers. also, because medicaid is in the

cabinet and they work so closely -- and did work so closely with the exchange -- we also have a very experienced i.t. department. anyone knows that medicaid has i.t.ve a pretty super department that supports it, but so do the other departments within our cabinet. we had a lot of experience in bringing a vendors and we also had a great partner in the deloitte company. we established an advisory board at was made up of all the stakeholders, as i'm sure it happened in the other states as well. one of the stakeholders, i just there havent out -- been varying degrees of success around the country. but the insurance agents have

been really involved in kentucky. we have over 2000 agents that have become certified on the exchange and are helping both small business as well as individuals get signed up. theylearly, even though still receive an insurance commission, when they help people fun of for medicaid they do not get a -- help people sign up for medicaid they do not get anything for that. a lot of agents are in lower income neighborhoods and communities where a lot of people that are uninsured would versus one medicaid of our qualified health plans. they have been really terrific in helping them as well. and of course, we have what we navigators tos or help all around the state. our exchange is known as kentucky's health-care connection. why did we decide to do it?

it is not something we are proud of, but we are about the 44th sickest state in the country. if that is not reason enough, then i'm not sure what is. we all know that both education and health are such important for a statecks economic development, opportunities that are afforded to them. for health outcomes that are 50th and smoking, 40th in obesity, 43rd and sedentary lifestyles, 41st in diabetes, 48 in mental health days, 49th in poor physical health is, 50th in cancer death, 49th in cardiac heart disease, 40 third and high cholesterol, 48 and heart attacks, 44th in annual dental visits. something that any of us in our state would be proud of, and certainly not something if you

were serving as governor or decorative area of the cabinet for health and family services you would be proud of. you can see kynect and the affordable care act provided us and extraordinary opportunity to take it vantage of the law and turn our health around. our health statistics, we believe, could get worse before they get better. at least the reporting of them. the reason we say that is because there will be such high demand for screening and so may people that have gone without insurance for so long that we actually think there will possibly be a lot of chronic diseases that are righthave gone undiagnosed and unreported. -- that have gone on diagnosed and unreported. we know those numbers could go up, but ultimately we will be heading in the right direction.

these enrollment statistics are as of monday morning. when i given to you, it will give you an idea of how daily enrollment has picked up. for example, as of this morning, 195,502195,000 -- enrolled in health care coverage through kynect. have 148 thousand 830 seven that have qualified for medicaid. approximately 148,000 that have qualified for medicaid. that is about 6 -- 36% of enrollment. it started out about 30% enrollment has and medicaid. then to 70%0% and and then now settling in at about 75% of enrollment. that is, any -- enrolled in medicaid.

individuals found eligible for a subsidy to purchase a plan. some have just not yet chosen a plan. haveve 647,000 folks that conducted a preliminary screening. and our call center reported 400 56,000 calls that have been answered. -- 456,000 calls that have been answered. we have had just over a million visitors to our site. the other number that is not appear that we are very proud of 1471ntucky is that we have small businesses that have begun applications. -- about 500 48 of those about 548 of those am a about have come have completed them. clearly, in our state those are numbers we are proud of.

here is our cute call center .erson and our number i'm happy to answer questions and turn it over to christine. >> thanks so much. i'm really happy to be here to represent the smallest state in the union. you will have the largest evening union at the end. on behalf of our leadership, governor chafee and the legislative leadership and our colleagues in the cabinet, we like the idea of being the smallest state in the union and the top two exchanges in the

country in terms of enrollment and beating our targets. likewise, we have very similar statistics to other states in the context of making our way through the uninsured. of the wayhird moving up into half of the way in medicaid, of new enrollees. and in the number of uninsured in the state with the tax credit. about lessons learned, because the numbers have been all over the paper. everyone is focused on enrollment, enrollment, enrollment. but there are some lessons that we have learned and there are some really important steps forward that we need to take. there are going to be books written about lessons learned at both the federal level and the state level, and there should be. number one is this kind of a massive i.t. build and the

implications of that in a government setting versus the private sector setting. i think that the difference in how we approach it has to be reflected on, and we need to on the government side how we do these things. for us in rhode island, we have been very fortunate. our system is working very well and we are moving to system stabilization as opposed to fixing -- we are fixing, but as , thatd to having to redo issue is at the core of all of our businesses. , lesson learned, and it is essential that there is cooperation between departments and state agencies and the leadership in states. if you don't have it, it is very difficult to make sure that you do not have -- that you accomplish your goals.

third, there are fundamental problems in the basic laws of be cleanedt need to up. and if we don't clean them up in the next year or so, there will be ramifications to that. eligibility, to the implementation of the law, and they tie everybody stands because we cannot get agreement on moving forward. and i think that is essential, that we need to get over this and move forward and fix the things that need to be fixed. the problems in the launch at the federal level scared away a lot of early adopters, particularly in the business community. that is not a good thing. the federal government has done a great job recovering and they are moving forward really well. but we have good knowledge that

there was some damage done in the arcing and outreach and we have to redouble area -- redouble efforts in that area. customer service is essential. and it is real private sector kind of customer service that we need to provide. because we are providing services to a range of people. you've got the medicaid population. you've got middle income and upper income individuals getting 100% ofits, or buying the costs, and then you have small businesses. it is essential that we look at those customer service pieces. fromnvestment in marketing a government view of the world, that is a very different thing. different from the way private sector looks at marketing. sales.estment in i know that is not always the best word, but the truth is, that is what is happening now.

we do need to rethink how we look at and invest in those kinds of components. business from the future, small business focus is essential. full employee choice for small as many states are moving toward is not just looking at ways to reduce cost of insurance, but many other things. small business is essential in that component. we need to understand what they want and how to provide the kind of data and information that their employees need to make decisions. finally, this is the most important investment in health care that has been made for 70 years. i've been at this for 30, which

is way longer than i ever thought i would be at it. this is it. if we don't take this opportunity to invest in looking at what the data and outcomes are in addition to enrollment on cost, quality, if we don't provide consumers with a transparency -- and businesses with the transparency of how insurance works, how to make decisions, it doesn't have to be as complicated as it has been. it,an break it down, unpack and provide people with information so they can make better decisions, not only when they enroll in a health plan, but also when they are making provider decisions. providers will finally have the tools if we do this right with the data. providers will have the tools to push back and start redesigning more from the bottom up how payments need to be changed and how they can practice medicine and work with consumers in the way that they have wanted to,

which is holistically. at the end of the day, if we cannot all stand up here in a couple of years and talk to you about what the outcomes were on worker productivity, health , and health care outcomes costs, if we cannot do that, coverage is only one piece. americans want to know what they got for their investment. we need the data and analytics to make sure they get those answers. thanks very much.

xgrid morning, everyone. my name is mila kaufman -- >> good morning, everyone. my name is mila kaufman. if it was not for the foundation helping me get some consulting report, -- support, i would not be part of this success story. i was the first employee hired and i had one more employee working with me the first month. the foundation stepped in to help, so thank you so much to the foundation and thank you for having me here today. day.er 1 was a great bloomberg news that day was reporting that we were one of four jurisdictions that was open on time and stayed open and consumers were able to do pretty much everything from start to finish, shop for health plan planns, make a health selection, and actually hit the

"invoice me" button. it was a great day, and it is still a great day every day for d.c.no place -- healthlink.com. issue withill some functionality -- we have full functionality for businesses as well as individuals. proud that we were the market -- marketplace selected by opm and officials in congress as well as congressional staff to have their job-based coverage and in december we also enrolled the president, so i thank him for his business as well. we have brought insurance company churches and product choices. on the individual side, 34 products. on the small group side, 267 different products. and we also have all of the major health insurance companies

participating. edna care, blue cross to shield, kaiser permanente, as well as united on the group side. through some of the slides. i wanted you all to have them to give you a sense of where most of the product offerings are, both individual and small group. i want to talk briefly about employer and employee choice. this is something that christy mentioned earlier, how important not only focus on the individual side of things, but also on small business clients. from day one, at dchealthlink.om com we were able to offer small businesses more choice than they currently have. they essentially have the purchasing power of large employers and can offer their employees the types of choices that were only available to

large employers in the past. small business getting coverage through dchealthlink.com can choose a meant -- a mental level and then all of the carriers the various levels. that is an option that never experienced -- existed before. they can allow the employees or the employer to choose the different benefit levels. i also included some slides to show you a range of prices. just want to note that the prices are very competitive in the district. in fact, if you are a 27-year-old person, you can get a policy for $124 a month. with one of the largest carriers. if you are 55, you can get a policy for a little under $300 a month.

it is very affordable coverage. range at theed the shop site for you, which i will not go through. but i think it is interesting to see where the prices are in a marketplace. i do want to focus on our experience with enrollment. and also share some challenges and lessons learned with you. 10 -- and we released data on a monthly basis. in a couple of weeks we will release more updated information. we do that for a number of reasons, including the fact that whenve seen a movement in coverage becomes effective for a particular enrollee. is thatfound initially some people want to january 1 coverage, but online they signed .p for february 1 coverage what we have been doing is accommodating consumers who wanted the earlier stargate.

date.rt if we release numbers on a weekly basis, it will be more accurate in terms of who enrolled for january 1 coverage, february 1 coverage, etc. betterthly release works in being able to provide all of you with more accurate data on enrollment. as of january 10, we had over 20,000 people enrolled, including both the shop side and congressional enrollment on the shop side. individuals and families and rolling in the andvidual marketplace private, qualified health plans, as well as through dchealthlink.com and to medicaid. that is the total number of enrollees. you, thattell exceeded all of mike's occasions. all of my expectations. d.c. has one of the lowest uninsured rates in the nation.

over the years, we've done a lot to expand coverage options for our residents and small businesses. this, thee started old census data showed that we had about 42,000 uninsured people in the district. we have more updated information and the most current information on the uninsured shows that we have about 100 35,000 uninsured. the district expanded medicaid right away right after the affordable care act was enacted. and people went up to 200% of federal poverty level income qualified for medicaid. we believe the huge drop is a result of the early medicaid expansion. we started to look at our goals and try to figure out how many people we can enroll in year

one, our numbers from the start were a lot lower than kentucky, i have to say. but i thought with my team, let's try to hit the target of 5000 in the first three months before december 31. that was a high enough target for us to set, and still be realistic. wethe first three months, exceeded that target. we had a thousand people sign up for february 1 coverage. and we were able to get 4600, almost 4700 people enrolled into medicaid. in the first three months, we exceeded our goal by a whole lot. and we had almost 12,000 enrollees in the shop. -- i just want

theote for all of you that numbers in the next week or so that we will be releasing will include enrollment by effective date for january and february as well as march muscle you will have that break down once we release that. march, so you will have that break down once we release that. another interesting aspect of enrollment is who we are enrolling. we can show you by age category our highest enrollment by age. it is in the age group of 26-34-year-olds. that theou know largest percentage of our uninsured, in fact, 60% of our uninsured population is under the age of 40. right from the start we were very focused on the younger members of our community. and we have a success story to tell when it comes to and rolling those younger members. we did some creative outreach.

a youth we have enrollment leadership council that advises us and many of our d.c. health link a sisters that help us with on the ground enrollment and provide us with chretien -- creative ideas. we have done events in kids clubs, bars, and air jordan, -- when sneakers were there were lines out of the stores with young people trying to buy the air jordan sneakers, we were out there trying to educate and enroll those people. at midnight, snacks at denny's, those are the types of things that young people do after they finish at the dance clubs. we were there trying to educate and enroll and our numbers on the age group -- the younger age group evidently shows that. we have an event planned for valentine's day as well as youth

enrollment day in the middle of february. it will be an ice rink and doing all kinds of things with the younger population. to talk a little bit about one of the challenges that we have seen, and that is, the ap tc population. people who do not qualify for medicaid, but do call a five for tax credits. i have been very disappointed in how many have been enrolling. beenof it has back-to-school coverage on the private side. we are trying to engage in a new strategy. once we tell you that you are eligible, why is it you are not selecting your health plan?

my team and i are shifting gears to try to be more's pacific. -- more specific. we are trying to align ourselves that provide tax advice during tax season, and we will have brokers there to help consumers that walking with tax help to get them enrolled as well. -- that walk in for tax help to get them enrolled as well. we think that strategy will help a lot to reach the population it qualifies for tax credits, but for whatever reason are not enrolling. i also want to briefly talk about some of the i.t. challenges. improven the "find and those quote mode. and we are adding -- "find an improved" mode. and we are adding functionality all the time. by that i mean, our system was not ill to allow you to reset your own username.

50% to 60% of the calls to the call center work -- was consumers who forgot their username and needed us to reset it. initially, our i.t. folks were handling that. consumers would have to unfortunately call back several times to get that done, which was making the wait times for the call center longer. and it is an inconvenience to a consumer. i know for myself, i wanted it instantly. we added that feature so that a consumer can avoid: the call center and reset their own username. -- a consumer can avoid calling the call center and reset their own username. and the consumers that i've had a less than positive experience, we take those lessons and focus our i.t. strategy to always making the consumer experience better.

i will close by saying that this is going to take time. this is not an overnight sensation. this is the most fundamental effort to make sure that all americans, all those who live and work in the u.s. have asked us for high-quality, affordable coverage. it took us a long time to get to over 40 million uninsured. totook us a long time to get the reasons for personal bankruptcies being a medical condition. long time to get to this irrational system of health care financing and delivery. it is going to take us a little bit of time to get us on a

better path. financeh that where we medical care in a way that is sustainable for all of us, not just individuals, but the nation as a whole. here tothe reporters keep that in mind, and the public who is thinking about enrolling. and if they are in a state that is not a success story like us, give the site, give the federal government another chance. we are all in this to improve everyone's lives, everyone's health. and to make sure that over the long term, people have access to the medical care that they need. and the kind of financial security that families need. we are committed to all of you and we will work day and night to make sure every single person gets the kind of coverage they need. thank you.

>> thank you. now we will hear from peter lee in california. >> thank you for -- thank you. it is great to be joining you. a lot of my points will echo remarks you've heard from rhode island, kentucky, the district of columbia. first, how are we doing? we are now two thirds of the way through open enrollment. we have a lot of data on the first three months and some in the last couple of weeks. --re is a lot of internist interest. in southern california, we have seen about 1.1 million people enroll, newly eligible in medi-cal about 600,000, or in covered california's exchange

product, about 500,000. our enrollment in the covered california exchange, we will like to see 85% of them being subsidy oh jewel, 15% not eligible for subsidies -- being subsidy eligible. 15% not eligible. and we don't care where they shop. we look forward to sharing data on all exchange a moment in february. because that is one of the stories that is not really being talked about, the amount of enrollment in coverage where americans are benefiting from guaranteed issue coverage. though not buying directly through an exchange. california is obviously a big state. in the month of october, 30,000 people enrolled and in november,

about 80,000. in the first two weeks of january, we saw more and moment than we saw in the first two months of open a moment. that is good news. we think they have generally done a good job of getting the word out that people know that covered california is there. when we look at who is enrolled, we are seeing in many areas a good mix across the state, but in some areas we think we have challenges. in proportioned to those who are subsidy eligible, about 50% of the

latino community, which is essential and important hearing california. but in some regions of the state, we are doing very well relative to some bassford -- based projections. three months and we have surpassed the entire projections of what the six-month enrollment time frame would be. orange county, san diego, bay area, places like that. in other areas, we are not enrolling as strongly, the inland empire, central valley. this means we have pivoted right out of the gate to say, what can we do to invest our strategies now? havehe two things that i likeo you there is, first, i think many of the state, as long well as things -- as well as things have gone, we have not provided the best service that we have wanted to. some of it has been because we've had much higher service volume than we expected. the in it is because

person assistance in communities, licensed agents, certified enrollment count -- counselors, certified county workers, has been slower than we want. it has been because we or our health plan partners have been not as effective as we wanted into indicating with a consumer, so they have needed to call back again. what have we done? we are doing six or seven things to improve customer service now during an -- open enrollment. we are adding literally hundreds of customer service workers, many of whom will be bilingual. we are adding self-service tools for consumers. campaigns,g e-mail following up on consumers that have started enrollment. improving on that functionality. even better the agents and certified counselors in the field.

secondly, we have adjusted our marketing. it is encouraging to note that the reason you are seeing states be so relatively successful is that states have the resources to do marketing. alfred has been investing substantially -- california has been investing substantially in tv, radio, social outreach. and we have adjusted some of those strategies as we have been going into the last two months to new and expanded placements, in particular spanish language and targeting the latino community, but also with a shifted message. many of the consumers, in particular the underserved, have said they need more details of why it is affordable, what the benefits are, and what we will be focusing -- and we will be focusing on those messages. as well as focusing on the fact havewe now in california 25,000 people in committees to help people enroll sitting across the table. and we think this will be vital

as we go forward, communicating through insurance agents, certified health workers, county workers will stop and it is free and confidential. -- county workers. and it is free and confidential. we think that these people are worried it will cost them something or they are worried about confidentiality issues. we are addressing these issues head-on. finally, our marketing will be telling the story through the voices of those who have gotten insurance and how they have been benefited. finally, i would reiterate a couple of remarks made by my areeagues, which is why we talking about open enrollment in a year, and we are already thinking about that -- i think the exciting thing that we are at now is needing to think about not just coverage, but health care. we are now spending a lot of time to help make sure that people who enroll get access to needed care when they need it,

and for the services they are covered for. and we are looking forward to turning our attention not just to coverage, but to the right care in the right time and in a cost-effective manner. that is the next thing we will be turning our attention to. thank you and we look forward to your questions. >> thanks so much to all of you. heard is at you've series of common themes. everyone faces some aspect of health i.t. challenge. some more successfully than others. you heard from audrey, the shout out to the team they had at deloitte, and also drawing on the experience at the medicaid department in standing up i.t. systems. the you herded across the board, a common theme with i.t. a common theme in understanding the customer and what the different sets of customers needs and desires were, both in terms of functionality of websites -- you heard me let talking about

people wanting to reset their usernames if they forgot it, like most of us always do, etc. andon themes of finding out learning as they go about the challenges that arise and adapting to them. essentially, a very clear story here is that these challenges can be overcome and a lot of people are getting coverage as a result. let me take the moderators for artist to ask one quick question and then we would like to -- prerogatives to ask one quick question and then we would like to open it up to all of you. one of the learnings here has been that there are issues in the actual law, the underlying a smoothprecludes enrollment of individuals and families. i would like to ask you, christy, briefly expand on that. what are the issues you are identifying that in a perfect world, congress and others would come back to and revisit with potentially new legislation?

are numerous issues that relate to the back and forth between people who are on the cusp of medicaid and the tax credit. and some of the ways that they get stuck on either side of that. is affordability standard , and thisn individual is what we'll call of -- disqualify somebody from getting a tax credit, if they have and employer-based coverage. the problem is, if they have access to an employer-based coverage, and the afford ability standard is based on the individual, not the family cost -- which does not have the same employer subsidy -- that affordability standard excludes the family from accessing

insurance access. and there are another number of issues related to how the small business side of this work. areas where i think it could be more effective for small businesses. >> are others of you finding that? >> the biggest issue for us is identity proofing. young and you don't have a credit history, if you you not born here, or if were in a traditional family where the wife in most cases did not work and did not have credit history in her own name and is now divorced, it is very

difficult to get identity proofing instantly. if they cannot get assistance online instantly, they are not going to go to improve for they are. that is at the top of my wish list to fix. >> we would like to open it up to those of you in the audience for questions. identify yourself by name and affiliation. with kaiser appleby health news. there has been a lot of talk in a last week or so about whether we know if the folks signing up had insurance previously or not. i know that is a difficult question to answer, but are any of you tracking that? is there a way to track that?

what do we know about that? >> we started having these discussions about a month ago and we are beginning to discuss with the department of insurance as well as the insurance carriers that are participating. maybe some of their insurance carriers track that and one does not. we want to get a clearer picture. a lot of people cannot afford insurance without the tax credit . they can go directly to an agent and they are not dealing with an exchange. the numbers of people that are getting insurance for the first time possibly, or a better rate for insurance now going privately without the exchange is much higher than our overall numbers reflect. we just don't know how much. add that we have

anecdotal self-reported information from our in person about 50% of the collect that.lp our plan is after open enrollment finishes, we will do a survey of all consumers who are in rolled through the individual marketplace in qualified health plans toenroll. ifalso ask questions like they had coverage, did it work for them? did it cover their medical needs? that's sort of thing. we will also be asking them what motivated them to get in short, whether it was a tax penalty or something else. we will have a lot of information.

>> i can tell you one of the most interesting moments i had in the past couple of months was the moment i realized there was not a clear question in all of the eligibility enrollment data is massive,, which there was not a clear question. there are a couple of proxies we can use. we are developing that information. there are reports we can pull from the system. we will probably do a survey as well. but we are looking immediately at putting that question in. >> ok, great. >> peter from california. >> sorry, peter. do you want to speak to that? >> no. >> ok, great. npr.am from

one of the biggest problems we see popping up these days are people being incorrectly adjudicated into medicaid. then they do not seem to be able to get out until they get a denial from medicaid. and i guess medicaid in many takes is so backed up it weeks and weeks. in the meantime they cannot go ahead and buy an exchange plan. is this something that you have a way of dealing with? i do not know if you know about this problem, but i am getting if note if not dozens -- dozens of letters of this multiple happening in states. >> there are two components to this question that are interesting. one is, there are people who may qualify for medicaid to do not want to enroll in medicaid and plan rather buy a private to rid or their kids are getting put into medicaid. so, that's

another piece of the law that needs to be fixed. people should be allowed to do that. the second component is that interaction between medicaid and the tax credit piece and people getting caught. i think -- i will not speak for my colleagues, but my understanding is many of the states are seeing that. the state-based exchanges in general can be much more nimble when things like that happen. in the federal exchanges, they cannot be. are absolutely taking those cases and working them through as quickly as possible. there are certainly wait times that i do not think ultimately are acceptable, but that is being cleaned up. this is another one of those things that needs to be fixed.

a little bitve more flexibility in how we can fix it. we have also had the issue of a person qualifies for medicaid but does not want medicaid. portion. a large 50m aware of less than cases. the bottom-line is, if that person does not take medicaid, the person cannot receive tax credits. in the 50 or so cases, we manually deleted the application from our system. that enables our consumer to complete the short form, which is full priced coverage, and tot is how we have been able enroll. that is not something i would expect. when they qualify for the comprehensive public program that we have, the assumption initially was they would get enrolled.

>> what do you think is causing that? is it the stigma that some people continue to perceive of medicaid? personally, we have seen this with younger individuals. if they have grown up in middle to upper-class families, they have gotten out of college, they have a job. maybe they still qualified to be on their family plan. they just have not been added. there is still confusion in that . one of the things i would like there to that though is, is in impression that you can just choose medicaid. that's completely incorrect. i'm sure that's not the way it is in rhode island or the district or california. you cannot press a button and say, i choose medicaid. in kentucky, you fill out the information, and if you all of five for medicaid by the information -- if you have have

mollified for medicaid by the information you put in and we are able to verify, that is how you are afforded an opportunity to sign up for medicaid. to build on what christine has said, there is a process by which if you have incorrectly enrolled, to not choose to enroll, it is an unfortunate thing. we are all working manually when people call. there is a process. the federal government requires informationpeople to get more information from them to confirm identity or salaries or whatever. so, there is a process i which by which time it takes to get you on enrolled. it is short. >> here -- i hate to do this, but i have no self-restraint on this issue.

are the core problems of the way we developed and the implementation of it is the focus was on the eligibility and enrollment system as the thing that solved all problems. the reality is that when you go in to buying a product or at a range of products, you get a lot of information before you get to the point where you actually sign up and by -- buy. that component was not focused on by the federal requirements, by the system folks. so, many of us have websites that were wrapped around or loaded on top of that system that allowed people to look at -- but they are not anywhere

near as sophisticated or developed, i think, at least in our case, as i would like them to be. people can draw those conclusions. have 80% of the information that would give them an 80% clue they were eligible for this or get this tax credit or medicaid might be an option. from the information, once they go into the enrollment system, if something is not matching up, that is what customer service is about. that is our ability to move -- what our ability to move should be about. i think you will see many of us put a lot more effort, and we are urging and encouraging at the federal level the help we the robert wood johnson foundation and others is critical in making that wraparound happen. so, that is essential.

>> great. leavy had a norm question here. let's get the microphone over to him. >> thanks. norm leavy with the los angeles times. i wonder if you could talk about the feedback you are getting from the various carriers in the marketplace, about next year, about carriers who might be interested in joining or the converse if you are hearing anything. thanks. answer pretty quickly. yes, yes, and yes. in kentucky, we have a small group of carriers involved in the individual plants. we only have three. in one of them, the national much, humana, had a smaller area to choose from. they are not completely statewide. and them on the other hand, they made some adjustments can narrow and werovider network

have federally one of the co-ops in kentucky. we have a smaller insurance such ashan many have the district or california. i'm not sure about rhode island's. managedave heard from care plans that are owned by larger carriers. we have heard that they want to, i and the market. we have a great relationship with the carriers. they are a small group of people. we talk to them regularly. some of them have talked to us about mistakes they have made from the beginning, maybe in their network or their going verywide to a certain area quickly. they, too, have been evaluating this. we expect our number of carriers to certainly grow and the

network to become more robust. >> two components to the answer. one is yes, we are definitely in conversations with other thinkrs to come in, and i we will be successful with that. the carriers have been fantastic to work with. , all of themnd have stepped up in great ways. .his is a complicated exchange i want to point out there's another interesting component in the marketplace. there are three screens. there is the medicaid dream, the tax credit for individual consumer screen, and the tax stream. one of our carriers is a national for-profit entity and the other is a nonprofit. they announced the formation of

-- and i hear that imitation is the sincerest form of flattery, so i'm happy this gives us a chance to talk about this. they have both announced they are going to do private exchanges within their own carrier health plan for businesses. and i think part of that is because carriers are nervous about what full employee choice, where employees can choose between carriers, real competition on the consumer level, as opposed to the business-to-business side, that is raising some interesting dynamics. it really will get us to this question about transparency and competition and consumer-based .ork i'm delighted to have that conversation. you have to look at all three streams. they are very different interactions. >> i would just add --

a second.hang on just we will start and i will come to you. >> thank you. the gate, we had all of the carriers in the commercial market on the individual and the small group side. one of our carriers, we are the only jurisdiction where they are participating both in a small group exchange and the individual marketplace. we were very pleased early on. we built a carrier portal to .ake it as easy as possible we have a lot of testing with the carriers. we worked very closely with each of them. each company is in a different place when it comes to how sophisticated their i.t. side is. the years different insurers have invested different amounts into their i.t.

we are realistic, pragmatic. tell us where you are. we will work with each of you in a different way. that is what we did. we have an excellent relationship with all of our carriers. i have to thank them publicly. on the individual side, two, consumersre allowing until february 14 two paid the january 1 coverage bill, which is pretty remarkable. there is a very close relationship around the 834's and -- >> the 999's. [laughter] clarify, theseo are all different forms that have to be shipped back and forth to enroll. >> way more than anyone wants to know. we are in the same boat as the

carriers. all of this is new. the goal is to work with each one and get it done for the consumer. not inpe -- any carrier the marketplace that wants to come into the district, they are welcome and i will work with every carrier that comes in. >> we want to give peter lee a chance to comment on this question as well. peter? >> yes. it is a somewhat different philosophy. we told the plans a year ago if they want to be part of the individual marketplace to step up and not stand by the sidelines. letting plans that were not in the marketplace reviews the common next year. the one exception is medi-cal plans. medi-calaid -- the market can come in. this is potentially of a deal. the plansences with

in covered california are recognizing this is a long-term play and are looking at things like benefits, how do we improve the benefits, but really haven't we learn what is happening over -- reallytwo years how do we learn what is happening over the first two years? the plans are recognizing with us that this is not a short-term play. we need to pace our growth and the changes for consumers are based on information. question just a quick about narrow networks. as we heard from audrey in kentucky, there was the sense that the networks were too narrow, at least for some of the carriers. this has been a controversial question across much of the country. happen inkely to california? do you think carriers will go back to expanding networks or are they wanting to go ahead with a strategy of having narrow networks, green line pricing,

and high quality and attempting to give people the best possible value for their money as they enroll in coverage? >> ok. a couple things. almostross california, 60,000 doctors are in one or more than one of the health plans contracted with covered california. that's a substantial majority of the doctors. the reality is, every doctor is not in every health plan. we have made sure that every health plan has enough doctors, hospitals, nurses to serve everyone who enrolls. it will really be our job to make sure that that reality comes true for consumers. the second part of our job, and i think this is true for all of our exchanges around the country, making consumers understand the implications of their choices. directories inn improving those directories over time. we have seen in this last month

consumers say, well, i went to my doctor who is in the directory, and they do not think they are part of the network. some of the doctors do not understand there is not necessarily a separate coverage -- covered california network. they are part of the access individual product network and that is it. of those are the issues we will be focused on. do notg adequacy -- i think that any of the plans are looking at their strategies overall. >> this is why the state a stick changes can be so much more ,ffect it that a federal completely federally run system, because every state has a .ifferent market in our state, for example, the ride at -- the plans, the commercial plants we are offering have extensive networks. everybody is covered, pretty much. is, how do youw

provide incentives to rethink how you get really good integrated and innovative new withcts into the market full employee choices as a core component of that so the individual is making the choice and not the employer on behalf of the individual, and so they have the kind of information and metrics in terms of work and quality trends trends that matter to individuals making choices. that is transparency. it's a completely different conversation. it is not, you started with narrow networks because of geographic issues or limitations with the way you are able to bring plans then, but a completely different conversation in rhode island. each of us is going to combat it from a slightly different respect it in terms of getting those -- different perspective

in terms of getting those innovative radix online. it is one of the reasons why states like ours are going to be able to use this investment very effectively to be a catalyst for the overall change that needs to take place in the health-care system. >> susan, i know we are wrapping up your, but i really want to underscore that. that is what is perceived in the differences in the exchanges. that is so important. when you are state based -- when our governor announced we would go the state based exchange route, what he said then could not be more true today. which is he was making the decision to do this state based even though it was not politically beam or popular decision, but he was doing it because he felt as though we knew our insurance market has, we have the personal and professional relationships with those carriers.

most of those had been in the state for long time and they better understand the state and the demographics in the market. for our people, whether it is medicaid or in the private insurance market. you are really looking out for the consumer in a much more intimate way through the state aced exchanges. and we are so much more nimble. for many of these individuals -- they are stuck in i.t. cyberspace and where they are stuck, somehow their information is not connecting up. this is a great example. same thing in kentucky. we have had a few of those. literally, they are worked by hand between our exchange staff and the insurance carrier and the carriers are manually working these by hand as well. that's not something you get any much larger system. i hope that others who did not choose the state-based exchange will see this as a real consumer

success story for their constituents and their voters and citizens within their state, to help them get better coverage. >> that's a perfect place to and because it encapsulates several themes. this has been a major learning process. it has been a learning process particularly at the state level in states who now have the opportunity to make enormous differences in the health care delivery system going forward, on the basis now have a much greater understanding of what consumers are going to want, what kinds of tools will need to be made available to consumers, and how all of this can be brought to bear on effectuating the ultimate goals of the affordable care act, which is to create an affordable and sustainable health care system over time. i want to say thanks once more to peter liu joined us from covered california.

two our colleague from the d.c. exchange. to christy ferguson from the rhode island exchange. and audrey haynes, as well as heather howard. thanks to all of you for joining us today, and we look forward to seeing you at our next reporters' roundtable. [captioning performed by the national captioning institute] [captions copyright national cable satellite corp. 2014] >> back on capitol hill today, the house gavels in earlier briefly. they are expected to return at 2 p.m. eastern time for legislative speeches. to build they are working on today including one that would allow veterans to pay in-state tuition no matter their state of residence. and the look of state politics

today with more state of the state speeches. c-span will be live in oklahoma for governor mary fallin's address over on c-span3. and later, a live debate from florida's her teeth district. -- 13th district. the special election is next tuesday. you can watch the coverage live on c-span3. that is in a car wreck wrote about extensively in my book. the whole time i was in the hospital, not injured, really. i had a cut on my leg and a theen ankle, i was praying other person in the car would be ok. and the other person in the car was one of my best friends, which i didn't know. i didn't recognize that at these site of the crash.

i think because i pray for him over and over to be ok and he wasn't, i felt like, nobody listens. god was not listening. very long timea of not believing and not believing that prayer is would be -- prayers would be answered. it took me a long time really to come back. >> first lady laura bush, tonight at 9 p.m. eastern on c-span and c-span3. also on c-span radio and www.c-span.org. with her atterview the george bush presidential center in dallas at 10:30. isp's to continue to innovate and bring new business models to consumers.

best area. the >> the big corporations are the ones with the tremendous amount inmarket power and influence washington, d.c. to influence policy to go their direction. if consumers are really going to be the losers in this deal, and i think that is why so many of them are speaking up and asking the fcc to move forward with a clear path to protect them. >> the impact of the net neutrality rule tonight on "the communicators" on c-span2. >> kentucky senator rand paul was that the internet foundation communication conference and washington, d.c. where he called for a refill of part of the protectsct that mutations companies run being sued. senator paul spoke for about half an hour.

>> if we can return to our program. thank you very much. i am a member of the internet education foundation board along with roger, who you heard earlier. we are going to move to an interview with the senator here, senator paul in case you cannot recognize him. i want to thank you for being here. we appreciate your support not only in attendance, but interest in what we are doing. check out the website if you will. i'm going to introduce greg ferran steen was going to be conducting the interview for 15-20 minutes or so.

he is an author and educator. he writes in the area of social technology and politics, issues that all of us in this room are interested in. he designs curriculum that teaches communication skills and you can read at least some of what he writes, maybe everything, at techcrunch. thank you very much. [applause] >> i am so excited to have senator paul here. i think we're looking at the future of the republican party. it is libertarianism or a libertarian-style conservatism is coming to power. we don't know how this interacts with innovation and so that is what we are going to explore. the first question i have is, last year in a document you cowrote with your father you said that the technology revolution has come all in five years without government

permission. on the other hand, the birth of the internet was a government-funded laboratory and public universities played a vital role. my question is, does the government in some ways be essential to innovation? >> there is a role for government. -- there was a role for government. but the real explosion of the internet was a lack of control. it was a place where people went where they want told what to do. if you look at the different successes of companies versus traditional industry or manufacturing, government was already involved with other industries with rules and revelations that you could not innovate. i think that is what we need to protect against with the internet. it is a free and open place and we don't want government to get too involved with that because i think will stifle innovation.

>> do you think funding for science innovation goes up, down, or stays the same? >> i have always said that things people say are good angst that government can do, whether or not it is r and d or humanitarian purpose, but in the context of spending money -- my biggest problem is that we bring in 2.8 trillion dollars and we spent $3.8 trillion. if you come to me and say that we want some government r&d, i will be like, well, tommy what you're going to cut. in the old days we just cap adding up -- kept adding onto things. that is what happens now. there is no prioritization in governmental spending. maybe r&d is a more important than -- we spent millions on twiggy the squirrel last year.

twiggy these squirrel is a waterskiing squirrel that we use to advertise american walnuts in india. maybe r&d for studying diabetes or a scientific pursuit, i would say, well, i think i would rather spend the $3 million on r&d if it doesn't look like there is a market for that. there is a marketplace that does support many things as far scientific advancement. some comes from universities but quite a bit comes from people wanting to make money trying to sell what they discover. >> let's move on to the nsa. i think you're almost in total alignment on the tech industry, calling for an end on the collection of data. and disclosure of users who are spied on. except, i believe that you said snowden and intelligence director james clapper should share a prison cell. as a leader, what you think snowden's punishment should be

and how can encourage more whistleblowing activity? i am looking for specifics. we want to know exactly how you plan -- >> i was trying to be provocative and sometimes i do that. as far as sharing a cell, i was trying to make the point that you have some people who i think have gone crazy over the top. if they saw edward snowden, they would lynch him or shoot him. i think those people need to realize when they are saying things like that, which i think are absurd, but they need to realize that if they are so big on the law has to be what the law is, james clapper lied, committed perjury, and it is five years in prison. if they want to throw the book at snowden they have to equally look at james clapper. ever since the espionage act of 1917 we have gone overboard. if you want to look at the aftermath and during world war i

to the labor activists, socialists, people who disagreed with the war, the draft -- we put people in jail for 10 and 20 years. we had something called the sedition act of 1917 and a minister was put in jail for 15 years. eugene debs was the socialist candidate back in the teens. he was put in jail for 20 years. we have to be careful in times of war and in times of threat to our country that we do not go crazy on penalties. the current penalties on the book, particularly if you said snowden committed -- it could be it could be the death penalty. i think that his motives were good and saying that this is something that is unconstitutional and the government should not be doing it. in a federal judge has agreed with him. on the other side of the coin i don't think that we can completely have no secrets. if you're a sergeant in the military or a captain, i don't think you can just download all the government secrets and put them out on the internet.

there do have to be some rules and there are some problems with disclosing secrets. people could die. do i think the other side is overstating what snowden has done? i say this to be funny but it is also true. the real secret he announced to the world is not that we are spying on terrorists, is that we are spying on americans. that is the real news. all americans' records are being collected. you think there is a terrorist in the world that did not already feel like their phone was being listened to? i just didn't realize they were collecting all of our records all of the time. can'tthink you really have no rules. you have a whistleblower program. but he did not go that route. the other problem for snowden from a historical point is that history will record that he has taken up residence in a country that is not real good at with sort of bill of rights issues and privacy. that is going to taint him somewhat in history.

it is not my job to make a judgment on him other than the issue is important and without him we never would have known this. in that sense, he has served the country in having a real great debate over our privacy and what the government can look at. and should look at. >> you've also called him a civil disobedient. what you think should happen to him if he comes back to the united states? >> many have pushed back. the people who are big fans of the national surveillance states and don't care much about the bill of rights, they pushed back and say martin luther king stayed and faced his medicine. he was in jail in birmingham. that is true but he was in jail for 33 days. he did not face life imprisonment or the death penalty. many who have opposed me on this have said, oh, you are crazy. you can't be a civil disobedient if you're not willing to face the time.

to me, that would mean you have to be willing to be a martyr. people are calling for the death penalty for him. i think that is inappropriate. what exactly his penalty is, i have not figured out or decided that i want to publicly say if you should get this or should not get this. i have come out and said that i believe that i don't think he deserves the death penalty or life imprisonment. at the same time we do have to have laws. if you sign a contract, they are important. it is just like insider trading. we have gone overboard on the insider trading things, but if you work for a big company on wall street and you cited agreement -- if you steal their secrets and give them to people, you have given a crime and broken the contract and should be punished for that. even though i'm a big believer in the open transmission of information, i am a big believer in contracts. that bushe said republicans do not do well in

silicon valley. when you got to fund raise, the household names from google and facebook are still in camp obama and maybe camp hillary. how must the majority of the republican party change? >> i think in 2016, if you had a more libertarian leaning republican and some unlike hillary clinton, i think you can transform for people think they have allegiance for. who has been the biggest proponent for going to war in the middle east and funneling arms? hillary clinton. has she been anyone who said anything about privacy? she has been a big proponent of the surveillance state. and the nsa. there is a chance if you had someone on the republican side, they might all the sudden say -- on that side, they might say maybe democrats do not represent me. i guess the perception -- i

don't know everything about silicon valley, but i think people come up and say i supported president obama but i am more conservative on taxes and fiscal issues than he is. on social issues, i am more liberal than the republicans are. i think there are three ways. i think they are looking for something they do not immediately fix in either party. >> are you saying that hillary clinton was a proponent of the surveillance tapes? >> yes. she has never been a critic. if ron wyden were here, i would say he is a democrat who is an advocate of privacy. i would not that hillary clinton i in that category. >> ok. speaking of the rise of libertarianism you and your , father are popular on the web. they are getting pushback from republican leaders, especially in the house. do you think this internet libertarianism is an overly vocal minority or is your

party's leadership ignoring an important part of this country? >> i think there is a growing movement. if you look at the use, they the youth voted three to one for president obama. if you look at the polling data now, because of the nsa spying and president obama has become an extension of the bush administration with less concern for civil liberties, there has not been as many people speaking out on this. if you think it through, there was almost a hatred for bush from people who believed in civil liberties and thought he had gone too far on the war. president obama has carried on all of those things. he did bring some troops home. as far as your right to privacy, he has gone up far beyond what bush has begun. i think there is a growing mood among young people looking for something different. i think people are not as wedded to one party or another as they

used to be. you will see a lot of people consider themselves to be independent. i think young people are among that. people in silicon valley are among that. there are people who supported the president in 2008 the did not support him in 2012, prominent people who switched. i think there is an opening. >> one thing that is very concerning is the republican party seems almost anti-science in some ways, denying evolution and others. how do you plan to speak out against that? how do you plan to change that perception? >> i am not sure if there is an exact answer. i do not think the republican party has ever been anti-science though some people promote a different understanding of science. yeah, there are a few. some might be in the republican party. by and large, i think we get characterized. you get people who are from one party.

they say something and they say that is the way all republicans believe. the same thing happens for democrats as well. i come from a science background. i am a physician. i come from a science background. i do not think you will hear anything coming for me that is anti-science. >> why do you think libertarianism is so popular on the web? why do you think they are so effective at using web tools? >> i am not sure i have the answer to that. i think there is a huge bunch of people part of this "leave me alone" coalition. that's what i like to describe it as. the internet is a place for freedom and for being able to do, people gravitate to it because they have a lot of freedom. a lot of people are just individuals. even when they were for big companies, when i have been out visiting google or facebook, when you go in, there is an atmosphere not of structure you cannot go five steps without be

able stop to have food or nap or play ping-pong. it is less rigidity and more openness. i think people are attracted to that. it is a libertarian sense of "as long as i am not hurting somebody else, leave me alone to do it i want to do." >> labor unions are almost nonexistent and tech companies. -- in tech for pennies. -- i and tech companies. do you think the happy future in the u.s.? why do you think they often butt heads with innovators? >> i am not against the small guy having leverage against the big guy. the interesting about labor is that when you look at the anti-trust laws, the idea was to keep business from getting so big that the consumer would have -- labour would have no leverage

or the consumer would have no leverage. the interesting thing is really right now, the small guy has no leverage. i am a physician. i am a small guy and my individual practice. i have almost no leverage. they will not let me organize with other physicians to negotiate my contract with the insurance companies or have 10,000 retailers say this is my representative and you say now we have leverage. i think the antitrust laws have made harder, not just for labor but for the small guy to organize. they call that collusion. it is actually a mistake. antitrust laws are keeping the small guy down and the big guy in place. i have a bill to change the antitrust laws. i hear from independent pharmacists that we have no leverage against the big chains. i would let the independent physicians and retailers

organize so they could have leveraged against bigger companies. that is a roundabout way to say there is a place for organization -- there is a place for organizations. labor unions had the heyday trying to get rid of really horrific working conditions with people losing limbs and fingers and having no safety at work and 100-hour work weeks. i do not think they really have a place so much really in the high-tech industry. they are not paying slave wages in silicon valley or anything. >> no. [laughter] we're doing quite well. in a previous interview, you once called silicon valley as "communitarian." what did you mean by that? does that conflict with your own philosophy? >> i do not remember saying that but i accept that i might have. there is a sense, particularly

in young people, they still want to make money and do things that are successful. they are socially conscious in the sense that they also want to do things that protect the environment. i am not saying that in a bad way. i am saying that in a good way. i am supportive of a bill in our legislation about letting people incorporate as "b corporations." right now the rules are such if you are a for-profit corporation and i say i want to buy from this were some because they are environmentally friendly, you are not allowed to because if they cost more you're doing a disservice to your stockholders. i'm opening up some of the corporate laws. they can always leave your company and they do not like what you are doing. you should be able to do things even if they are not the least expensive thing because you are concerned for the environment. there is a community spirit with people with -- with young people and the way they approach business.

>> patents and intellectual property. >> can i call my lawyer? [laughter] >> some people and that patents are a kind of legalized government monopoly and they are strangling innovation. do you see patents as a legalized monopoly? >> no, and i think that -- i can remember this question from 30 years ago. there were libertarians that had written that china do not have any. i think it ought to be protection for intellectual property. patents are really complicated. that is why i joked about having a lawyer. the rules are so complicated. how we fix it is complicated. >> patents for software will

probably come up in the spring. what is your position on that? >> i am not sure. i have not read the bill yet. the last time we did it was a year or two we did some kind of patent reform. i was never sure because i did not understand the right or wrong side of it. it is complicated. even with protection of intellectual property, for example with the books, i think we do life of the author in 70 years. -- there is patent limits. and 70 years. there is patent limits. is there an absolute right or wrong? i do not know. some argue that drugs patents are too long. that is why drug prices are so high. maybe. i do not know the exact limits to win a patent should end. i do know that a part of the problem with drugs that it takes to approve them. there's the fda burden of trying to get something approved. it has gone too far.

we want safety but now we have burdensome bureaucracy that is taking millions of dollars to get something approved. the bottom-line is that i am open-minded on it. i see some of the problems that people are going through and challenging everybody's patton -- patent just to get a payday on that. >> one more question and then i know you had to run. you have a very busy day. the rise of the libertarian leaning conservative, the tea party, do you think that would exist without the internet? >> no. in fact, one of the beauties of the internet is that it gives voice to minority voices that were not necessarily within the mainstream. when you have three television networks. i know cable is not the internet. it was the beginning of a revolution in information. you have dozens of television stations now. you also have the internet. there will come a time,

television like in new york city, a congressional race is so expensive they cannot afford to be on television in new york city. the advertising is cable or the internet. the internet is fascinating. i do a search and i am looking at stuff at night. and i am like, wow, my ads are everywhere. the figure out what i am looking at. i miss me the preference of -- i must meet the preference of somebody who would support me. my ads go up. [laughter] you are not advertising to everybody. you're advertising to the people already interested. one more point i would like to make before i go is there is a difference, and this is very important if you are in the world of information and you make money off information, if you are google and share yourself on that information, if

we lump that in with the government, we say all of that is bad. allowing information to know about you is bad. that is a real problem. the model of the internet does require information to go around. i do not think it is the same. i think it is important we understand it is not the same. when i went to google, i said it is important that people do not perceive gmail to be government mail. if they think all privacy is the same and you cannot make a contract to say make my privacy and honestly used -- anonymously used, you're going to get government blanket come in and kill everything. they will not only go after the government, which we should do, if they equate the internet as the same thing -- >> should there be regulations on the way google correct -- collects information?

>> it should be a contract. >> if users agree, you think it is ok. >> this is something they may not like me for. we made a mistake in the picture act by saying we protected internet people from being sued. i want a contract with google. i want them to adhere to my contract. we can negotiate it. if they're going to send people knocking on my door and knowing my name, i'm probably not going to use their search engine. if they can keep it anonymous and they are going to do my preferences and i make an agreement it is really about contracts. my other suggestion to a lot of these companies, and this is coming from someone not in the business but i get a lot of free advice and you can pay me in bitcoin if it is good advice, is that it is very important for them to put up a fight. i know they're putting up a fight, but i would say even more against the government and invasion of privacy.

my understanding is that this has hurt a lot of companies in europe because they think we are trying to fight for americans only do not care for europeans. if that is true, they will go to european companies. we have to put up a fight. i am suing the nsa and i would love anyone willing to support that fight. it cannot be just about transparency. a lot have gotten together. i support what they are saying. president obama responded and said some of these can become public. that is it. it is good. that is not the end of it. the government should not be collecting this data. i want these companies to support the next step. is it constitutional to collect with a single warrant 100 million people's records? my belief is no. you cannot. it should name the person. the fourth amendment says you name the person. what i think, and i think it is

good for your business model, support going the next step which is really shutting down the collection. >> do you take it to the supreme court if you can? >> yes. i think we will go. we have 350,000 people who have signed up. i would like people on the internet and really promote our lawsuit and let's get 3 million. but get 10 million people on our lawsuit. we could -- let's get 10 million people on our lawsuit. opa/pipad the same s battle that we did. 10 million people signed up for a lawsuit sends a message. it is good for your business. you need to go the extra mile to show your customers that in europe and the world you're going to stand up to what is unconstitutional. you are going to stand up and not just be transparent for court orders, but we're going to oppose the government collecting the records unless they name an individual. >> if they had to search for

individuals, do you think they should in the future be immunized for that? or you want to change that? >> i don't like immunity. i think you should honor a contract. if i tell all of you that your privacy agreement can be breached any cannot be sued, it is only so much. i am not for regulating privacy agreement or any of the search engines for what they can do. if you say i cannot sue you if you breach my privacy agreement, i'm getting angry at the private entities, too. that is what we are. the patriot act says i cannot sue the phone company. i had a privacy agreement. they advertise that when you're waiting on hold. they are like -- we are protecting your privacy and doing all this. they are but i cannot sue them if they break my contract. i have to sue them in order for

them to adhere to the contract. >> that is a fascinating idea. i have not heard that proposed yet. >> that is the area where i will sometimes disagree. for business reasons they would like the patriot act. you have to have that. that is the check and balance to the consumer on my information. you're going to abide by your contract. that is something we ought to change as we go forward. also, we have a website we just put up called defendthefourth.com. on that people can sign up for the lawsuit. i hope we will rally more people to try to get to this cause. we will probably find our lawsuit hopefully within the next week. we have the complaint mostly written. last week the federal board on privacy and civil liberties came out with more harsh statement saying it was illegal and unconstitutional. it is not about having more internal controls and lawyers. it is about whether or not you

should be collecting the data at all. we do not think they should collect the data. i am for it. they can have your information. they should not go to the company that holds your information and say we want everybody that you hold information for. that is indiscriminate eyes. that is a generalized warrant. that is akin to the writs of assistance that we had at the time of the revolution. that is why we passed the fourth amendment so that we would not have that. >> we have a time for one more question and then i will let you leave. what is the future of libertarianism in the republican party? it is not just small government. >> i think of it as a bright future. some of it is an old-fashioned idea and some new. the old-fashioned ideas federalism. federalism is a devolved power. power is not all in washington. the other thing is you can agree to disagree. for example, the concept what the government should be involved with, particularly on

social issues, is different in alabama than san francisco. everybody agree? it's a little bit different. at if you want to enforce universal either way -- let's say in washington you want to enforce a real conservative doctrine on social issues, then you are going to have to tell san francisco they cannot have their rules. but if you go the opposite way, and i think we are in danger of maybe going the opposite way, that washington is going to dictate to alabama, i do not think it makes for good relations. part of federalism is agreeing to disagree. if you live in alabama and you have one conception of some of the social issues in san francisco and you have a different, the best way we can get along is to agree to disagree. we have some laws that are slightly different at the local level. it is not a one-size-fits-all. it is complicated. we have some things like the federal tax code and federal

benefits. my hope is that we can sort of figure out some of these more contentious issues by agreeing to disagree and having a little difference between localities. >> fascinating. thank you so much. >> thank you for having me. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2014] >> i was in a car wreck. which i wrote about extensively in my book. the whole time i was in the hospital, not injured really -- i mean, i had a cut on my leg and a broken ankle -- i was praying that the other person in the car would be ok. and the other person in the car

was the boyfriend of one of my best friends, which i did not know. i did not really recognize that at the site of the trash. i think because i prayed over and over for him to be ok and he wasn't, i thought, well, nobody, god is and not listening. my prayer was not answered. i went through a very long time of not believing, not believing that prayers could be answered. and it took me a long time really and a lot of growing up to come back to faith. tonight lady laura bush at 9 p.m. eastern live on c-span and c-span3. also on c-span radio and www.c-span.org. and watch our interview with mrs. bush at the george bush presidential center in dallas at 10:30. house is about to

gavel land for one minute speeches. members are expected to recess shortly thereafter. there are two bills on the calendar, including one that would allow veterans to pay in-state tuition no matter what state they have residence in. votes will be held later this week a bill that restricts hunters and fishermen. the speaker pro tempore: the house will be in order. the prayer will be offered by our chaplain, father conroy. chaplain conroy: let us pray. eternal god, we give you thanks for giving us another day. guide our minds, thoughts, and desires this day. by your spirit, breathe into us a new spirit. shape this congress and our